Accuracy of Buffy Coat in the Diagnosis of Disseminated Histoplasmosis in AIDS-Patients in an Endemic Area of Brazil

Leitão, Terezinha do Menino Jesus Silva; Filho, Antônio Martins; Filho, José Evaldo P Sousa; Tavares, Bruno de Melo; Mesquita, Jacó Ricarte Lima de; Farias, Luís Arthur Brasil Gadelha; Mota, Rosa Salani; Damasceno, Lisandra Serra

doi:10.3390/jof5020047

Cited by 6 publications

(4 citation statements)

References 24 publications

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“…The GDG recommended complementary testing using microscopic analysis of the buffy coat, histopathological analysis, culture, and antibody or DNA detection in patients with clinical forms of histoplasmosis different to the disseminated disease [ 16 , 19 ].…”

Section: Resultsmentioning

confidence: 99%

Summary of Guidelines for Managing Histoplasmosis among People Living with HIV

Pérez

Cáceres

Ford

et al. 2021

JoF

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Histoplasmosis is a frequent fungal opportunistic infection in people living with HIV (PLHIV), associated every year to a total of 5% to 15% of AIDS-related deaths among this population. In 2020, the first global guidelines for diagnosing and managing disseminated histoplasmosis among PLHIV was published. This document recommends (1) detection of circulating Histoplasma antigens as the recommended laboratory assay to diagnose histoplasmosis among PLHIV; (2) the use of liposomal amphotericin for induction therapy in severe or moderately severe disease, followed by a maintenance therapy with itraconazole for 12 months; a shorter maintenance therapy could be considered if the patient is clinically stable and if immune status has improved; (3) antiretroviral therapy initiation as soon as possible among patients with histoplasmosis without involvement of central nervous system; and (4) that for the treatment of co-infection with histoplasmosis and tuberculosis (TB), treatment of TB should be initiated according to the World Health Organization treatment guidelines. Appropriate health education of providers, supportive supervision, and policy guidance for the care of PLHIV are required.

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Section: Resultsmentioning

confidence: 99%

Summary of Guidelines for Managing Histoplasmosis among People Living with HIV

Pérez

Cáceres

Ford

et al. 2021

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“…According to Leitao et al , stained smears of buffy coat have low accuracy (26%); nonetheless, they are easy to perform and can give a quick diagnosis in low-resource endemic areas and reduce mortality. 43…”

Section: Introductionmentioning

confidence: 99%

Progressive disseminated histoplasmosis in HIV-positive patients

et al. 2022

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Background: Histoplasmosis is the most common endemic mycosis among people living with advanced HIV infection. Purpose: Describe general aspects and challenges of this disease and its association with HIV. Research Design: Review of literature. Study Sample: Articles found using different combinations of terms including “disseminated histoplasmosis” and AIDS/HIV or immunosuppression in PubMed, Scopus, WHO Global health library, and Scielo database. Analysis: We look for information on epidemiology, pathogenesis, diagnosis, and treatment of histoplasmosis in AIDS patients. Results: Histoplasmosis is caused by Histoplasma capsulatum, a dimorphic fungus encountered throughout the world, mainly in soil enriched with bat and bird excreta. Progressive disseminated histoplasmosis is the main presentation of this mycosis in people living with advanced HIV and is fatal if left untreated. Symptoms include a systemic disease characterized by fever, weight loss, night sweats, skin manifestations, hepatomegaly, splenomegaly, and septic shock. Diagnostic tests include culture, visualization of H. capsulatum by direct and histopathological examination, serology, antigen, molecular, and skin testing. Patients with disseminated disease require aggressive and prolonged treatment to eradicate the pathogen and include amphotericin B and itraconazole. In many low income countries of endemic regions, histoplasmosis in HIV-positive patients is often undiagnosed or misdiagnosed as another opportunistic infection, due to the similarity in clinical manifestations and to the paucity of better diagnostic tests. Conclusion: Histoplasmosis remains a neglected disease. Few studies about the disease and expensive treatments make it difficult to reduce the morbidity and mortality of this condition. Public health services and physicians must be aware of histoplasmosis' burden among the HIV-positive population.

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“…There are few national publications on this subject, and epidemiological data in our country are scarce. The state of Ceara has one of the highest rates of histoplasmosis in HIV patients in the world, with substantial mortality, although information on other immunosuppressed patients is scarce (Leitão, et al, 2019). The aim of the present study was to describe the main IFIs after kidney and liver transplantation in a reference center, as well as their evolution, treatment, and clinical features, in an attempt to enable better identification of cases and earlier and more appropriate management.…”

Section: Introductionmentioning

confidence: 99%

Invasive fungal infections in kidney and liver transplant recipients in a center in northeast Brazil

Holanda¹,

Oliveira

Leitão³

et al. 2021

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Objective: Describe the main invasive fungal infections (IFIs) after kidney and liver transplantation at a referral center, as well as their evolution, treatment, and clinical features. Material and Methods: This was a retrospective, observational, descriptive, case series study involving IFIs diagnosed between January 2012 and December 2019 in kidney and liver transplant recipients. Results: Among 769 kidney transplants, only 1 patient received the organ from a living donor and the other transplants were from deceased donors. 15 IFIs were diagnosed (7 histoplasmoses, 4 cryptococcoses, 3 candidemias, and 1 aspergillosis), while in 673 liver transplants, 8 IFIs were diagnosed (6 candidemias, 1 murcomycosis, and 1 cryptococcosis). Of the total 23 patients, 6 (26%) had infection diagnosed within 6 months after transplantation. The primary immunosuppressive regimen used was tacrolimus (82.6%), prednisone (82.6%), and mycophenolate (56.5%). Amphotericin B deoxycholate was the leading antifungal agent used for treatment, with nephrotoxicity in 80% of the cases. In the clinical follow-up, 14 patients progressed to cure (60.9%) and 9 to death (39.1%). A worsening of renal function was observed in most patients in the present study. Conclusion: Candidemia, histoplasmosis, and cryptococcosis were the most frequent IFIs, with the majority occurring later, 6 months after transplantation, and associated with high mortality.

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Accuracy of Buffy Coat in the Diagnosis of Disseminated Histoplasmosis in AIDS-Patients in an Endemic Area of Brazil

Cited by 6 publications

References 24 publications

Summary of Guidelines for Managing Histoplasmosis among People Living with HIV

Summary of Guidelines for Managing Histoplasmosis among People Living with HIV

Progressive disseminated histoplasmosis in HIV-positive patients

Invasive fungal infections in kidney and liver transplant recipients in a center in northeast Brazil

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