Getting Histoplasmosis on the Map of International Recommendations for Patients with Advanced HIV Disease

Bongomin, Felix; Kwizera, Richard; Denning, David W.

doi:10.3390/jof5030080

Cited by 29 publications

(38 citation statements)

References 36 publications

(68 reference statements)

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“…Education has proven to be an essential tool to increase the recognition of cases in endemic resource-constrained settings (Caceres et al, 2015), and also, it may be a future strategy to implement in non-endemic areas. Other pillars of utmost importance to effectively fight against histoplasmosis should be to consider it a notifiable infection, to quantify the real extent of the problem (Bongomin et al, 2019b;Staffolani et al, 2020), and to put into practice the use of rapid and reliable tools to detect and control potential environmental and animal sources of human infection (Cunningham et al, 2015;Gómez et al, 2018Gómez et al, , 2019Rothenburg et al, 2019).…”

Section: Future Directions and Conclusionmentioning

confidence: 99%

Timely Diagnosis of Histoplasmosis in Non-endemic Countries: A Laboratory Challenge

Buitrago

Martín-Gómez

2020

Front. Microbiol.

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Human histoplasmosis is a fungal infection caused by the inhalation of microconidia of the thermally dimorphic fungi Histoplasma capsulatum. Autochthonous cases of histoplasmosis have been diagnosed in almost every country, but it is considered an endemic infection in specific areas of the world. Many of them are popular travel destinations or the source of migratory movements. Thus, the vast majority of the registered cases in non-endemic countries are imported. They correspond to people having been exposed to the fungus in endemic locations as immigrants, expatriates, transient workers or tourists, with reported cases also associated to organ donation. Misdiagnosis and delays in initiation of treatment are not uncommon in cases of imported histoplasmosis. They are associated to high fatality-rates specially in patients with compromised cellular immunity in which progressive disseminated forms develop. The diagnosis of this infection in non-endemic countries is hampered by the lack of clinical suspicion and a dearth of available diagnostic tools adequate to offer rapid and accurate results. Non-culture-based assays such as nucleic-acid amplification tests present as a suitable alternative in this situation, offering improved sensitivity and specificity, shortened turnaround time, and increased biosafety by avoiding culture manipulation. In non-endemic regions, molecular techniques are being used mainly in laboratories from countries that have registered an increase in the incidence of imported cases. However, the number of published techniques is limited and lack consensus. Efforts are currently under way to standardize nucleic acid amplificationbased techniques for its implementation in areas registering a rising number of imported cases.

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Section: Future Directions and Conclusionmentioning

confidence: 99%

Timely Diagnosis of Histoplasmosis in Non-endemic Countries: A Laboratory Challenge

Buitrago

Martín-Gómez

2020

Front. Microbiol.

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“…In immunosuppressed patients, especially in HIV positive population, it causes a progressive disseminated disease [2]. Mortality rates in AIDS population have been reported as 30-50% when treated, and 100% in absence of treatment [3]. Although this fungus has a cosmopolitan distribution, there are some areas of high endemicity as Ohio and Mississippi basins in North America, several countries from Central and South America and different regions in the African continent [4][5][6].…”

Section: Introductionmentioning

confidence: 99%

“…immigrants [11]. It has been estimated that about a half million of people acquire the infection per year and around 100,000 develop a disseminated disease [3]. Certain regions of Brazil and Venezuela have been considered hotspots of the disseminated form of the disease [12].…”

Section: Introductionmentioning

confidence: 99%

“…Diagnosis of histoplasmosis is challenging in both endemic and non-endemic regions due to its similarity to other diseases as tuberculosis, usually the first clinical suspicion, and the limitations and low availability of diagnostic tools. Consequently, many efforts have been recently made with the aim of improving diagnosis and combat histoplasmosis [3]. In this chapter, we describe the conventional methods used to diagnose histoplasmosis coupled with an update about the new tests available.…”

Section: Introductionmentioning

confidence: 99%

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Laboratory Diagnosis of Histoplasmosis: An Update

Buitrago¹,

Valero²

2020

Histoplasma and Histoplasmosis

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Early diagnosis of histoplasmosis is essential to establish a suitable antifungal therapy and reduce morbidity and mortality rates. However, laboratory diagnosis remains challenging due to the low availability of proper methods and the lack of clinical suspicion. Conventional diagnosis is still largely used even though limitations are well known. Isolating the fungus is time consuming and requires manipulation in BSL3 facilities, while direct visualization and histopathology techniques show low sensitivity and need skilled personnel. New approaches based on the detection of antibodies and antigens have been developed and commercialized last years. Although sensitivity and specificity of these methods is variable, antigen detection has been recently listed as an essential diagnostic test for AIDS patients due to its excellent performance. DNA detection methods are recognized as promising tools but there is still a lack of consensus among laboratories and there are not commercial tests available. Not all methods are widely available, thus most laboratories combine classical and other tests in order to overcome aforementioned limitations. In this chapter, we review the diagnostic pipeline currently available for the diagnosis of histoplasmosis in microbiological laboratories, from conventional to new developed tests. Most recent approaches are introduced and future perspectives are discussed.

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“…Diego H Caceres and Audrey Valdes focus on the issue of the association of histoplasmosis and tuberculosis [8]. As the difficulties in diagnosing histoplasmosis have perpetuated a low awareness, Felix Bongomin and David Denning from GAFFI emphasize the need for advocacy with international Public Health Agencies in order to create conditions for the optimal diagnosis and treatment of this major killer of HIV-infected patients [9]. In the next few years, as new diagnostic tests are scaled up, and as the increased awareness momentum grows to fill the knowledge gaps, histoplasmosis may change from a confidential pathogen known by few, to a more "mainstream" public health problem with well-defined clinical algorithms everywhere.…”

mentioning

confidence: 99%