Multiple opportunistic fungal infections in an individual with severe HIV disease: A case report

Almeida-Silva, Fernando; Damasceno, Lisandra Serra; Serna, Maria José Buitrago; Valero, Clara; Quintella, Leonardo Pereira; Almeida‐Paes, Rodrigo; Muniz, Mauro de Medeiros; Zancopé‐Oliveira, Rosely Maria

doi:10.1016/j.riam.2015.09.001

Cited by 16 publications

(10 citation statements)

References 16 publications

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“…Similar results were found in Colombia and China (Pan et al, 2013;Arango et al, 2011). A factor to take into account regarding the actual ratio of disseminated histoplasmosis is the reporting bias, since the scientific community tends to report the most serious and unusual cases of infectious diseases (Almeida-Silva et al, 2016;Silva-Ferreira et al, 2017). For instance, in this systematic review, several uncommon manifestations of histoplasmosis were detected, such as osteoarticular, urinary, ocular, and heart involvement (Rocha and Severo, 1994;Unis et al, 2004;Chang et al, 2007;Arcieri et al, 2007).…”

Section: Discussionmentioning

confidence: 99%

The occurrence of histoplasmosis in Brazil: A systematic review

Almeida

Almeida-Silva

Guimarães

et al. 2019

International Journal of Infectious Diseases

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Background: Histoplasmosis is a systemic disease caused by the dimorphic fungus Histoplasma capsulatum. Diagnosis is often delayed, or it is misdiagnosed as tuberculosis. In Brazil, the infection is common and cases of histoplasmosis have been described in all regions of the country; however, the real problem is underestimated since notification of histoplasmosis is not mandatory. Methods: Human histoplasmosis cases diagnosed in Brazil and published up to December 2018 were identified through a search conducted in the PubMed/MEDLINE, SciELO, and Web of Science databases. Moreover, the isolation of H. capsulatum from animals or environmental sources in Brazil was also evaluated. Results: A total of 207 articles fulfilled the inclusion criteria and were evaluated, involving a total of 3530 patients with a diagnosis of histoplasmosis during the period studied. Of these patients, 78.3% were male, giving a male-to-female ratio of approximately 4:1. Histoplasmosis presented a higher frequency in individuals between the fourth and fifth decades of life. Disseminated disease was the most common form of histoplasmosis. Isolation of H. capsulatum on culture media and histopathology using staining methods were the diagnostic methods with the best efficiency. The best results in the identification of the H. capsulatum were achieved for samples from mononuclear phagocyte system components, skin and mucosa, and hematological samples. Regarding predisposing factors for histoplasmosis, HIV infection was the most common underlying condition. The overall mortality rate was 33.1%. Conclusions: This study represents the first available systematic review demonstrating Brazilian cases of histoplasmosis in the literature and highlights that the disease is more widespread in the Brazilian territory than has previously been thought.

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Section: Discussionmentioning

confidence: 99%

The occurrence of histoplasmosis in Brazil: A systematic review

Almeida

Almeida-Silva

Guimarães

et al. 2019

International Journal of Infectious Diseases

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“…At that time, the induced sputum and histopathology of bone marrow revealed a positive H. capsulatum. Concurrent PJP and HP were further confirmed with a nested PCR 8. This case demonstrates the diagnosing of multiple OIs in a highly straightforward manner and hence offers no diagnostic challenges.…”

Section: Discussionmentioning

confidence: 60%

“…For instance, in our patient, the concomitant PHP and PJP might have led to an overwhelming infection because of deficient cellular immunity, low clinical suspicion and delayed aggressive therapy. Though a portion of such cases with an inadequate treatment response could have a third or fourth concomitant pathogen,8 we retrieved no additional pathogen despite multiple cultures.…”

Section: Discussionmentioning

confidence: 99%

ConcurrentPneumocystis jiroveciiand pulmonary histoplasmosis in an undiagnosed HIV patient

et al. 2018

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Concurrent (PJ) and pulmonary histoplasmosis (PHP) are rare in a single HIV individual. We present a challenging case of concomitant PJ and PHP in a young HIV individual. A 44-year-old man presented to the emergency department with progressive pulmonary symptoms. He was hypoxic with bilateral pulmonary opacities on chest radiograph. CT of the chest showed a geographical pattern of ground-glass attenuation. He started receiving intravenous antibiotics in addition to oral Bactrim for suspected PJ. He also began receiving itraconazole, given suspected PHP with recent bat-droppings exposure. HIV test was positive, though history was negative; the CD4 count was 5 cells/mm Later, he developed respiratory failure without clinical improvement. First bronchoalveolar lavage (BAL) failed to confirm opportunistic pathogens. Repeat BAL revealed PJ but no Histoplasma. Histoplasma antigens were positive, confirming histoplasmosis. The patient died despite aggressive treatment with intravenous Bactrim and amphotericin B.

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“…Several cohorts of patients with histoplasmosis/TB coinfection and advanced HIV were reviewed by Caceres et al [ 13 ]. Other coinfections involving TB and these fungal pathogens have also been reported [ 14 , 15 , 16 ]. Therefore, even if TB is detected, mixed infections with fungal pathogens should be ruled out, hence the importance of diagnostic techniques that allow performing a simultaneous detection.…”

Section: Introductionmentioning

confidence: 99%

Differential Diagnosis of Fungal Pneumonias vs. Tuberculosis in AIDS Patients by Using Two New Molecular Methods

Bernal‐Martínez

Herrera

Valero

et al. 2021

JoF

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Opportunistic fungal pneumonias (OFP) are the main cause of death in AIDS patients worldwide. Diagnosis of these infections is often late as tuberculosis (TB) is frequently the first suspicion. In addition, diagnostic tools have limitations and are unavailable in disadvantaged regions. To perform the differential diagnosis of the main fungi causing OFP in AIDS patients (Histoplasma capsulatum, Cryptococcus neoformans/C. gattii and Pneumocystis jirovecii) vs. the Mycobacterium tuberculosis complex (MTBC), two new assays were developed: (i) a multiplex real-time PCR (MRT-PCR) and (ii) a simple and cost-effective method based on real-time PCR and the analysis of melting curves after amplification (MC-PCR). Both of the techniques were optimized and standardized “in vitro”, showing a suitable reproducibility (CV ranged between 1.84 and 3.81% and 1.41 and 4.83%, respectively), a 100% specificity and detection limits between 20 and 2 fg of genomic DNA per 20 µL of reaction. A validation study was performed by retrospectively using 42 clinical samples from 37 patients with proven fungal infection or TB, and 33 controls. The overall sensitivity for the MRT-PCR assay and the MC-PCR assay was 88% and 90.4%, respectively. Both techniques were fast, sensitive and reproducible, allowing for the detection of these pathogens and the performance of a differential diagnosis.

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Multiple opportunistic fungal infections in an individual with severe HIV disease: A case report

Cited by 16 publications

References 16 publications

The occurrence of histoplasmosis in Brazil: A systematic review

The occurrence of histoplasmosis in Brazil: A systematic review

ConcurrentPneumocystis jiroveciiand pulmonary histoplasmosis in an undiagnosed HIV patient

Differential Diagnosis of Fungal Pneumonias vs. Tuberculosis in AIDS Patients by Using Two New Molecular Methods

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