Opportunistic Invasive Mycoses in AIDS: Cryptococcosis, Histoplasmosis, Coccidiodomycosis, and Talaromycosis

Abstract

In many settings, despite increasing roll out of antiretroviral therapy (ART), opportunistic invasive mycoses produce a substantial burden of disease. The prevalence of specific fungal pathogens depends on their endemicity. Viral suppression achieved by greater access to ART and increased the availability of point-of-care testing with rapid diagnostic tests (RDTs) aid to curtail the associated fungi morbidity. RDTs allow earlier screening to preemptively initiate treatment of opportunistic fungal pathogens. Identifying asymptomatic cryptococcal infection before starting ART is crucial in reducing the risk of the immune reconstitution inflammatory syndrome (IRIS). There is an urgent need to decrease the burden of opportunistic invasive fungal infections in individuals with HIV/AIDS through different interventions: (a) continue to expand the deployment of ART to the most affected populations to achieve viral suppression; (b) ensure early diagnosis of fungal pathogen with point-of-care testing;

Cryptococcosis in Colombia: Compilation and Analysis of Data from Laboratory-Based Surveillance

“…In many settings, including Colombia, despite the increasing use of antiretroviral drugs, and in some cases the early diagnosis of HIV, the incidence of systemic fungal infections such as cryptococcosis continues to rise and increase the burden of the disease [ 6 ], primarily in limited settings. This is why regions such as sub-Saharan Africa reported almost 73% of cryptococcal meningitis cases in the year 2014, and more dramatically, 74% of deaths attributed to the disease were documented in this area [ 7 ].…”

Talaromyces marneffei fungemia after travel to China in a Canadian patient with AIDS

“…In addition, latent T. marneffei infection can occur, with disease reactivation at any time in immunocompromised hosts. 5 Our patient's illness likely represented reactivation of latent disease in the context of a low CD4 count. He may have acquired the infection during his time of residence in Guangzhou or during one of his return trips, most recently 1 year before presentation at our institution.…”

Invasive fungal disease in humans: are we aware of the real impact?

“…(42) Disseminated histoplasmosis, reported worldwide with about 100,000 cases occurring every year, has most endemic cases in the Americas, where the incidence has been estimated to reach 25% of patients with HIV infection, being an AIDS-defining illness in up to 75% of patients and with mortality rates of almost 60%. (6,42,46) In Latin America, it is estimated that, among people living with HIV, the number of deaths caused by histoplasmosis may be higher than those caused by tuberculosis. In fact, histoplasmosis, which is considered neglected in this region, is often misdiagnosed as tuberculosis (47) Talaromycosis, restricted to southeast Asia, southern China and northeastern India, remains one of the major causes of HIV-associated mortality in these endemic areas, especially in people with undiagnosed and untreated HIV infection.…”