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2010, Number 2

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Med Cutan Iber Lat Am 2010; 38 (2)

Classical histoplasmosis in the immunosupressive patient

Negroni R, Arechavala AI, Maiolo EI

Language: Spanish
References: 36
Page: 59-69
PDF size: 360.13 Kb.


ABSTRACT

Classical histoplasmosis is a systemic endemic mycosis due the dimorphic fungus Histoplasma capsulatum var capsulatum. This mycosis is prevalent in America and Africa. The etiologic agent lives in soil rich in organic materials, with birds and bat feces. The infection is acquired by inhalation of microconidiae from the mycelial form of the fungus and it is usually mild and self-limited. Patients suffering AIDS, lymphomas, CMV infections, organ transplant recipients, treatment with high dose of corticosteroids and other immunosuppressive drugs, present the disseminated progressive histoplasmosis which is usually severe and potentially fatal. In these cases lesions are located at the skin, mucous membrane, lymph nodes, liver, spleen and adrenal glands, and less frequently CNS. The diagnosis of histoplasmosis is usually made by finding this fungus in the direct microscopic examination of different clinical samples and its isolation in cultures, by mean of mycologic and histopathologic studies. Serologic tests searching for antibodies, are very useful in chronic progressive cases, immunodiffusion, counterimmunoelectrophoresis and complement fixation are the more specific reactions. In acute and subacute disseminated histoplasmosis these tests are not very efficient and ELISA searching for antigens of the H. capsulatum cell wall is more often used, but it is not specific.
Amphotericin B is indicated in acute cases, those with CNS involvement, patients suffering diarrhea or tuberculosis. Other cases are treated with itraconazole. There is not any active vaccine for the prevention of this mycosis.


REFERENCES

  1. Negroni, R.: Clinical spectrum and treatment of classic histoplasmosis. Rev Iberoamer Micología 2000; 17: 159-67.

  2. Kauffman, C.: Histoplasmosis. In: Dismukes W, Pappas P.C., Sobel J.D. Medical Mycology. Oxford University Press. 2003. .198- 285.

  3. Kaufman, C.: Endemic Mycoses: Blastomicosis, Histoplasmosis and Sporotrichosis. Infect. Dis Clin North. Amer 2006; 3: 645-62.

  4. Kwon-Chung K.J., Bennett J.E.: Histoplasmosis. In: Kwong-Chung K.J., Bennett J.E. (eds). Medical Mycology. Lea & Febiger. Philadelphia. 1992, pp. 464-513.

  5. Negroni, R.: Histoplasmose. Em: Cimerman S, Cimerman B. Condutas em Infectologia. Atheneu, Sao Paulo. 2004; pp. 376-83.

  6. Lacaz C da S., Porta E., Costa Martins E., Heins-Vaccari E., Takashio de Melo, N.: Histoplasmose Clássica. Em: Lacaz C. da S. et al. (Ed.) Tratado de Micología Médica. Ed. Sarvier. Sao Paulo. 2002; pp. 594-617.

  7. Rippon J.W.: Histoplasmosis. En: Rippon J.W. (Ed.). Micología Médica. Editorial Interamericana Mc Graw-Hill 1988; pp. 410-66.

  8. Muniz M.M., Pizzini C.V., Peralta J.M., Reiss E., Zancopé-Oliveira RM. Genetic diversity of Histoplasma capsulatum strains isolated from soil, animals and clinical especimens in Rio de Janeiro State, Brazil, by a PCR-Based random amplified polymorphic DNA assay. J Clin Microbiool 2001; 39: 4487-94.

  9. Perrotta D., Abrantes R., Canteros C., Rodero L., Davel G: Caracterización molecular de cepas autóctonas de Histoplasma capsulatum por medio de RAPD-PCR. Rev Argent Microbiol 2001; 33: 160-166.

  10. Negroni R.: Histoplasmosis. En: Cecchini E, Gonzalez Ayala S.E. Infectología y Enfermedades Infecciosas. Ediciones Journal. Buenos Aires. 2008; pp. 472-6.

  11. Alsip S., Dismukes W.E.: Approach to the patient with suspected histoplasmosis. In: Remington J.S., Swart M.N. (Eds). Current Clinical topics in infectious diseases. New York. Mc Graw Hill. 1986; pp. 254-96.

  12. Wheat L.J., Kauffman C.: Histoplasmosis. In: Walsh T., Rex J (Ed.): Fungal Infections, Part II. Recent advances in Diagnosis, Treatment and Prevention of Endemic and Cutaneous Mycoses. Infect Dis Clin N Am 2003; 17: 1-19.

  13. Negroni P.: Micosis Profundas. Vol. II. Histoplasmosis. Comisión de Investigaciones Científicas de la Provincia de Buenos Aires. La Plata. 1960.

  14. Negroni R., Arechavala A., Robles A.M.: Histoplasmosis diseminada crónica como afección oportunista. Med. Cut. Iberolatinoamericana. 1987; 15: 377-83.

  15. Negroni R.: Micosis asociadas al SIDA. En: Benetucci J. SIDA y enfermedades asociadas. 3º Edición. FUNDAI. Buenos Aires. 2008; pp. 325-51.

  16. Wheat L.J.: Histoplasma capsulatum. In: Yu V, Weber R., Raoult D (Ed.). Antimicrobial Therapy and Vaccine. Apple Tree Productions L.L.C. New York. 2nd Edition. 2002; 1069-79.

  17. Corti M., Cendoya C.A., Soto I., Esquivel P., Trione N., Villafañe MF., Corbera K. M., Helou S., Negroni R.: Disseminated histoplasmosis and AIDS: clinical aspects and diagnostic methods for early detection. AIDS Patient Care STDS 2000; 14: 149-54.

  18. Negroni R.: Manifestaciones cutáneas mucosas de la histoplasmosis diseminada (histoplasmosis clásica o histoplasmosis capsulati). Dermatol Argent 2008; 14: 104-10.

  19. Silveira F.P., Husain S.: Fungal infections in solid organ transplantation. Med Mycology 2007; 45: 305-20.

  20. Marques S.A., Hozumi S., Camargo R:M.P., Carvalho M.F.C. Marques M.E.A. Histoplasmosis presenting as cellulitis 18 years after renal transplantation. Med Mycology 2008; 46: 725-8.

  21. Peddi V.R., Hariharan S., First M.R. Disseminated histoplasmosis in renal allograft recipients. Clin Transpl 1996; 10: 160-5.

  22. La Rocco MT, Burgert M. Fungal infections in the transplant recipient and laboratory methods for diagnosis. Rev Iberoam Micol 1997; 14: 143-6.

  23. Bracca A, Tosello ME, Girardini JE, Amigot SL, Gomez C, Serra E. Molecular detection of Histoplasma capsulatum var. capsulatum in human clinical samples. J Clin Microbiol 2003; 41: 1753-5.

  24. Arechavala AI, Robles AM, Negroni R, Bianchi M, Taborda A. Valor de los métodos directos e indirectos de diagnóstico en las micosis sistémicas asociadas al sida. Rev Inst Med Trop Sao Paulo, 1993, 35: 163-9.

  25. Restrepo A. Histoplasmosis. En: Restrepo A, Robledo J, Leiderman E, Restrepo M, Botero D, Vedoya VI. Enfermedades Infecciosas, 6° Edición, Corporación para Investigaciones Biológicas, Medellín Colombia, 2003, p. 316-26.

  26. Bianchi M, Robles AM, Vitale R, Helou S, Arechavala A, Negroni R. The usefulness of blood culture in diagnosing HIV-related systemic mycoses: evaluation of a manual lysis centrifugation method. Med Mycol 2000; 38: 77-80.

  27. Baddley JW, Sankara IR, Rodríguez JM, Pappas PG, Many WJ Jr. Histoplasmosis in HIV-infected patients in a Southern regional medical center: poor prognosis in the era of highly active antiretroviral therapy. Diagn Microbiol Infect Dis 2008; 62:151-56.

  28. Huber F, Nacher M, Aznar C, Pierre-Demar M, ElGuedi M, Vaz T, et al . AIDS-related Histoplasma capsulatum var. capsulatum infection: 26 years experience of French Guiana. AIDS 2008; 22: 1047-53.

  29. Negroni R, Robles AM, Arechavala AI, Iovannitti C, Helou S, Kaufman L. Chronic meningoencephalitis due to Histoplasma capsulatum. Usefulness of serodiagnostic procedures in diagnosis. Serodiagn Immunother Infect Dis 1995; 7: 84-8.

  30. Zancope-Oliveira RM, Bragg SL, Reiss E, Wanke B, Peralta JM. Effects of histoplasmin M antigen chemical and enzymatic deglycosylation on cross-reactivity in enzyme-linked immunoelectrotransfer blot method. Clin Diagn Lab Immunol 1994; 1: 390-3.

  31. Pizzini C, Zancopé-Oliveira RM, Reiss E, Hajjeh R, Kaufman L, Peralta JM. Evaluation of a Western blot test in an outbreak of acute pulmonary histoplasmosis. Clin Diagn Lab Immunol 1999, 6: 20-3.

  32. Wheat LJ, Witt J, Dirkin M, Connolly P. Reduction in false antigenemia in the second generation Histoplasma antigen assay. Med Mycol 2007; 45: 169-71.

  33. Kauffman CA. Diagnosis of histoplasmosis in immunosuppressed patients. Curr Opin Infect Dis 2008; 21: 421-5.

  34. Lindsley MD, Holland HL, Bragg SL, Hurst SF, Wannemuehler KA, Morrison CJ. Production and evaluation of reagents for detection of Histoplasma capsulatum antigenuria by enzyme inmmunoassay. Clin Vaccine Immunol 2007; 14: 700.

  35. Gomez BL, Figueroa JI, Hamilton AJ, Diez S, Rojas M, Tobon AM, et al . Detection of the 70- kilodalton Histoplasma capsulatum antigen in serum of histoplasmosis patients: correlation between antigenemia and therapy Turing follow-up. J Clin Microbiol 1999, 37:675-80.

  36. Egan L, Connolly P, Wheat J, Fuller D, Davis TE, Knox K, Hage CA. Histoplasmosis as a cause for a positive FungitellTM (1 3)- -D-glucan test. Med Mycol 2007; 45: 1.




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