RESUMO
Patients with severe COVID-19 are at increased risk for invasive fungal infections, which are underestimated. Histoplasmosis reactivation in endemic areas should not be overlooked in this population. In a previous study, seroconversion to anti-histoplasmin antibodies by ELISA was detected in 6/39 (15.4%) patients with severe COVID-19. In this work, samples were further investigated to detect seroconversion to antibodies against the Histoplasma capsulatum 100-kDa antigen (Hcp100) by ELISA. Seroconversion to anti-Hcp100 antibodies was detected in 7/39 patients, of whom 6 also seroconverted anti-histoplasmin antibodies. These results reinforce previous findings that show histoplasmosis as an underdiagnosed fungal entity complicating COVID-19.
This study verifies that patients with severe COVID-19 at intensive care units are at risk for histoplasmosis reactivation in endemic areas. Accurate diagnosis of this deadly fungal disease among critically ill patients with COVID-19 living in endemic areas for histoplasmosis is needed.
Assuntos
COVID-19 , Histoplasmose , Animais , Histoplasmose/diagnóstico , Histoplasmose/epidemiologia , Histoplasmose/microbiologia , Histoplasmose/veterinária , Histoplasmina , Histoplasma , Estado Terminal , Anticorpos Antifúngicos , COVID-19/veterinária , Antígenos de FungosRESUMO
Histoplasmosis is a multifaceted condition caused by the dimorphic fungi Histoplasma capsulatum whose infective spores are inhaled and reach the lungs, the primary organ of infection. The meningeal form, considered one of the most serious manifestations of this mycosis, is usually seen in individuals with impaired cellular immunity such as patients with acquired immunodeficiency syndrome, systemic lupus erythematous or solid organ transplantation, and infants given their immunological immaturity. The most common presentation is self-limited and occurs in immunocompetent individuals who have been exposed to high concentrations of conidia and mycelia fragments of the fungi. In those people, the condition is manifested by pulmonary disorders and late dissemination to other organs and systems. We report a case of central nervous system histoplasmosis in an immunocompetent child.
Assuntos
Erros de Diagnóstico , Histoplasmose/diagnóstico , Meningite Fúngica/diagnóstico , Injúria Renal Aguda/etiologia , Anfotericina B/efeitos adversos , Anfotericina B/uso terapêutico , Antifúngicos/uso terapêutico , Líquido Cefalorraquidiano/microbiologia , Criança , Remoção de Dispositivo , Cefaleia/etiologia , Histoplasma/imunologia , Histoplasma/isolamento & purificação , Histoplasmina/sangue , Histoplasmina/líquido cefalorraquidiano , Histoplasmose/líquido cefalorraquidiano , Histoplasmose/complicações , Histoplasmose/tratamento farmacológico , Humanos , Hidrocefalia/diagnóstico , Hidrocefalia/etiologia , Hidrocefalia/cirurgia , Hipopotassemia/etiologia , Imunocompetência , Itraconazol/uso terapêutico , Masculino , Meningite Fúngica/líquido cefalorraquidiano , Meningite Fúngica/complicações , Meningite Fúngica/tratamento farmacológico , Meningite Fúngica/microbiologia , Transtornos de Enxaqueca/diagnóstico , Infecções Relacionadas à Prótese/etiologia , Infecções Relacionadas à Prótese/microbiologia , Infecções Estafilocócicas/etiologia , Staphylococcus epidermidis/efeitos dos fármacos , Resistência a Vancomicina , Derivação Ventriculoperitoneal/efeitos adversosRESUMO
La histoplasmosis es una afección polifacética producida por el hongo dimorfo Histoplasma capsulatum , cuyas esporas son inhaladas y llegan al pulmón, órgano primario de infección. La forma meníngea, considerada como una de las manifestaciones más graves de esta micosis, suele presentarse en individuos con alteraciones en la inmunidad celular: pacientes con síndrome de inmunodeficiencia humana adquirida, con lupus eritematoso sistémico o con trasplante de órgano sólido, así como en lactantes, debido a su inmadurez inmunológica. La forma de presentación más usual es de resolución espontánea y se observa en individuos inmunocompetentes que se han expuesto a altas concentraciones de conidias y fragmentos miceliares del hongo. En estas personas, la afección se manifiesta por trastornos pulmonares y por la posterior diseminación a otros órganos y sistemas. Se presenta un caso de histoplasmosis del sistema nervioso central en un niño inmunocompetente.
Histoplasmosis is a multifaceted condition caused by the dimorphic fungi Histoplasma capsulatum whose infective spores are inhaled and reach the lungs, the primary organ of infection. The meningeal form, considered one of the most serious manifestations of this mycosis, is usually seen in individuals with impaired cellular immunity such as patients with acquired immunodeficiency syndrome, systemic lupus erythematous or solid organ transplantation, and infants given their immunological immaturity. The most common presentation is self-limited and occurs in immunocompetent individuals who have been exposed to high concentrations of conidia and mycelia fragments of the fungi. In those people, the condition is manifested by pulmonary disorders and late dissemination to other organs and systems. We report a case of central nervous system histoplasmosis in an immunocompetent child.
Assuntos
Criança , Humanos , Masculino , Erros de Diagnóstico , Histoplasmose/diagnóstico , Meningite Fúngica/diagnóstico , Injúria Renal Aguda/etiologia , Anfotericina B/efeitos adversos , Anfotericina B/uso terapêutico , Antifúngicos/uso terapêutico , Líquido Cefalorraquidiano/microbiologia , Remoção de Dispositivo , Cefaleia/etiologia , Histoplasma/imunologia , Histoplasma/isolamento & purificação , Histoplasmina/sangue , Histoplasmina/líquido cefalorraquidiano , Histoplasmose/complicações , Histoplasmose/líquido cefalorraquidiano , Histoplasmose/tratamento farmacológico , Hidrocefalia/diagnóstico , Hidrocefalia/etiologia , Hidrocefalia/cirurgia , Hipopotassemia/etiologia , Imunocompetência , Itraconazol/uso terapêutico , Meningite Fúngica/complicações , Meningite Fúngica/líquido cefalorraquidiano , Meningite Fúngica/tratamento farmacológico , Meningite Fúngica/microbiologia , Transtornos de Enxaqueca/diagnóstico , Infecções Relacionadas à Prótese/etiologia , Infecções Relacionadas à Prótese/microbiologia , Infecções Estafilocócicas/etiologia , Staphylococcus epidermidis/efeitos dos fármacos , Resistência a Vancomicina , Derivação Ventriculoperitoneal/efeitos adversosRESUMO
Se describe un brote de histoplasmosis que afectó a 6 cadetes de la Fuerza Aérea Argentina, sin antecedentes patológicos previos. Todos consultaron por problemas respiratorios después de haber limpiado un hangar. En ese recinto se encontraron abundantes deyecciones de animales, presuntamente de palomas y murciélagos. Los pacientes sufrieron fiebre, mialgias, taquipnea y tos no productiva. Las radiografías y tomografías de tórax mostraron imágenes pulmonares micronodulares, engrosamiento de los tabiques interalveolares y adenopatías hiliares. Todos tuvieron una evolución favorable y no requirieron tratamiento antifúngico. Las pruebas de inmunodifusión y contrainmunoelectroforesis con antígenos de Histoplasma capsulatum fueron positivas, al igual que las intradermorreacciones con histoplasmina. Se recogieron 5 muestras de tierra del lugar, las que fueron inoculadas por vía intraperitoneal a 20 hámsteres. De los cultivos de hígado y bazo de dichos animales se consiguió aislar la fase micelial de H. capsulatum. La cepa aislada se comparó con las obtenidas de 12 pacientes argentinos utilizando perfiles genéticos y se observó un clado único con más de 96% de similitud, lo que confirma la homogeneidad de las cepas argentinas. Si bien la histoplasmosis es endémica en la Pampa húmeda, este es el primer brote totalmente documentado al sur del paralelo 34°.
An histoplasmosis outbreak affecting 6 previously healthy Air Force cadets is herein presented. The patients suffered from fever and respiratory symptoms after having cleaned an abandoned hangar soiled with pigeons and bat droppings. They all presented fever, myalgia, tachypnea, and nonproductive cough. Chest X-ray and CT scan studies showed disseminated reticulonodular images affecting both lungs. Hiliar adenomegalies were also observed. All patients achieved a favourable outcome without antifungal treatment. Both serologic tests searching for specificic antibodies (immunodiffusion and counterimmunoelectrophoresis) and histoplasmin skin tests were positive in all cases. Five soil samples mixed with pigeons and bat droppings were collected from the hangar. Suspensions of these samples were inoculated into 20 hamsters by intraperitoneal injection; mycelial phase of H. capsulatum was isolated from liver and spleen cultures. The genetic profile of this strain was compared with 12 isolates obtained from Argentinean patients, and a great degree of homogeneity was observed (> 96% similarity). Although histoplasmosis is endemic in the wet Pampas, this is the first epidemic outbreak reported south of the 34th parallel.
Assuntos
Adulto , Animais , Cricetinae , Humanos , Masculino , Adulto Jovem , Surtos de Doenças , Histoplasmose/epidemiologia , Militares , Argentina/epidemiologia , Quirópteros/microbiologia , Columbidae/microbiologia , DNA Fúngico/análise , Plumas/microbiologia , Fezes/microbiologia , Histoplasma/classificação , Histoplasma/genética , Histoplasma/crescimento & desenvolvimento , Histoplasma/isolamento & purificação , Histoplasmina , Histoplasmose/diagnóstico , Histoplasmose/transmissão , Mesocricetus , Exposição Ocupacional , Testes CutâneosRESUMO
A histoplasmosis outbreak affecting 6 previously healthy Air Force cadets is herein presented. The patients suffered from fever and respiratory symptoms after having cleaned an abandoned hangar soiled with pigeons and bat droppings. They all presented fever, myalgia, tachypnea, and nonproductive cough. Chest X-ray and CT scan studies showed disseminated reticulonodular images affecting both lungs. Hiliar adenomegalies were also observed. All patients achieved a favourable outcome without antifungal treatment. Both serologic tests searching for specificic antibodies (immunodiffusion and counterimmunoelectrophoresis) and histoplasmin skin tests were positive in all cases. Five soil samples mixed with pigeons and bat droppings were collected from the hangar. Suspensions of these samples were inoculated into 20 hamsters by intraperitoneal injection; mycelial phase of H. capsulatum was isolated from liver and spleen cultures. The genetic profile of this strain was compared with 12 isolates obtained from Argentinean patients, and a great degree of homogeneity was observed (> 96% similarity). Although histoplasmosis is endemic in the wet Pampas, this is the first epidemic outbreak reported south of the 34th parallel.
Assuntos
Surtos de Doenças , Histoplasmose/epidemiologia , Militares , Adulto , Animais , Argentina/epidemiologia , Quirópteros/microbiologia , Columbidae/microbiologia , Cricetinae , DNA Fúngico/análise , Plumas/microbiologia , Fezes/microbiologia , Histoplasma/classificação , Histoplasma/genética , Histoplasma/crescimento & desenvolvimento , Histoplasma/isolamento & purificação , Histoplasmina , Histoplasmose/diagnóstico , Histoplasmose/transmissão , Humanos , Masculino , Mesocricetus , Exposição Ocupacional , Testes Cutâneos , Adulto JovemRESUMO
Epidemiologic studies of deep mycosis have been scarce in Bolivar state, where paracoccidioidomycosis and histoplasmosis are considered as endemic diseases. The aim of this study was to determine paracoccidioidomycosis and histoplasmosis prevalences in people from a suburb of San Féix, Bolívar state, Venezuela. Three-hundred volunteers agreed to participate in this study and they were inoculated with paracoccidioidine and histoplasmine. Identification and epidemiologic data were registered. Reading of skin tests after 24 hours was performed in 275 persons. Paracoccidioidine test was positive in 10.2% (n=28). A higher percentage of positive reactions in the age group of 40-50 years old (n=10; 35.7%) was observed. Bricklayers, farmers and miners were positive in 27.3% (3 out of 11), a higher percentage than in people with other occupations. Histoplasmine test was positive in 7.6% of cases (n=21). The higher percentage of reactivity was observed in the age group of 40-50 years old (n=9; 42.9%). There was a direct proportional relationship between staying time in the locality and H. capsulatum infection mainly in persons staying in the area for more than 30 years (p < 0.05). These results showed low prevalences of P. brasiliensis and H. capsulatum infection in this area.
Assuntos
Histoplasmose/epidemiologia , Paracoccidioidomicose/epidemiologia , Adolescente , Adulto , Fatores Etários , Criança , Pré-Escolar , Feminino , Proteínas Fúngicas , Histoplasmina , Humanos , Lactente , Testes Intradérmicos , Masculino , Pessoa de Meia-Idade , Exposição Ocupacional , Prevalência , Fumar/epidemiologia , População Suburbana/estatística & dados numéricos , Venezuela/epidemiologiaRESUMO
La paracoccidioidomicosis es una de las micosis sistémicas más frecuente en Venezuela. Su agente etiológico es Paracoccidioides brasiliensis. Investigaciones previas, sugieren que en el municipio Tovar del estado Aragua (Venezuela) existen zonas endémicas para Paracoccidioides brasiliensis en las que los agricultores están ocupacionalmente expuestos. Además, han sido descritas algunas áreas endémicas comunes para Paracoccidioides brasiliensis y Histoplasma capsulatum. En consecuencia, se determinó la prevalencia de la infección por ambos hongos en 131 agricultores del Caserío La Entrada (municipio Tovar), mediante la intradermorreacción a la paracoccidioidina e histoplasmina. La prevalencia fue 90,1% para Paracoccidioides brasiliensis y 72,5% para Histoplasma capsulatum, encontrándose copositividades en 88 agricultores (67%). No se encontró asociación estadísticamente significativa (p=0,186) entre las intradermopositividades. La frecuencia de infección por Paracoccidioides brasiliensis y/o Histoplasma capsulatum resultó independiente de la edad, sexo y del tiempo laborando en la agricultura. Altos porcentajes de intradermopositividades fueron encontrados en menores de 10 años de edad (paracoccidiodina: 89,3%; histoplasmina: 75%) y en aquellos que tenían menos de un año como agricultores (paracoccidiodina: 85,4%; histoplasmina: 65,9%). Los hallazgos obtenidos sugieren que en el área geográfica estudiada coexisten Paracoccidioides brasiliensis y Histoplasma capsulatum. Además, que la infección ocurre rápida y tempranamente en la vida de estos individuos, permitiendo inferir que la endemicidad de estos microorganismos y el riesgo de contraer la infección son elevados en los trabajadores agrícolas
The paracoccidioidomycosis is one of the more frequent systemic mycosis in Venezuela. His etiologic agent is Paracoccidioides brasiliensis. Previous investigations, suggest the existence of endemic zones for Paracoccidioides brasiliensis in which the farmers are occupationally exposed in the Tovar Municipality of the Aragua state (Venezuela). In addition, some common endemic areas for Paracoccidioides brasiliensis and Histoplasma capsulatum have been described. Consequently, the prevalence of the infection by both fungi was determined in 131 farmers from the Caserío La Entrada (Tovar Municipality), by means of the intradermoreaction to paracoccidioidin and histoplasmin. The prevalence was 90.1% for Paracoccidioides brasiliensis and 72.5% for Histoplasma capsulatum, being the skin reactivity positive for both antigens in 88 farmers (67%). Association was not statistically significant (p=0,186) among the skin reactivities. The frequency of infection by Paracoccidioides brasiliensis and/or Histoplasma capsulatum was independent from age, sex and time working in farms. High percentages of skin reactivity were found in individuals under 10 years of age (paracoccidiodin: 89.3%; histoplasmin: 75%) and in people working as farmers less than one year (paracoccidiodin: 85.4%; histoplasmin: 65.9%). Findings suggest that there is a coexistance of Paracoccidioides brasiliensis and Histoplasma capsulatum in the studied geographic area. In addition, the infection occurs fast and early in the life of these individuals, allowing to infer that those microorganisms are endemic and the risk of contracting the infection are elevated in the farmers
Assuntos
Humanos , Masculino , Adulto , Feminino , Criança , Histoplasmina , Micoses/diagnóstico , Paracoccidioides/patogenicidade , Doenças Transmissíveis , Saúde OcupacionalAssuntos
Histoplasmose/diagnóstico , Pneumopatias Fúngicas/diagnóstico , Adulto , Animais , Animais Selvagens/microbiologia , Argentina , Columbidae/microbiologia , Diagnóstico Diferencial , Fezes/microbiologia , Hepatomegalia/etiologia , Histoplasmina/imunologia , Histoplasmose/complicações , Histoplasmose/diagnóstico por imagem , Histoplasmose/patologia , Histoplasmose/transmissão , Humanos , Hipergamaglobulinemia/etiologia , Imunodifusão , Testes Intradérmicos , Pneumopatias Fúngicas/complicações , Pneumopatias Fúngicas/diagnóstico por imagem , Pneumopatias Fúngicas/patologia , Pneumopatias Fúngicas/transmissão , Masculino , Ratos/microbiologia , Esplenomegalia/etiologia , Tomografia Computadorizada por Raios XRESUMO
OBJECTIVE: To analyze the epidemiological and clinical characteristics of Histoplasma capsulatum infection in a group of volunteers who had traveled to Guatemala. METHODS: A review was performed of the clinical records of nine patients who consulted at the Tropical Medicine Outpatient Unit of Hospital Clinic in Barcelona, Spain. RESULTS. All patients were attended for travelers' diarrhea. In addition, one student had also presented with respiratory symptoms and fever while in Guatemala and her chest X-ray showed interstitial infiltrates. The epidemiological history recognized risk factors for histoplasmosis in all patients (all of them had been working in the reconstruction of an old school building). The intradermal histoplasmin test was performed and was positive in all nine patients. None of the students required treatment. CONCLUSIONS: Histoplasmosis should be included in the differential diagnosis of returning travelers' fever. The diagnosis would have been missed in all of our patients if not for a directed clinical history taking. It is important to reinforce prevention measures, e.g. the use of face masks, when working in an environment with a risk for acquiring histoplasmosis.
Assuntos
Histoplasmose/diagnóstico , Adulto , Feminino , Guatemala , Histoplasmina , Histoplasmose/epidemiologia , Histoplasmose/terapia , Humanos , Masculino , ViagemRESUMO
Histoplasma capsulatum is a dimorphic pathogenic fungus that causes a wide spectrum of disease when mycelial fragments are inhaled. Resistance to H. capsulatum is dependent on cellular immunity mediated by T cells and macrophages. Here we standardized the production of extracts containing cell-free antigens (CFAgs) and observed their efficacy in evaluating cellular immunity during murine histoplasmosis. CFAgs induced a more potent delayed-type hypersensitivity (DTH) response in H. capsulatum-infected mice than did histoplasmin-a classical antigen. This DTH response to CFAgs is able to determine the immune status of infected mice and to predict their death. Moreover, CFAgs stimulated spleen cells from immune mice to produce higher amounts of gamma interferon (IFN-gamma) in vitro. Finally, immunization with CFAgs protected against a lethal inoculum of H. capsulatum. These results demonstrate that CFAgs may be useful for the evaluation of cellular immune response and as a potential source for the development of a vaccine against histoplasmosis.
Assuntos
Antígenos de Fungos/administração & dosagem , Antígenos de Fungos/imunologia , Histoplasma/imunologia , Histoplasmina/imunologia , Histoplasmose/imunologia , Histoplasmose/prevenção & controle , Animais , Antígenos de Fungos/isolamento & purificação , Histoplasma/patogenicidade , Histoplasmina/administração & dosagem , Histoplasmose/microbiologia , Histoplasmose/mortalidade , Humanos , Hipersensibilidade Tardia , Imunidade Celular , Imunização , Interferon gama/biossíntese , Masculino , Camundongos , Camundongos Endogâmicos CBA , Baço/citologia , Baço/imunologiaRESUMO
Since Paracoccidioides brasiliensis and Histoplasma capsulatum are known to be present in similar environments, there have been many epidemiologic investigations regarding the prevalences of these two organisms. However, cross-reactivity can occur in paracoccidioidin and histoplasmin skin tests, and this usually results in the overestimation of the prevalence of P. brasiliensis. The prevalence of infection with P. brasiliensis was evaluated in a cross-sectional study of 298 asymptomatic school children in the Brazilian Amazon region (Mato Grosso State). In this investigation, the reactivity of children to two different P. brasiliensis antigen preparations, paracoccidioidin and a purified 43-kD glycoprotein (gp43), was compared with or without the co-administration of histoplasmin. In the group of individuals receiving paracoccidioidin who had a positive histoplasmin skin test result, the prevalence of exposure to P. brasiliensis was 44% (16 of 36). This reactivity to P. brasiliensis was significantly higher than that observed in other groups, which ranged from 4% to 6% (P < 5 x 10(-4) for each). Overall prevalence was 4.6% (95% confidence interval = 2.5-7.7%). These data suggest that gp43 provides a better estimate of exposure to P. brasiliensis when the co-administration of histoplasmin is desired.
Assuntos
Antígenos de Fungos/análise , Proteínas Fúngicas , Glicosaminoglicanos/análise , Histoplasmina/análise , Paracoccidioides/imunologia , Paracoccidioidomicose/epidemiologia , Adolescente , Brasil/epidemiologia , Criança , Feminino , Proteínas Fúngicas/imunologia , Glicoproteínas/imunologia , Glicosaminoglicanos/imunologia , Histoplasmina/imunologia , Humanos , Testes Intradérmicos , Masculino , Paracoccidioidomicose/diagnóstico , Paracoccidioidomicose/imunologia , Prevalência , Testes CutâneosRESUMO
Paracoccidiodomycosis and histoplasmosis are endemic diseases in the south of Venezuela, representing a public health problem. Prevalence of Paracoccidiodes brasiliensis and Histoplasma capsulatum infections were estimated in Monte Ralo, a rural community area of Bolivar state using paracoccidiodine and histoplasmine skin tests. Paracoccidiodine was intradermically injected to 173 persons and readings were made at 24 and 48 h afterwards to 167 persons (97.85%). Reaction was positive in 8.5% (n = 14) at 24 h post-injection and 13.2% (n = 20) at 48 h. Farmers showed the higher percentage of positivity at 24 and 48 h. One hundred-seventy five persons were intradermically injected with histoplasmine but 167 and 157 of them attended for reading of the dermal reaction at 24 and 48 h post-injection respectively. Tests were positive in 25.7% (n = 43) at 24 h and 42.7% (n = 67) at 48 h. Further studies are needed in surrounding places to delimit the endemic area of these mycosis in the Bolivar state. However, epidemiological vigilance of PCM and H should be considered by local health authorities.
Assuntos
Coccidioidina/efeitos adversos , Histoplasmina/efeitos adversos , Histoplasmose/epidemiologia , Paracoccidioidomicose/epidemiologia , Adolescente , Adulto , Distribuição por Idade , Criança , Pré-Escolar , Coccidioidina/farmacologia , Doenças Endêmicas , Feminino , Histoplasmina/farmacologia , Histoplasmose/diagnóstico , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Paracoccidioidomicose/diagnóstico , Vigilância da População , Fatores de Risco , População Rural , Distribuição por Sexo , Testes Cutâneos/métodos , Venezuela/epidemiologiaRESUMO
Pulmonary histoplasmosis is a rare disease in Spain. Moreover, it is difficult to diagnose due to unspecific clinical and radiological symptoms. The isolation of the fungus is essential for a proper diagnosis. Nevertheless, it is very difficult to identify the fungus itself in respiratory stains and we usually need invasive techniques. For all these reasons and taking into account the increase in journeys and immigration, we believe that it is probably underdiagnosed in our country. We report a case of acute pulmonary histoplasmosis in a Spanish traveller and emphasize the importance of the anamnesis and the value of the microbiologist's experience to obtain the diagnosis.
Assuntos
Histoplasmose/diagnóstico , Pneumopatias Fúngicas/diagnóstico , Viagem , Doença Aguda , Adulto , Animais , Quirópteros/microbiologia , Reações Falso-Negativas , Fezes/microbiologia , Histoplasma/isolamento & purificação , Histoplasma/fisiologia , Histoplasmina , Histoplasmose/epidemiologia , Humanos , Imunocompetência , Imunodifusão , Exposição por Inalação , Testes Intradérmicos , Pneumopatias Fúngicas/epidemiologia , Pneumopatias Fúngicas/microbiologia , Masculino , Nicarágua , Espanha/etnologia , Esporos Fúngicos , Escarro/microbiologia , Coloração e RotulagemRESUMO
In order to know mycosis frequency in the North of the State of Puebla, Mexico, in habitants from the communities of Ayotoxco, Mazatepec and Zacatipan were studied. Previous medical study biological samples were submitted to direct examination, smear and culture. Histoplasmin and sporotrichin skin test were applied to 57 individual from Zacatipan. From 110 patients 146 mycological studies were performed. Eighty six cases (59%) of mycosis were detected: 43 finger or toenails onychomycosis, 25 tinea pedis, seven tinea capitis, four cases of tinea manum and, finally, five cases of seborrhoeic dermatitis and two of pitiriasis versicolor. We isolated: 18 streins of dermatophytes, mainly Trichophyton rubrum and T. mentagrophytes (11 and 5 strains respectively); 12 cultures of non-dermatophytes filamentous fungi; six cases of mycelia sterile; six yeast strains, most of them Candida spp but none C. albicans. From 57 patients to whom skin tests were applied, five of them (8.8%) were positive to both antigens; ten positive (17.6%) only to histoplasmin and eight (14%) to sporotrichin. This study showed that rural population from Puebla present a high frequency of superficial mycosis (61% of mycological studies). Considering the percentage of positive skin test we suppose that there are many not diagnosed sporotrichosis and histoplasmosis cases.
Assuntos
Dermatomicoses/epidemiologia , Bactérias/isolamento & purificação , Dermatite Seborreica/epidemiologia , Feminino , Fungos/isolamento & purificação , Glicosaminoglicanos/administração & dosagem , Histoplasmina/administração & dosagem , Humanos , Masculino , México/epidemiologia , Onicomicose/epidemiologia , Testes Cutâneos/estatística & dados numéricos , Tinha do Couro Cabeludo/epidemiologia , Tinha dos Pés/epidemiologia , Tinha Versicolor/epidemiologia , Leveduras/isolamento & purificaçãoRESUMO
Eight chilean teenagers traveled to Ecuador in january 1999, where they were bitten by mosquitoes, had contact with parakeets and lodged in poorly hygienic places; 6/8 visited for 5-10 minutes the interior of a bat cave. About a week later these 6 began with headache, myalgia and fever that lasted 2-3 weeks. 5/6 had dry cough with no respiratory distress. The index case was seen in the 2nd week of symptoms. A chest x-ray showed multiple nodular infiltrates as in the other five. Two had histoplasma serology, one was negative and the other positive at a low titer; histoplasmine skin test showed induration of 17-27 mm in all six. An acute histoplasmosis with massive exposure was diagnosed and treated with itraconazole for 3 weeks. All became asymptomatic and chest x-rays returned to normal. Histoplasmosis (non existent endogenously in Chile) is, among other geographic and tropical diseases, a risk for chilean travelers. Awareness of this in the general population and development of expertise in these diseases by local health care providers is required
Assuntos
Humanos , Adolescente , Adulto , Viagem , Surtos de Doenças , Histoplasmose/epidemiologia , Tetraciclina/uso terapêutico , Fluconazol/uso terapêutico , Itraconazol/uso terapêutico , Zona Tropical , Febre/etiologia , Histoplasma/patogenicidade , Histoplasmina , Histoplasmose/diagnóstico , Histoplasmose/tratamento farmacológico , Quirópteros/microbiologia , Radiografia Torácica , Sinais e SintomasRESUMO
Paracoccidioidomycosis is a systemic mycoses caused by Paracoccidioides brasiliensis, a dimorphic fungus that infects man through respiratory ducts. It has been accepted that its ecological niche is located in the soil and plants of subtropical forests of Latin America. The Province of Corrientes is located at the northeastern border of Argentina, in a subtropical area where important environmental modifications have been introduced in the last decade as consequence of damming the Paranà river at Yacyretà, one of the biggest hydroelectric dams in the world. Since there are no data on human infection provoqued by this fungal agent in Corrientes, the purpose of this study was to obtain information at present time about infection indexes and to assess if environmental changes introduced in the area could impact on the epidemiology of the disease. Skin tests with paracoccidioidin and histoplasmin were performed on 455 persons of both sexes, from 1 to 73 years of age, who live permanently in the area and voluntarily accepted to be included in the study. Both antigens were employed at the same time in order to evaluate crossed type reactions. Of the 455 persons, 52 (39 males-13 females) were reactive to paracoccidioidin (11.4%), with an increasing prevalence with age. According to previous data, these results would indicate an increase in the index of human infection by P. brasiliensis, and this may be related to the important changes in climatic and environmental conditions introduced in the area in the last years.
Assuntos
Meio Ambiente , Paracoccidioidomicose/epidemiologia , Clima Tropical , Adolescente , Adulto , Idoso , Argentina/epidemiologia , Criança , Pré-Escolar , Feminino , Proteínas Fúngicas/imunologia , Histoplasmina/imunologia , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Paracoccidioidomicose/diagnóstico , Testes CutâneosRESUMO
OBJECTIVE: Histoplasma capsulatum infection is considered to be endemic in the West Indies. Nevertheless, few epidemiologic studies have been conducted in this area. The histoplasmin skin test reflects the frequency of asymptomatic forms of histoplasmosis. We studied the prevalence of positive skin tests in a population of the French West Indies (Martinique). MATERIALS AND METHODS: Forty one patients (24 females and 17 males), age range 29 to 90 years, were tested for histoplasmin skin sensitivity between August and October 1997, in the department of dermatology of Fort de France (French West Indies). Patients with immunosuppression or personal history of histoplasmosis were excluded. RESULTS: Five patients had a positive skin test (12 p. 100). No significative association was found between a positive skin test and diabetes, rural occupations or exposure to bats. DISCUSSION: Despite the small number of cases, related with difficulties in obtaining histoplasmin, our study showed a sensitivity level similar to medium endemic areas of the USA. The positive skin test rate is much higher than the rate reported before in West Indies, in a sample of the population under 25 years of age.
Assuntos
Doenças Endêmicas , Histoplasmina , Histoplasmose/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Histoplasmina/imunologia , Histoplasmose/diagnóstico , Histoplasmose/imunologia , Humanos , Testes Intradérmicos , Masculino , Martinica , Pessoa de Meia-Idade , Sensibilidade e Especificidade , Pele/imunologiaRESUMO
The present work was undertaken to obtain epidemiological data on the extent and distribution of Histoplasma capsulatum var. capsulatum and Paracoccidiodes brasiliensis diseases in the Vipos, La Toma and Choromoro areas. Skin test surveys with histoplasmin and paracoccidioidin were carried out in the permanent human population of those localities. Mycological sputum studies and serological tests were performed to skin test reactors to determine if there were signs or symptoms of active mycotic disease. La Toma and Choromoro are highly prevalent areas of histoplasmosis (>30% the histoplasmin positive individuals) whereas Vipos can be relatively considered a highly prevalent area (between 20-30% the histoplasmin reactors) according to the normally accepted range used to define an endemic disease [2]. Early Histoplasma capsulatum infection (<10 years old) is reported for Vipos and Choromoro. La Toma has the highest rate of previous exposure to P. brasiliensis detected in the studied area (10.2%). Vipos residents are not infected with P. brasiliensis.
Assuntos
Histoplasmose/epidemiologia , Paracoccidioidomicose/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Anticorpos Antifúngicos/sangue , Argentina/epidemiologia , Criança , Pré-Escolar , Proteínas Fúngicas/imunologia , Histoplasma/imunologia , Histoplasma/isolamento & purificação , Histoplasmina/imunologia , Humanos , Lactente , Pessoa de Meia-Idade , Paracoccidioides/imunologia , Paracoccidioides/isolamento & purificação , Prevalência , Testes Cutâneos , Escarro/microbiologiaRESUMO
The present paper analyzes the histoplasmin electrophoretic profiles and the randomly amplified polymorphic DNA (RAPD) patterns of the fungus Histoplasma capsulatum isolated from Mexican patients with AIDS-associated histoplasmosis. Clinical isolates from Guatemala, Colombia, and Panama, as well as H. capsulatum isolates from different sources in nature, were also processed. All histoplasmin samples shared four antigenic fractions of 200, 49, 10.5, and 8.5 kDa in sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE). According to their percentage of relatedness, based on SDS-PAGE histoplasmin electrophoretic image analysis, H. capsulatum isolates were divided in two groups: group A contained all AIDS-associated isolates studied and two human reference strains from Mexican histoplasmosis patients without AIDS; group B included bat guano, infected bat, and cock excreta isolates from the State of Guerrero, Mexico, plus three human histoplasmosis strains from Guatemala, Panama, and Colombia. Polymorphic DNA patterns evaluated by RAPD-PCR showed three major bands of 4.4, 3.2, and 2.3 kb in most H. capsulatum isolates studied. Four groups were related by DNA polymorphisms: group I was formed by most of the AIDS-associated H. capsulatum isolates studied, one human histoplasmosis strain from Colombia, two human reference strains from Mexican patients without AIDS, and one human histoplasmosis strain from Guatemala. Group II consisted of only a single strain from Panama. Group III included three strains: one from a Mexican patient with AIDS and two isolated from nature in Guerrero (cock excreta and bat guano). The last, group IV, consisted of only one strain isolated from an infected bat, captured in Guerrero. A tight relationship between phenotypic and genotypic characterization was observed, and both analyses could be useful tools for typing H. capsulatum from different sources and geographic origins.