The relevance of clinical and epidemiological correlation in the early diagnosis of histoplasmosis: report of two clinical cases in Popayán, Colombia
Abstract
Histoplasmosis is an endemic mycosis in Colombia. Here we present two cases in the Cauca department, to indicate the clinical impact of histoplasmosis delayed diagnosis and treatment when its epidemiology is unknown. Informed consent was requested to review patients’ medical records and case report publication.
The first case was a patient diagnosed with human immunodeficiency virus and generalized presence of skin lesions. Initially, these lesions were diagnosed as herpes, but a postmortem diagnosis confirmed histoplasmosis through fungal cultures of tissues from the skin lesions. The second case is an immunocompetent patient with pulmonary symptoms diagnosed and treated for tuberculosis. However, given the lack of improvement and considering the bat cave entrance history, the patient was treated for possible pulmonary histoplasmosis with an adequate response.
We made a review of laboratory tests and histoplasmosis epidemiological data relevant to health professionals. We concluded that health institutions must provide rapid tests, such as antigen ones, to adequately diagnose and treat this mycosis; and also take corrective measures to minimize exposure to Histoplasma.
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References
Donnelly JP, Chen SC, Kauffman CA, Steinbach WJ, Baddley JW, Verweij PE, et al. Revision and update of the consensus definitions of invasive fungal disease from the European Organization for Research and Treatment of Cancer, and the Mycoses Study Group Education and Research Consortium. Clin Infect Dis. 2020;71:1367-76. https://doi.org/10.1093/cid/ciz1008
Colombo AL, Tobón A, Restrepo A, Queiroz-Telles F, Nucci M. Epidemiology of endemic systemic fungal infections in Latin America. Med Mycol. 2011;49:785-98. https://doi.org/10.3109/13693786.2011.577821
Kasuga T, White TJ, Koenig G, McEwen J, Restrepo A, Castañeda E, et al. Phylogeography of the fungal pathogen Histoplasma capsulatum. Mol Ecol. 2003;12:3383-401. https://doi.org/10.1046/j.1365-294x.2003.01995.x
Mittal J, Ponce MG, Gendlina I, Nosanchuk JD. Histoplasma capsulatum: Mechanisms for pathogenesis. Curr Top Microbiol Immunol. 2019;422:157-91. https://doi.org/10.1007/822018114
Benedict K, Mody RK. Epidemiology of histoplasmosis outbreaks, United States, 1938-2013. Emerg Infect Dis. 2016;22:370-8. https://doi.org/10.3201/eid2203.151117
Wheat LJ, Azar MM, Bahr NC, Spec A, Relich RF, Hage C. Histoplasmosis. Infect Dis Clin North Am. 2016;30:207-27. https://doi.org/10.1016/j.idc.2015.10.009
De Perio MA, Benedict K, Williams SL, Niemeier-Walsh C, Green BJ, Coffey C, et al. Occupational histoplasmosis: Epidemiology and prevention measures. J Fungi (Basel). 2021;26:510. https://doi.org/10.3390/jof7070510
Lockhart SR, Toda M, Benedict K, Cáceres DH, Litvintseva AP. Endemic and other dimorphic mycoses in The Americas. J Fungi. 2021;7:151. https://doi.org/10.3390/jof7020151
Taylor ML, Reyes-Montes MD, Estrada-Bárcenas DA, Zancopé-Oliveira RM, Rodríguez-Arellanes G, Ramírez JA. Considerations about the geographic distribution of Histoplasma species. Appl Environ Microbiol. 2022;88:e0201021. https://doi.org/10.1128/aem.02010-21
Mahajan VK, Raina RK, Singh S, Rashpa RS, Sood A, Chauhan PS, et al. Case report: Histoplasmosis in Himachal Pradesh (India): An emerging endemic focus. Am J Trop Med Hyg. 2017;97:1749-56. https://doi.org/10.4269/ajtmh.17-0432
Horwath MC, Fecher RA, Deepe GS JR, Histoplasma capsulatum, lung infection and immunity. Future Microbiol. 2015;10:967-75. https://doi.org/10.2217/fmb.15.25
Adenis A, Nacher M, Hanf M, Vantilcke V, Boukhari R, Blachet D, et al. HIV-associated histoplasmosis early mortality and incidence trends: From neglect to priority. PLoS Negl Trop Dis. 2014;8:1-5. https://doi.org/10.1371/journal.pntd.0003100
Centers for Disease Control and Prevention. Revision of the CDC surveillance case definition for acquired immunodeficiency syndrome. MMWR Morb Mortal Wkly Rep. 1987;36(Supp.1):S1-15.
Arango M, Castañeda E, Agudelo CI, De Bedout C, Agudelo CA, Tobón A, et al. Histoplasmosis: results of the Colombian National Survey, 1992-2008. Biomédica. 2011;31:344-56. https://doi.org/10.7705/biomedica.v31i3.348
Instituto Nacional de Salud. Boletín epidemiológico, semana 25. Fecha de consulta: 28 de octubre de 2022. Disponible en: https://www.ins.gov.co/buscador-eventos/BoletinEpidemiologico/2022_Bolet%C3%ADn_epidemiologico_semana_25.pdf
Taylor ML, Ruiz-Palacios GM, Reyes-Montes MR, Rodríguez-Arellanes G, Carreto-Binaghi LE, Duarte-Escalante E, et al. Identification of the infectious source of an unusual outbreak of histoplasmosis, in a hotel in Acapulco, state of Guerrero, Mexico. FEMS Immunol Med Microbiol. 2005;45:435-41. https://doi.org/10.1016/j.femsim.2005.05.017
Armstrong PA, Beard JD, Bonilla L, Arboleda N, Lindsley MD, Chae SR, et al. Outbreak of severe histoplasmosis among tunnel workers - Dominican Republic, 2015. Clin Infect Dis. 2018;66:1550-7. https://doi.org/10.1093/cid/cix1067
Ordóñez N, Tobón A, Arango M, Tabares A, De Bedout C, Gómez B, et al. Brotes de histoplasmosis registrados en el área andina colombiana. Biomédica. 1997;17:105-11. https://doi.org/10.7705/biomedica.v17i2.941
Jiménez RA, Urán ME, de Bedout C, Arango M, Tobón AM, Cano LE et al. Brote de histoplasmosis aguda en un grupo familiar: identificación de la fuente de infección. Biomédica. 2002;22:155-9. https://doi.org/10.7705/biomedica.v22i2.1154
Ramírez-Chaves HE, Mejía-Egas O, Zambrano G. Anotaciones sobre dieta, estado reproductivo, actividad y tamaño de colonia del murciélago mastín común (Molossus molossus: Molossidae) en la zona urbana de Popayán, Departamento del Cauca, Colombia. Chiropt Neotrop. 2008;14:384-90.
Di Mango Al, Zanetti G, Penha D, Menna Barreto M, Marchiori E. Endemic pulmonary fungal diseases in immunocompetent patients: An emphasis on thoracic imaging. Expert Rev Respir Med. 2019;13:263-77. https://doi.org/10.1080/17476348.2019.1571914
Tobón AM, Gómez BL. Pulmonary histoplasmosis. Mycopathologia. 2021;186:697-705. https://doi.org/10.1007/s11046-021-00588-4
Sousa C, Marchiori E, Youssef A, Mohammed TL, Patel P, Irion K, et al. Chest imaging in systemic endemic mycoses. J Fungi. 2022;8:1132. https://doi.org/10.3390/jof8111132
Butt AA, Michaels S, Greer D, Clark R, Kissinger P, Martin DH. Serum LDH level as a clue to the diagnosis of histoplasmosis. AIDS Read. 2002;12:317-21.
Kirn DH, Fredericks D, McCutchan JA, Stites D, Shuman M. Serum ferritin levels correlate with disease activity in patients with AIDS and disseminated histoplasmosis. Clin Infect Dis. 1995;21:1048-9. https://doi.org/10.1093/clinids/21.4.1048
Raggio B. Primary cutaneous histoplasmosis. Ear Nose Throat J. 2018;97:346-8. https://doi.org/10.1177/0145561318097010-1108
Batista JM, Martins MAP, Bertollo CM. Primary cutaneous histoplasmosis difficult to treat in immunocompetent patient: Case report and literature review. Einstein (Sao Paulo). 2021;19:eRC5488. https://doi.org/10.31744/einstein_journal/2021RC5488
Garza-Garza R, González-González SE, Ocampo-Candiani J. Manifestaciones cutáneas del VIH. Gaceta Med Méx. 2014;150(Supp.2):S194-221.
Gómez-Santana LV, Torre AC, Hernández BA, Volonteri VI, Laura B, Luis-Galimberti R. Mucocutaneous manifestations of infection by Histoplasma capsulatum in HIV-negative immunosuppressed patients. Actas Dermosifiliogr (Engl Ed). 2018;109:e27-32. https://doi.org/10.1016/j.adengl.2018.03.006
Bianchi MH, Santiso G, Lehmann E, Walker L, Arechavala A, Maiolo E et al. Utilidad del citodiagnóstico de Tzanck en un hospital de enfermedades infecciosas de la ciudad de Buenos Aires. Dermatol argent. 2012;18:42-6.
Gupta N, Arora SK, Rajwanshi A, Nijhawan R, Srinivasan R. Histoplasmosis: Cytodiagnosis and review of literature with special emphasis on differential diagnosis on cytomorphology. Cytopathology. 2010;21:240-4. https://doi.org/10.1111/j.1365-2303.2009.00693.x
Tkach AD, Moreno JD, Bava AJ. Diagnóstico presuntivo de histoplasmosis en un frotis sanguíneo. Acta Bioquim Clin Latinoam. 2012;46.
Toscanini MA, Nusblat AD, Cuestas ML. Diagnosis of histoplasmosis: Current status and perspectives. Appl Microbiol Biotechnol. 2021;105:1837-59. https://doi.org/10.1007/s00253-021-11170-9
Azar MM, Loyd JL, Relich RF, Wheat LJ, Hage CA. Current concepts in the epidemiology, diagnosis, and management of histoplasmosis syndromes. Semin Respir Crit Care Med. 2020;41:13-30. https://doi.org/10.1055/s-0039-1698429
Nacher M, Blanchet D, Bongomin F, Chakrabarti A, Couppié P, Demar M, et al. Histoplasma capsulatum antigen detection tests as an essential diagnostic tool for patients with advanced HIV disease in low and middle income countries: A systematic review of diagnostic accuracy studies. PLoS Negl Trop Dis. 2018;12:e0006802. https://doi.org/10.1371/journal.pntd.0006802
Falci DR, Monteiro AA, Braz Caurio CF, Magalhães TCO, Xavier MO, Basso RP, et al. Histoplasmosis, an underdiagnosed disease affecting people living with HIV/AIDS in Brazil: Results of a multicenter prospective cohort study using both classical mycology tests and histoplasma urine antigen detection. Open Forum Infect Dis. 2019;3:ofz073. https://doi.org/10.1093/ofid/ofz073
Ministerio de Salud y Protección Social de Colombia. Guía de práctica clínica basada en la evidencia científica para la atención de la infección por VIH/SIDA en personas adultas, gestantes y adolescentes. Guía para profesionales de la salud. Guía N° 39-2021. Fecha de consulta: 25 de octubre de 2022. Disponible en: https://www.minsalud.gov.co/sites/rid/Lists/BibliotecaDigital/RIDE/VS/PP/ET/gpc-vih-adultos-version-profesionales-salud.pdf
Cáceres DH, Gómez BL, Tobón ÁM, Minderman M, Bridges N, Chiller T, et al. Validation and concordance analysis of a new lateral flow assay for detection of Histoplasma antigen in urine. J Fungi. 2021;7:799. https://doi.org/10.3390/jof7100799
Vasconcellos ICDS, Dalla Lana DF, Pasqualotto AC. The role of molecular tests in the diagnosis of disseminated histoplasmosis. J Fungi (Basel). 2019;6:1. https://doi.org/10.3390/jof6010001
Organización Panamericana de la Salud y Organización Mundial de la Salud. Directrices para el diagnóstico y el manejo de la histoplasmosis diseminada en las personas con infección por el VIH. Washington, D.C.: OPS-OMS; 2020. Fecha de consulta: 3 de octubre del 2022. Disponible en: https://www.paho.org/es/node/71472
Huhn GD, Austin C, Carr M, Heyer D, Boudreau P, Gilbert G, et al. Two outbreaks of occupational acquired histoplasmosis: More than workers at risk. Environ Health Perspect. 2005;113:585-9. https://doi.org/10.1289/ehp.7484
Centers for Disease Control and Prevention (CDC). Biosafety in Microbiological and Biomedical Laboratories. 5th edition. 2009. Fecha de consulta: 5 de junio de 2022. Disponible en: https://www.cdc.gov/labs/pdf/CDC-BiosafetymicrobiologicalBiomedicalLaboratories-2009-P.pdf
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