A Case of Disseminated Histoplasmosis Detected in Peripheral Blood Smear Staining Revealing AIDS at Terminal Phase in a Female Patient from Cameroon

Histoplasmosis is endemic in the American continent and also in Sub-Saharan Africa, coexisting with the African histoplasmosis. Immunosuppressed patients, especially those with advanced HIV infection develop a severe disseminated histoplasmosis with fatal prognosis. The definitive diagnosis of disseminated histoplasmosis is based on the detection of Histoplasma capsulatum from patient’ tissues samples or body fluids. Among the diagnostic tests peripheral blood smear staining is not commonly used. Nonetheless a few publications reveal that Histoplasma capsulatum has been discovered by chance using this method in HIV infected patients with chronic fever and hence revealed AIDS at the terminal phase. We report a new case detected in a Cameroonian woman without any previous history of HIV infection. Peripheral blood smear staining should be commonly used for the diagnosis of disseminated histoplasmosis in the Sub-Saharan Africa, where facilities for mycology laboratories are unavailable

The burden of serious fungal infections in Cameroon

Fungal infections are frequent in Cameroon, and invasive fungal infections are sometimes detected, usually in HIV-infected patients. For these reasons, we have estimated the burden of fungal infections. Using published literature and population estimates for the at-risk group, we used deterministic modelling to derive national incidence and prevalence estimates for the most serious fungal diseases. HIV infection is common and an estimated 120,000 have CD4 counts <200 × 106/mL and commonly present with opportunistic infection. Oesophageal candidiasis in HIV is common, and in poorly controlled diabetics. We estimate 6720 cases of cryptococcal meningitis, 9000 of Pneumocystis pneumonia, 1800 of disseminated histoplasmosis annually complicating AIDS, and 1200 deaths from invasive aspergillosis in AIDS, but there are no data. We found that 2.4% of adults have chronic obstructive pulmonary disease (COPD) and 2.65% have asthma, with “fungal asthma” affecting 20,000. Chronic pulmonary aspergillosis probably affects about 5000 people, predominantly after tuberculosis but also with COPD and other lung diseases. Also, tinea capitis in schoolchildren is frequent. Overall, an estimated 1,236,332 people are affected by a serious fungal infection. There is an urgent need for government and clinician attention, improved laboratory facilities, fungal diagnostic tests, and competent laboratory technicians, as well as all World Health Organization (WHO)-endorsed essential antifungal drugs to be made available, as only fluconazole is registered and available in the country

C5 - Fabrication d’une crème à base de l’extrait hydro-éthanolique des feuilles de Terminalia glaucescens (combretaceae) et évaluation in vivo de l’activité antimycosique

Introduction : Les mycoses superficielles cutanées sont relativement fréquentes et la chimiorésistance aux antifongiques chimiques incite à rechercher de nouveaux médicaments. Terminalia glaucescens est une plante réputée en médecine traditionnelle comme active sur les micro-organismes pathogènes. Une crème à base d’un extrait de la plante a été fabriquée puis évaluée sur le plan clinique. Méthodologie : Un extrait hydro-éthanolique a été préparé à partir des feuilles. Ensuite, une crème lipophile/hydrophile contenant 2,88 % de l’extrait a été préparée. Les contrôles de qualité physico- chimiques et pharmaco-techniques ont été réalisés à savoir : le sens de l’émulsion, l’homogénéité, la stabilité, la qualité microbiologique, la rhéologie et le dosage des polyphénols totaux. Enfin, sous la supervision d’une praticienne dermatologue, une évaluation clinique a été réalisée sur 83 volontaires dont : 10 pour l’évaluation de la tolérance et de l’acceptabilité de la crème, 4 cas de dermatophytie de la peau glabre, 68 cas de teignes tondantes et 1 cas de dartre. Résultats : L’extrait hydro-éthanolique contient des polyphénols totaux à hauteur de 349,92 ± 0,002 mg EAG/g. La crème fabriquée (3 lots de 500 g et 2 lots de 1 kg) a présenté une tolérance cutanée satisfaisante. Les contrôles de qualité physico-chimiques et pharmaco-techniques habituels sont conformes. Le produit fini dénommé Makodermâ cream s’est avéré efficace pour le traitement des dermatophyties de la peau glabre (100 %), sur les teignes (75 %), mais pas sur le cas de dartre. La comparaison a été réalisée avec le Kétoconazole cream 2%, efficace sur la dermatophytie de la peau glabre (100 %) mais pas sur les teignes. Conclusion : Dans les limites de notre étude, la crème de Terminalia glaucescens, Makodermâ cream, s’est avérée plus efficace que Kétoconazole cream 2% sur les teignes. Ces résultats permettent de positionner ce potentiel médicament traditionnel amélioré comme une alternative thérapeutique dans la prise en charge des teignes

Histoplasmosis overlapping with HIV and tuberculosis in sub-Saharan Africa: challenges and research priorities

Histoplasmosis, tuberculosis and HIV are all highly prevalent in sub-Saharan Africa (SSA). Co-occurrence of two or more of these infections has been reported in several populations of patients, especially those with advanced HIV infection where these opportunistic infections contribute to a significant morbidity and mortality. With a high burden of pulmonary tuberculosis (PTB) secondary to HIV in SSA, histoplasmosis is commonly misdiagnosed as smear-negative PTB in HIV patients due to similar clinical and radiological presentations. This is also partly the result of the lack of trained clinical and laboratory personnel to make a definite diagnosis of histoplasmosis. There is a low index of clinical suspicion for histoplasmosis, and cases are mostly discovered accidently and documented through case reports and case series. Similarly, the high cost and lack of fungal diagnostics in most SSA countries makes it difficult to make a diagnosis. There is a need to build local capacity for mycology so that patients are managed to improve on the index of clinical suspicion and diagnostic capabilities. Moreover, simple accurate point-of-care diagnostic tests and first-line antifungal treatment for histoplasmosis are not available in many SSA countries. This review describes the existence of co-infections of histoplasmosis, tuberculosis and HIV in SSA, highlighting the challenges and research priorities

Screening for acute disseminated histoplasmosis in HIV disease using urinary antigen detection enzyme immunoassay:A pilot study in Cameroon

Acute disseminated histoplasmosis (ADH) is an AIDS-defining illness and reported in Cameroon, but there are few data about its incidence. Between June and August 2019, we conducted a descriptive cross-sectional study to screen for histoplasmosis in a population of adults with HIV infection, irrespective of their CD4 T-cell counts, using Histoplasma urine antigen detection enzyme immunoassay (EIA) and histoplasmin skin test. Of the 138 participants screened, 36 (26%) had detectable antigen in urine, using an OD cut off of 0.045. Skin lesions were present in two (6%) cases. Of 39 patients tested for histoplasmin skin test positivity, one was positive. Histoplasma antigenuria was associated with a positive history of chest infection (Odds ratio: 3.632, 95% confidence interval: 1.635-8.071, p= 0.001). As 30 (21.7%) of titres were between 0.045 (the current cut off) and 0.25, the cut off may need adjustment in Cameroon, using disease confirmation with alternative, highly sensitive diagnostic approaches such as PCR and bone marrow examination. H. capsulatum infection appears to be common among HIV-infected patients attending outpatient clinics at the Buea Regional Hospital. There is an acute need to improve awareness and management of HIV patients with respect to H. capsulatum infection.</p

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.

IntroductionDisseminated histoplasmosis, a disease that often resembles and is mistaken for tuberculosis, is a major cause of death in patients with advanced HIV disease. Histoplasma antigen detection tests are an important addition to the diagnostic arsenal for patients with advanced HIV disease and should be considered for inclusion on the World Health Organization Essential Diagnostics List.ObjectiveOur objective was to systematically review the literature to evaluate the diagnostic accuracy of Histoplasma antigen tests in the context of advanced HIV disease, with a focus on low- and middle-income countries.MethodsA systematic review of the published literature extracted data on comparator groups, type of histoplasmosis, HIV status, performance results, patient numbers, whether patients were consecutively enrolled or if the study used biobank samples. PubMed, Scopus, Lilacs and Scielo databases were searched for published articles between 1981 and 2018. There was no language restriction.ResultsOf 1327 screened abstracts we included a total of 16 studies in humans for further analysis. Most studies included used a heterogeneousgroup of patients, often without HIV or mixing HIV and non HIV patients, with disseminated or non-disseminated forms of histoplasmosis. Six studies did not systematically use mycologically confirmed cases as a gold standard but compared antigen detection tests against another antigen detection test. Patient numbers were generally small (19-65) in individual studies and, in most (7/10), no confidence intervals were given. The post test probability of a positive or negative test were good suggesting that this non invasive diagnostic tool would be very useful for HIV care givers at the level of reference hospitals or hospitals with the infrastructure to perform ELISA tests. The first results evaluating point of care antigen detection tests using a lateral flow assay were promising with high sensitivity and specificity.ConclusionsAntigen detection tests are promising tools to improve detection of and ultimately reduce the burden of histoplasmosis mortality in patients with advanced HIV disease

Diagnostic capacity for cutaneous fungal diseases in the African continent

BACKGROUND: Cutaneous fungal infections are very common, especially in poorer communities and with intercurrent HIV infection. Determining the fungal pathogen in skin-related fungal neglected tropical diseases (NTDs) determines optimal therapy. We undertook a country survey across many African countries to determine the diagnostic capacity for skin fungal diseases.METHODS: A detailed questionnaire was delivered to country contacts to collect data on availability, frequency, and location of testing for key diagnostic procedures and followed up with 2 rounds of validation by video call and by confirmation of individual country data confirmation by email.RESULTS: Of 47 countries with data, seven (15%) and 21 (45%) do not offer skin biopsy in the public or private sector, respectively, but 22 (46%) countries do it regularly, mostly in university hospitals. Direct microscopy is often performed in 20 of 48 (42%) countries in the public sector and not done in 10 (21%). Fungal cultures are often performed in 21 of 48 (44%) countries in the public sector but not done in nine (20%) or 21 (44%) in either public or private facilities. Histopathological examination of tissue is frequently used in 19 of 48 (40%) countries but not in nine (20%) countries in the public sector. The cost of diagnostics to patients was a major limiting factor in usage.CONCLUSION: Major improvements in the availability and use of diagnostic tests for skin, hair, and nail fungal disease are urgently needed across Africa.</p