HISTOPLASMIN SURVEY IN HIV-POSITIVE PATIENTS: RESULTS FROM AN ENDEMIC AREA IN NORTHEASTERN BRAZIL

SUMMARY Background. Disseminated histoplasmosis is common in AIDS patients with advanced immunosuppression in Ceará, Northeastern Brazil. The goal of this study was to determine the prevalence of Histoplasma infection in patients with HIV/AIDS living in Fortaleza, the capital of Ceará. Methods. Intradermal tests with histoplasmin (mycelial phase) were performed in 161 HIV patients with CD4 ≥ 350 cells/mm 3 . Evidence of recent illness was evaluated with immunodiffusion (ID) tests in 76 of these individuals. Results. A total of 11.8% of patients reacted to histoplasmin and 2.63% had ID test positive to Histoplasma. The presence of mango trees (Mangifera indica) in the patient neighborhood (OR = 2.870; 95% CI = 1.081-7.617; p = 0.040) and past activity involving soil (OR = 2.834; 95% CI = 1.045-7.687; p = 0.045) or visits to a farm (OR = 3.869; 95% CI = 1.189-12.591; p = 0.033) were significantly associated with Histoplasma infection. Conclusions. Patients with HIV living in Fortaleza have an expressive prevalence of infection with Histoplasma.RESUMO Introdução: Histoplasmose disseminada ocorre com grande frequência em pacientes com aids e imunossupressão avançada no Ceará, Brasil. O objetivo deste artigo é determinar a prevalência da infecção por Histoplasma em pacientes com HIV/aids residentes em Fortaleza capital. Métodos. Testes intradérmicos com histoplasmina (fase micelial), foram realizados em 161 pacientes com CD4 ≥ 350 células/mm 3 . Doença recente foi estudada por imunodifusão em 76 desses indivíduos. Resultados. Reagiram à histoplasmina, 11,8% dos pacientes e à imunodifusão para Histoplasma: 2,63%. A presença da árvore mangueira (Mangifera indica) na vizinhança (OR = 2,870; IC 95% = 1,081-7,617; p = 0,040), atividade com o solo no passado (OR = 2,834; IC 95% = 1,045-7,687, p = 0,045) e visitar sítio no passado (OR = 3,869; IC 95% = 1,189-12,591; p = 0,033); foram significativamente associados com positividade para o teste. Conclusões. Pacientes com HIV que vivem em Fortaleza apresentam uma prevalência expressiva de infecção por Histoplasma

Antiretroviral drugs saquinavir and ritonavir reduce inhibitory concentration values of itraconazole against Histoplasma capsulatum strains in vitro

Recent studies have shown that some drugs that are not routinely used to treat fungal infections have antifungal activity, such as protease inhibitor antiretroviral drugs. This study investigated the in vitro susceptibility of Histoplasma capsulatum var. capsulatum to saquinavir and ritonavir, and its combination with the antifungal itraconazole. The susceptibility assay was performed according to Clinical and Laboratory Standards Institute guidelines. All strains were inhibited by the protease inhibitor antiretroviral drugs. Saquinavir showed minimum inhibitory concentrations ranging from 0.125 to 1 mu g mL(-1) for both phases, and ritonavir presented minimum inhibitory concentrations ranging from 0.0312 to 4 mu g mL(-1) and from 0.0625 to 1 mu g mL(-1) for filamentous and yeast phase, respectively. Concerning the anti fungal itraconazole, the minimum inhibitory concentration values ranged from 0.0019 to 0.125 mu g mL(-1) and from 0.0039 to 0.0312 mu g mL(-1) for the filamentous and yeast phase, respectively. The combination of saquinavir or ritonavir with itraconazole was synergistic against H. capsulatum, with a significant reduction in the minimum inhibitory concentrations of both drugs against the strains (p < 0.05). These data show an important in vitro synergy between protease inhibitors and itraconazole against the fungus H. capsulatum. (C) 2016 Published by Elsevier Editora Ltda.CNPqCAPESUniv Fed Ceara, Postgrad Program Med Microbiol, Specialized Med Mycol Ctr, Fortaleza, CE, BrazilUniv Fed Ceara, Postgrad Program Med Sci, Fortaleza, CE, BrazilUniv Estadual Ceara UECE, Postgrad Program Vet Sci, Fortaleza, CE, BrazilUniv Fed Ceara, Dept Stat & Appl Math, Fortaleza, CE, BrazilUniv Fed Sao Paulo UNIFESP, Dept Microbiol Immunol & Parasitol, Sao Paulo, SP, BrazilHosp Sao Jose, Fortaleza, CE, BrazilUniv Fed Sao Paulo UNIFESP, Dept Microbiol Immunol & Parasitol, Sao Paulo, SP, BrazilCNPq: 303396/2014-8CNPq: 552161/2011-0CAPES: AE1 - 0052-000630100/11Web of Scienc

Coccidioidomycosis and Histoplasmosis in Equines: An Overview to Support the Accurate Diagnosis

Fungal infections of the respiratory tract of horses are not as frequent as those of bacterial and viral origin, often leading to worsening of clinical conditions due to misdiagnosis and incorrect treatment. Coccidioidomycosis and histoplasmosis are systemic mycoses caused by the dimorphic fungi Coccidioides spp. and Histoplasma capsulatum, respectively, which affect humans and a variety of other animals, including equines. These systemic mycoses of chronic and progressive nature can exhibit clinical manifestations similar to other microbial infections. Thus, this article broadly discusses the epidemiology, etiology, virulence, pathogenesis, clinical presentation, treatment, and diagnostic strategies of coccidioidomycosis and histoplasmosis, to support accurate diagnosis. (C) 2016 Elsevier Inc. All rights reserved.National Scientific and Technological Research CouncilBrazil (CNPq)Univ Fed Ceara, Postgrad Program Med Microbiol, Specialized Med Mycol Ctr, Dept Pathol & Legal Med,Sch Med, BR-60430275 Fortaleza, Ceara, BrazilUniv Estadual Ceara, Postgrad Program Vet Sci, Sch Vet, Fortaleza, Ceara, BrazilUniv Fed Sao Paulo, Dept Microbiol Immunol & Parasitol, Sao Paulo, BrazilUniv Fed Sao Paulo, Dept Microbiol Immunol & Parasitol, Sao Paulo, BrazilCNPq: 445670/2014-2CNPq: 552161/2011-0Web of Scienc

In vitro susceptibility of antifungal drugs against Sporothrix brasiliensis recovered from cats with sporotrichosis in Brazil

Sporotrichosis is an important subcutaneous mycosis of humans and animals. Classically, the disease is acquired upon traumatic inoculation of Sporothrix propagules from contaminated soil and plant debris. In addition, the direct horizontal transmission of Sporothrix among animals and the resulting zoonotic infection in humans highlight an alternative and efficient rout of transmission through biting and scratching. Sporothrix brasiliensis is themost virulent species of the Sporothrix schenckii complex and is responsible for the long-lasting outbreak of feline sporotrichosis in Brazil. However, antifungal susceptibility data of animal-borne isolates is scarce. Therefore, this study evaluated the in vitro activity of amphotericin B, caspofungin, itraconazole, voriconazole, fluconazole, and ketoconazole against animal-borne isolates of S. brasiliensis. The susceptibility tests were performed through broth microdilution (M38-A2). The results show the relevant activity of itraconazole, amphotericin B, and ketoconazole against S. brasiliensis, with the following MIC ranges: 0.125-2, 0.125-4 and 0.0312-2 mu g/ml, respectively. Caspofungin was moderately effective, displaying higher variation in MIC values (0.25-64 mu g/ml). Voriconazole (2-64 mu g/ml) and fluconazole (62.5-500 mu g/ml) showed low activity against S. brasiliensis strains. This study contributed to the characterization of the in vitro antifungal susceptibility of strains of S. brasiliensis recovered from cats with sporotrichosis, which have recently been considered the main source of human infections.Sao Paulo Research Foundation (FAPESP)National Council for Scientific and Technological Development (CNPq 304779/20113)Coordenacao de Aperfeicoamento de Pessoal de Nivel Superior (CAPES)Programa Estrategico de Apoio a Pesquisa em Saude VI - Fiocruz/CNPqFundacao Carlos Chagas Filho de Amparo a Pesquisa do Estado do Rio de Janeiro (FAPERJ)Univ Fed Ceara, Specialized Med Mycol Ctr, Postgrad Program Med Microbiol, Fortaleza, Ceara, BrazilUniv Fed Sao Paulo, Dept Microbiol Immunol & Parasitol, Cellular Biol Div, Sao Paulo, BrazilFundacao Oswaldo Cruz, Evandro Chagas Natl Inst Infect Dis, Rio De Janeiro, BrazilUniv Fed Sao Paulo, Dept Microbiol Immunol & Parasitol, Cellular Biol Div, Sao Paulo, BrazilFAPESP: 2011/07350-1FAPESP: 2009/54024-2CNPq: 304779/20113CAPES: AE1-0052-000650100/11Fiocruz/CNPq: 407771/2013-3FAPERJ: E-26/102.255/2013Web of Scienc