scholarly journals The Broad Clinical Spectrum of Disseminated Histoplasmosis in HIV-Infected Patients: A 30 Years’ Experience in French Guiana

2019 ◽  
Vol 5 (4) ◽  
pp. 115 ◽  
Author(s):  
Pierre Couppié ◽  
Katarina Herceg ◽  
Morgane Bourne-Watrin ◽  
Vincent Thomas ◽  
Denis Blanchet ◽  
...  
Keyword(s):  
French Guiana ◽  
Histoplasma Capsulatum ◽  
Opportunistic Infections ◽  
Clinical Findings ◽  
Diagnostic Methods ◽  
Medical Mycology ◽  
Time To Initiation ◽  
Level 3 ◽  
Endemic Areas ◽  
Biosafety Level

Histoplasmosis is a common but neglected AIDS-defining condition in endemic areas for Histoplasma capsulatum. At the advanced stage of HIV infection, the broad spectrum of clinical features may mimic other frequent opportunistic infections such as tuberculosis and makes it difficult for clinicians to diagnose histoplasmosis in a timely manner. Diagnosis of histoplasmosis is difficult and relies on a high index of clinical suspicion along with access to medical mycology facilities with the capacity to implement conventional diagnostic methods (direct examination and culture) in a biosafety level 3 laboratory as well as indirect diagnostic methods (molecular biology, antibody, and antigen detection tools in tissue and body fluids). Time to initiation of effective antifungals has an impact on the patient’s prognosis. The initiation of empirical antifungal treatment should be considered in endemic areas for Histoplasma capsulatum and HIV. Here, we report on 30 years of experience in managing HIV-associated histoplasmosis based on a synthesis of clinical findings in French Guiana with considerations regarding the difficulties in determining its differential diagnosis with other opportunistic infections.

Endemic dimorphic fungi

2017 ◽  
Author(s):  
Angela Restrepo ◽  
Angel A. Gónzalez ◽  
Beatriz L. Gómez
Keyword(s):  
Histoplasma Capsulatum ◽  
Paracoccidioides Brasiliensis ◽  
Fungal Spores ◽  
Coccidioides Immitis ◽  
Dimorphic Fungi ◽  
Clinical Presentations ◽  
Causative Agents ◽  
Risk Patients ◽  
Level 3 ◽  
Biosafety Level

Endemic dimorphic infections are acquired by inhalation of fungal spores which undergo a thermal transition to a yeast-like phase in the host. The causative organisms are geographically restricted and are isolated from the environment; likewise, the infections are associated with people living in, or visiting, these endemic regions. The clinical presentations range from asymptomatic to chronic, and disseminated, depending on the host immune status and other risk factors. The infections and their causative agents are: histoplasmosis (Histoplasma capsulatum), paracoccidioidomycosis (Paracoccidioides brasiliensis/lutzii), blastomycosis (Blastomyces dermatitidis/gilchristii), coccidioidomycosis (Coccidioides immitis/posadasii), talaromycosis (previously penicilliosis; Talaromyces [Penicillium] marneffei), and emmonsiosis (Emmonsia species). Diagnosis relies on microscopy and culture, histology, and immunological detection. Owing to their infectious nature, all of these organisms must be handled using biosafety level-3 containment. Treatment is based around azole administration, usually itraconazole, with amphotericin B for the more severe forms or for the most at risk patients.

scholarly journals Echinococcosis of the spine

2021 ◽  
Vol 6 (4) ◽  
pp. 288-296
Author(s):  
Spyridon Sioutis ◽  
Lampros Reppas ◽  
Achilles Bekos ◽  
Eleftheria Soulioti ◽  
Theodosis Saranteas ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Treatment Options ◽  
Current Treatment ◽  
Clinical Findings ◽  
Diagnostic Methods ◽  
Spinal Stabilization ◽  
Cyst Excision ◽  
Endemic Areas ◽  
Spinal Cord Decompression ◽  
Infection Of The Spine

Echinococcosis or hydatid disease affecting the spine is an uncommon manifestation of Echinococcus granulosus infection of the spine. More commonly found in endemic areas, it causes significant morbidity and mortality as it grows slowly and produces symptoms mainly by compressing the spinal cord. As diagnostic methods are non-specific, diagnosis and management are usually delayed until the disease is advanced, thereby therapy is usually unlikely. Treatment is usually surgical, aiming at cyst excision, spinal cord decompression and spinal stabilization. This article summarizes the clinical findings of echinococcosis of the spine, discusses the specific laboratory and diagnostic findings, lists the current treatment options, and reviews the patients’ outcomes. The aim is to prompt clinicians to be aware of the possibility of echinococcosis as a possible diagnosis in endemic areas. Cite this article: EFORT Open Rev 2021;6:288-296. DOI: 10.1302/2058-5241.6.200130

scholarly journals What is AIDS in the Amazon and the Guianas in the 90-90-90 era?

2020 ◽  
Author(s):  
Mathieu Nacher ◽  
Antoine Adenis ◽  
Basma Guarmit ◽  
Aude Lucarelli ◽  
Denis Blanchet ◽  
...  
Keyword(s):  
Antiretroviral Therapy ◽  
Opportunistic Infection ◽  
French Guiana ◽  
Opportunistic Infections ◽  
Early Death ◽  
Diagnostic Methods ◽  
Cerebral Toxoplasmosis ◽  
Sharp Decline ◽  
Systematic Screening ◽  
The Past

IntroductionIn the past decade, new diagnostic methods and strategies have appeared, HIV testing efforts and the generalization of antiretroviral therapy may have influenced the number of opportunistic diagnoses and mortality of HIV-infected patients. To test this hypothesis we compiled data on the top opportunistic infections and causes of early death in the HIV cohort of French Guiana.MethodsHIV-infected persons followed in Cayenne, Kourou, and Saint Laurent du Maroni hospitals from 2010 to 2019 were studied. The annual incidence of different opportunistic infections and annual deaths were compiled. For patients with opportunistic infections we calculated the proportion of early deaths.ResultsAt the time of analysis, among 2 459 patients, (treated and untreated) 90% had a viral load <400 copies, 91% of the patients in the cohort were on antiretroviral treatment, and 94.2% of patients on treatment for over 6 months had undetectable viral loads. Only 9% of patients had CD4 counts under 200 per mm3. Disseminated histoplasmosis clearly remained the most frequent (128 cases) opportunistic infection among HIV-infected persons followed by cerebral toxoplasmosis (63 cases) and esophageal candidiasis (41 cases). Cryptococcal meningitis was ranked 5th most frequent opportunistic infection as was tuberculosis (31 cases). The trend for a sharp decline in early deaths continued (3.9% of patients).ConclusionsDespite the successes of antiretrovirals, patients presenting with advanced HIV are still common and they are still at risk of dying. Improved diagnosis, and notably systematic screening with appropriate tools are still important areas of potential progress.Author summaryIn the past decade, new diagnostic methods and strategies have appeared, HIV testing efforts and the generalization of antiretroviral therapy may have influenced the number of opportunistic diagnoses and mortality of HIV-infected patients. To test this hypothesis we compiled data on the top opportunistic infections and causes of early death in the HIV cohort of French Guiana. HIV-infected persons followed in Cayenne, Kourou, and Saint Laurent du Maroni hospitals from 2010 to 2019 were studied. The annual number of different opportunistic infections and annual deaths were compiled. For patients with opportunistic infections we calculated the proportion of early deaths. At the time of analysis, most patients were virologically controlled and had restored immunity. However, histoplasmosis clearly remained the most frequent (128 cases) opportunistic infection among HIV-infected persons followed by cerebral toxoplasmosis (63 cases) and esophageal candidiasis (41 cases). Cryptococcal meningitis was ranked 5th most frequent opportunistic infection as was tuberculosis (31 cases). The trend for a sharp decline in early deaths continued (3.9% of patients). Despite the successes of antiretroviral therapy, patients presenting with advanced HIV are still common and they are still at risk of dying. Improved diagnosis, and notably systematic screening with appropriate tools are still important areas of potential progress.

scholarly journals Point of Care Diagnostics in the Age of COVID-19

Diagnostics ◽  
2020 ◽  
Vol 11 (1) ◽  
pp. 9
Author(s):  
Meysam Rezaei ◽  
Sajad Razavi Bazaz ◽  
Sareh Zhand ◽  
Nima Sayyadi ◽  
Dayong Jin ◽  
...  
Keyword(s):  
Point Of Care ◽  
Diagnostic Methods ◽  
Global Public Health ◽  
Current Standard ◽  
Healthcare Facilities ◽  
Major Threat ◽  
Point Of Care Diagnostics ◽  
Recent Outbreak ◽  
Control Virus ◽  
Biosafety Level

The recent outbreak of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and its associated serious respiratory disease, coronavirus disease 2019 (COVID-19), poses a major threat to global public health. Owing to the lack of vaccine and effective treatments, many countries have been overwhelmed with an exponential spread of the virus and surge in the number of confirmed COVID-19 cases. Current standard diagnostic methods are inadequate for widespread testing as they suffer from prolonged turn-around times (>12 h) and mostly rely on high-biosafety-level laboratories and well-trained technicians. Point-of-care (POC) tests have the potential to vastly improve healthcare in several ways, ranging from enabling earlier detection and easier monitoring of disease to reaching remote populations. In recent years, the field of POC diagnostics has improved markedly with the advent of micro- and nanotechnologies. Due to the COVID-19 pandemic, POC technologies have been rapidly innovated to address key limitations faced in existing standard diagnostic methods. This review summarizes and compares the latest available POC immunoassay, nucleic acid-based and clustered regularly interspaced short palindromic repeats- (CRISPR)-mediated tests for SARS-CoV-2 detection that we anticipate aiding healthcare facilities to control virus infection and prevent subsequent spread.

scholarly journals Surgical Approach to Splenic Hydatid Cyst: Single Center Experience

2013 ◽  
Vol 98 (4) ◽  
pp. 346-353 ◽  
Author(s):  
Cengiz Eris ◽  
Sami Akbulut ◽  
Mehmet Kamil Yildiz ◽  
Hasan Abuoglu ◽  
Mehmet Odabasi ◽  
...  
Keyword(s):  
Hydatid Cyst ◽  
Surgical Approach ◽  
Treatment Options ◽  
Clinical Findings ◽  
Partial Cystectomy ◽  
Diagnostic Methods ◽  
Septic Complications ◽  
Single Center Experience ◽  
Medicinal Treatment ◽  
Splenic Hydatid Cyst

Abstract The benefits and risks of surgery for splenic hydatid cyst (SHC) remain controversial. We aimed to share our experience about a surgical approach for SHC. Sixteen consecutive patients with SHC disease who underwent open splenectomy at our hospital between January 2006 and July 2012 were retrospectively evaluated. Data on the patients' demographic features, clinical findings, radiological and serological diagnostic methods, and surgical and medicinal treatment options were collected and used to generate descriptive profiles of diagnosis, treatment course, and outcome. The patient population was composed of 6 females and 10 males, with an age range of 18 to 79 years (mean age: 47.0 ± 18.0). Radiological examinations detected hydatid cysts in spleen alone (n = 7) or both spleen and liver (n = 9). Preoperative serological testing identified 13 of the patients as IHA positive. All except 1 patient received a 10- to 21-day preoperative course of albendazole therapy and all patients received vaccination 1 week prior to surgery. Seven patients underwent splenectomy. The remaining patients underwent splenectomy with partial cystectomy and omentopexy (n = 6), partial cystectomy and unroofing (n = 1), pericystectomy (n = 1), or pericystectomy with partial nephrectomy (n = 1). All except one patient received a 10- to 45-day postoperative course of albendazole. No patients developed serious complications or signs of recurrence during the follow-up. The clinical profile of SHC disease at our hospital includes diagnosis by radiological methods, splenectomy treatment by simple or concomitant procedures according to the patient's symptoms, cyst size, number and localization, and compression of adjacent organs, and adjunct vaccination to decrease risk of postoperative septic complications. This profile is associated with low risk of complications and high therapeutic efficacy.

AIDS-related Histoplasma capsulatum var. capsulatum infection: 25 years experience of French Guiana

AIDS ◽  
2008 ◽  
Vol 22 (9) ◽  
pp. 1047-1053 ◽  
Author(s):  
Florence Huber ◽  
Matthieu Nacher ◽  
Christine Aznar ◽  
Magalie Pierre-Demar ◽  
Myriam El Guedj ◽  
...  
Keyword(s):  
French Guiana ◽  
Histoplasma Capsulatum

scholarly journals Network Experiences from a Cross-Sector Biosafety Level-3 Laboratory Collaboration: A Swedish Forum for Biopreparedness Diagnostics

2017 ◽  
Vol 15 (4) ◽  
pp. 384-391 ◽  
Author(s):  
Johanna Thelaus ◽  
Anna Lindberg ◽  
Susanne Thisted Lambertz ◽  
Mona Byström ◽  
Mats Forsman ◽  
...  
Keyword(s):  
Level 3 ◽  
Biosafety Level

scholarly journals Evaluation of Children's Appendicitis Score Compared With Pediatric Appendicitis Score in Diagnosis of Pediatric Appendicitis

2020 ◽  
Author(s):  
Mohammad Khaasteh ◽  
Fariba Heidari ◽  
Akram Motamedi ◽  
Kafieh Aslani ◽  
Masoud Jamshidi ◽  
...  
Keyword(s):  
Acute Appendicitis ◽  
Clinical Findings ◽  
Diagnostic Methods ◽  
Diagnostic Tools ◽  
Diagnostic Challenge ◽  
Diagnostic Features ◽  
Surgical Field ◽  
Us Findings ◽  
Pathology Reports ◽  
Appendicitis Score

Introduction: Identification and promotion of diagnostic methods has been a continuous effort to reduce disease and its complications and reduce costs associated with treatment. Despite all these efforts and improving our knowledge of diseases and diagnostic tools, pediatric appendicitis remains part of the diagnostic challenge in the surgical field. The aim of this is to compare the two diagnostic criteria of appendicitis (Children's Appendicitis Score [PAS] Versus Pediatric Appendicitis Score [CAS]) and evaluation of the diagnostic features of them. Methods: A retrospective cohort study was conducted on all children admitted to the hospital's emergency center with a possible diagnosis of appendicitis (270 patients) during 2018 and 2019 at Tabriz Pediatric Hospital. Based on the clinical examinations and para-clinical findings some of the patients were underwent the surgical intervention (220 cases) and some discharged and followed up for a period of 2 and 4 weeks later (50 cases). The data were analyzed through SPSS ver. 16 software. Results: The results of the present study indicated that if CAS was associated with ultrasound, the specificity of these criteria would improve and could be more acceptable compared with the PAS. In addition, it was revealed that WBC≥11000, as well as PMN≥65% and guarding were very specific for diagnosis and complication of acute appendicitis. There was a significant relationship between US findings and pathology reports (P<0.05). Conclusion: In conclusion, the CAS criteria were more sensitive and the PAS was more specific in diagnosing pediatric acute appendicitis.

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