scholarly journals Cytological Spectrum of Pulmonary Histoplasmosis Diagnosed by Bronchoalveolar Lavage: 12 Years of Experience in French Guiana

2021 ◽  
Vol 7 (7) ◽  
pp. 576
Author(s):  
Kinan Drak Alsibai ◽  
Houari Aissaoui ◽  
Antoine Adenis ◽  
Morgane Bourne-Watrin ◽  
Felix Djossou ◽  
...  
Keyword(s):  
Bronchoalveolar Lavage ◽  
Hot Spots ◽  
French Guiana ◽  
Histoplasma Capsulatum ◽  
Patient Characteristics ◽  
Years Of Experience ◽  
Hiv Patients ◽  
Pulmonary Histoplasmosis ◽  
Lymphocytic Infiltrates ◽  
Clustering Pattern

Disseminated histoplasmosis is a major cause of mortality in HIV-infected patients. Rapid and efficient diagnosis of Histoplasma capsulatum is crucial. Cytopathology is available in most hospitals and represents a rapid diagnostic alternative. In this study, we reviewed 12 years of experience to describe the cytology of histoplasmosis diagnosed by bronchoalveolar lavage (BAL) in relation to patient characteristics. BAL-diagnosed pulmonary histoplasmosis concerned 17 patients (14 HIV+). BAL cellularity ranged from 76,000 to 125,000 cells/mL in HIV patients, and 117,000 to 160,000 cells/mL in non-HIV patients. Macrophages predominated in all HIV patients (from 60% to 88%), lymphocytic infiltrates ranged from 5% to 15%, and neutrophils were very heterogeneous (from 2% to 32%). The number of H. capsulatum at hot spots seemed greater in HIV-infected than in immunocompetent patients (9 to 375 vs. 4 to 10) and were inversely proportional to the CD4 counts. Yeasts were both intracellular and extracellular in 85.7% of the HIV patients. This is the most comprehensive series detailing the cytological aspects of BAL in the diagnosis of H. capsulatum, focusing on the number of yeasts and their clustering pattern. The cytological examination of the Gomori-Grocott-stained BAL allows a reliable diagnosis of histoplasmosis.

scholarly journals Reintroduction of immunosuppressive medications in pediatric rheumatology patients with histoplasmosis: a case series

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Rachel A. Brown ◽  
Fatima Barbar-Smiley ◽  
Cagri Yildirim-Toruner ◽  
Monica I. Ardura ◽  
Stacy P. Ardoin ◽  
...  
Keyword(s):  
Rheumatic Disease ◽  
Lupus Erythematosus ◽  
Histoplasma Capsulatum ◽  
Case Series ◽  
Organ Damage ◽  
Necrosis Factor Alpha ◽  
Pulmonary Histoplasmosis ◽  
Immunosuppressive Medications ◽  
Biologic Dmard ◽  
Factor Alpha

Abstract Background Children with rheumatic diseases (cRD) receiving immunosuppressive medications (IM) are at a higher risk for acquiring potentially lethal pathogens, including Histoplasma capsulatum (histoplasmosis), a fungal infection that can lead to prolonged hospitalization, organ damage, and death. Withholding IM during serious infections is recommended yet poses risk of rheumatic disease flares. Conversely, reinitiating IM increases risk for infection recurrence. Tumor necrosis factor alpha inhibitor (TNFai) biologic therapy carries the highest risk for histoplasmosis infection after epidemiological exposure, so other IM are preferred during active histoplasmosis infection. There is limited guidance as to when and how IM can be reinitiated in cRD with histoplasmosis. This case series chronicles resumption of IM, including non-TNFai biologics, disease-modifying anti-rheumatic drugs (DMARDs), and corticosteroids, following histoplasmosis among cRD. Case presentation We examine clinical characteristics and outcomes of 9 patients with disseminated or pulmonary histoplasmosis and underlying rheumatic disease [juvenile idiopathic arthritis (JIA), childhood-onset systemic lupus erythematosus (cSLE), and mixed connective tissue disease (MCTD)] after reintroduction of IM. All DMARDs and biologics were halted at histoplasmosis diagnosis, except hydroxychloroquine (HCQ), and patients began antifungals. Following IM discontinuation, all patients required systemic or intra-articular steroids during histoplasmosis treatment, with 4/9 showing Cushingoid features. Four patients began new IM regimens [2 abatacept (ABA), 1 HCQ, and 1 methotrexate (MTX)] while still positive for histoplasmosis, with 3/4 (ABA, MTX, HCQ) later clearing their histoplasmosis and 1 (ABA) showing decreasing antigenemia. Collectively, 8/9 patients initiated or continued DMARDs and/or non-TNFai biologic use (5 ABA, 1 tocilizumab, 1 ustekinumab, 3 MTX, 4 HCQ, 1 leflunomide). No fatalities, exacerbations, or recurrences of histoplasmosis occurred during follow-up (median 33 months). Conclusions In our cohort of cRD, histoplasmosis course following reintroduction of non-TNFai IM was favorable, but additional studies are needed to evaluate optimal IM management during acute histoplasmosis and recovery. In this case series, non-TNFai biologic, DMARD, and steroid treatments did not appear to cause histoplasmosis recurrence. Adverse events from corticosteroid use were common. Further research is needed to implement guidelines for optimal use of non-TNFai (like ABA), DMARDs, and corticosteroids in cRD following histoplasmosis presentation.

Factors Associated with Geophagy and Knowledge About Its Harmful Effects Among Native Sub-Saharan African, Caribbean and French Guiana HIV Patients Living in Northern France

2016 ◽  
Vol 21 (12) ◽  
pp. 3630-3635 ◽  
Author(s):  
Isabelle Kmiec ◽  
Yohan Nguyen ◽  
Christine Rouger ◽  
Jean Luc Berger ◽  
Dorothée Lambert ◽  
...  
Keyword(s):  
French Guiana ◽  
Hiv Patients ◽  
Factors Associated ◽  
Northern France ◽  
African Caribbean ◽  
Sub Saharan ◽  
Harmful Effects

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 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.

scholarly journals Cytological and Histopathological Spectrum of Histoplasmosis: 15 Years of Experience in French Guiana

2020 ◽  
Vol 10 ◽  
Author(s):  
Kinan Drak Alsibai ◽  
Pierre Couppié ◽  
Denis Blanchet ◽  
Antoine Adenis ◽  
Loïc Epelboin ◽  
...  
Keyword(s):  
French Guiana ◽  
Years Of Experience

scholarly journals Acute Pulmonary Histoplasmosis Outbreak in A Documentary Film Crew Travelling from Guatemala to Australia

2019 ◽  
Vol 4 (1) ◽  
pp. 25 ◽  
Author(s):  
Stephen Muhi ◽  
Amy Crowe ◽  
John Daffy
Keyword(s):  
Medical Care ◽  
Documentary Film ◽  
Histoplasma Capsulatum ◽  
Febrile Illness ◽  
Acute Febrile Illness ◽  
Widespread Distribution ◽  
Endemic Mycosis ◽  
Pulmonary Histoplasmosis ◽  
Vampire Bats

Histoplasma capsulatum is an endemic mycosis with a widespread distribution, although it is infrequently reported in travellers. In April 2018, five television crew members developed an acute febrile illness after filming a documentary about vampire bats in Guatemala. Patients developed symptoms after travelling to Australia, where they presented for medical care.

scholarly journals Protective Efficacy of H Antigen fromHistoplasma capsulatum in a Murine Model of Pulmonary Histoplasmosis

2001 ◽  
Vol 69 (5) ◽  
pp. 3128-3134 ◽  
Author(s):  
George S. Deepe ◽  
Reta Gibbons
Keyword(s):  
Histoplasma Capsulatum ◽  
Protective Efficacy ◽  
Interleukin 10 ◽  
Interleukin 4 ◽  
Fungal Burden ◽  
Pulmonary Exposure ◽  
Pulmonary Histoplasmosis ◽  
Macrophage Colony Stimulating Factor ◽  
Macrophage Colony ◽  
Stimulating Factor

ABSTRACT We previously reported that immunization with H antigen fromHistoplasma capsulatum did not protect mice against an intravenous challenge with yeasts. Here, we investigated the utility of H antigen to protect mice in a model of pulmonary histoplasmosis. Mice immunized with H antigen and challenged intranasally 4 weeks postvaccination were protected against sublethal and lethal challenges with H. capsulatum yeasts. If the challenge was performed 3 months after vaccination, there was a reduction in fungal burden following sublethal challenge and a modest delay in mortality in mice given a lethal inoculum. Vaccination was associated with production of gamma interferon, granulocyte-macrophage colony-stimulating factor, interleukin-4, and interleukin-10 by splenocytes. Vaccination with H antigen was not accompanied by a major expansion of CD4+ or CD8+ cells in spleens of mice. These results demonstrate that H antigen may be useful as a protective immunogen against pulmonary exposure to H. capsulatum.

scholarly journals Ten years of experience with closure of persistent foramen ovale: Patient characteristics and outcomes

2014 ◽  
Vol 64 (2) ◽  
pp. 113-116 ◽  
Author(s):  
Ralf Lehmann ◽  
Stephan Fichtlscherer ◽  
Henrica Baldauf ◽  
Volker Schächinger ◽  
Wolfgang Auch-Schwelck ◽  
...  
Keyword(s):  
Patient Characteristics ◽  
Years Of Experience ◽  
Foramen Ovale ◽  
Persistent Foramen Ovale
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