Short Report: Serum Aspergillus Galactomannan for the Management of Disseminated Histoplasmosis in AIDS

Service des Maladies Infectieuses et Tropicales, Centre d'Infectiologie Necker - Pasteur, Paris, France.
The American journal of tropical medicine and hygiene (Impact Factor: 2.7). 08/2012; 87(2):303-5. DOI: 10.4269/ajtmh.2012.12-0119
Source: PubMed


Disseminated histoplasmosis is an emerging infection in patients with cellular immune deficiency in non-endemic countries, caused by the migration from endemic regions and the development of travels. Diagnosis can be challenging in this context because rapid diagnostic tools such as Histoplasma antigen detection or appropriate molecular tools are generally unavailable, serology is often negative in immunosuppressed patients, and isolation of the fungus from cultures often takes several weeks. Here, we report the contribution of galactomannan serum detection for the management of an HIV-infected patient with disseminated histoplasmosis.

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    • "The evaluation of treatment efficacy with the regular monitoring of serum and urine Histoplama antigen concentrations using MVista Histoplasma antigen EIA is only available and recommended in the USA [76, 83]. For countries where this test is not available, under some conditions, notably the knowledge of the local epidemiology of cross-reacting fungal infections, certain authors consider the use of the Platelia Aspergillus EIA (BioRad) to monitor the therapeutic efficacy of antifungals [68, 71]. "
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    ABSTRACT: Histoplasma capsulatum is responsible for histoplasmosis, a fungal disease with worldwide distribution that can affect both immunocompromised and imunocompetent individuals. During the highly active antiretroviral therapy (HAART) era, morbidity and mortality due to histoplasmosis remained a public heatlh problem in low-income and high-income countries. The true burden of HIV-associated histoplasmosis is either not fully known or neglected since it is not a notifiable disease. Progress has been made in DNA patterns of strains and understanding of pathogenesis, and hopefully these will help identify new therapeutic targets. Unfortunately, histoplasmosis is still widely mistaken for multidrug-resistant tuberculosis, leading to numerous avoidable deaths, even if they are easily distinguishable. The new diagnostic tools and therapeutics developments have still not been made available in most endemic regions. Still, recent developments are promising because of their good clinical characteristics and also because they will be commercially available and affordable. This review of published data and gaps may help define and guide future research.
    03/2014; 1(2):119-128. DOI:10.1007/s40475-014-0017-8
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    • ". The cross-reactivity of Aspergillus GM assay has been observed in the management of a patient with histoplasmosis and some authors have suggested the Aspergillus GM assay may have utility as an adjunctive test for the diagnosis of histoplasmosis when other non-invasive tests are unavailable [20] [21]. Table 1 enlists reported evidence of cross-reactivity of Platelias Aspergillus GM assay in immunocompromised patients with culture-proven histoplasmosis . "
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    ABSTRACT: Non-invasive assays are increasingly being used in patients with suspected fungal infections. Limitations to these tests include limited sensitivity, specificity, and cross reactivity with other fungal pathogens. Herein we report a case of disseminated histoplasmosis producing a false positive serum and bronchoalveolar lavage (BAL) Aspergillus galactomannan assays. This test may have a role in the evaluation of patients with suspected histoplasmosis in settings where Histoplasma antigen testing is not widely available.
    Medical Mycology Case Reports 12/2012; 1(1):119–122. DOI:10.1016/j.mmcr.2012.10.009
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    ABSTRACT: International travel is increasing. As fungal infections associated with travel are rare diseases, they are often underestimated and misdiagnosed. Thus, updated knowledge in this area is of key importance for physicians not only for pretravel counselling but also for the management of patients upon their return. We present an update of data published in 2012 and 2013. We present an overview of epidemiological changes, especially new endemic areas, and the implications of climate and natural disasters. Through experimental and clinical data, new insights into the pathophysiology of fungal infections associated with travel have been obtained, especially for Cryptococcus spp. Recently published diagnostic tools could lead to faster and more accurate diagnosis. Lastly, recent prognostic and therapeutic data are emphasized.
    Current Fungal Infection Reports 12/2013; 7(4). DOI:10.1007/s12281-013-0151-0
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