A Rapid Screening Program for Histoplasmosis, Tuberculosis, and Cryptococcosis Reduces Mortality in HIV Patients from Guatemala

Medina, Narda; Alastruey‐Izquierdo, Ana; Bonilla, Oscar; Gamboa, Osmar; Mercado, Danicela; Pérez, Juan Carlos Domínguez; Salazar, Luis Roberto; Arathoon, Eduardo; Denning, David W.; Rodríguez-Tudela, Juan Luis

doi:10.3390/jof7040268

Cited by 28 publications

(36 citation statements)

References 21 publications

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“…Then, we compared the absolute differences in histoplasmosis incidence between these analyses and data obtained from the screening program performed from 2017-2019. A detailed description of the program was published previously [6,7]. Briefly, patients were enrolled at healthcare facilities, which are part of a national network that covers 81.2% (13 out of 16) of the sites that provide care to HIV-infected patients in the country.…”

Section: Study Design and Participantsmentioning

confidence: 99%

Incidence of Histoplasmosis in a Cohort of People with HIV: From Estimations to Reality

et al. 2021

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Among people with HIV, histoplasmosis represents an important cause of mortality. Previous studies provided estimates of the disease incidence. Here, we compared those estimates with the results obtained from a screening program implemented in Guatemala, which included histoplasmosis detection for people with HIV. To compare the results of this program with previous estimations, a literature search was performed and reports concerning histoplasmosis incidence were analyzed. The screening program enrolled 6366 patients. The overall histoplasmosis incidence in the screening program was 7.4%, which was almost double that estimated in previous studies. From 2017 to 2019, the screening program showed an upward trend in histoplasmosis cases from 6.5% to 8.8%. Histoplasmosis overall mortality among those who were newly HIV diagnosed showed a decrease at 180 days from 32.8% in 2017 to 21.2% in 2019. The screening approach using rapid diagnostic assays detects histoplasmosis cases more quickly, allowing a specific treatment to be administered, which decreases the mortality of the disease. Therefore, the use of these new techniques, especially in endemic areas of histoplasmosis, must be implemented.

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Section: Study Design and Participantsmentioning

confidence: 99%

Incidence of Histoplasmosis in a Cohort of People with HIV: From Estimations to Reality

et al. 2021

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“…In comparison, antigen detection has a sensitivity near 100%. 37 Additionally, Ag testing can be performed more easily than conventional assays, Ag testing generate results in a couple of hours in comparison with days or weeks need for culture isolation, these factors related to assay performance may have directly impacted case detection. 10,14,38 In 2017, a diagnostic laboratory in Guatemala tested a total of 1,953 PLHIV for cryptococcosis and histoplasmosis.…”

Section: Re Sultsmentioning

confidence: 99%

Implementation of rapid diagnostics assays for detection of histoplasmosis and cryptococcosis in central american people living with HIV

Cáceres

Araúz

Flores

et al. 2021

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Objectives: Histoplasmosis and cryptococcosis are important public health problems in people living with HIV (PLHIV) in Central America. Conventional laboratory assays, based on microscopy and culture, are not optimal for the diagnosis of either disease.However, antigen (Ag) assays are rapid and highly accurate for the diagnosis of these infections. Methods: Laboratory surveillance of PLHIV was carried out in four hospitals in Panama, Honduras and Nicaragua, between 2015 and 2019. Detection of Histoplasma antigens in urine was performed by enzyme immunoassay (EIA), and Cryptococcus antigen detection in sera and cerebrospinal fluid specimens was performed by lateral flow assay (LFA). Results: A total of 4,453 PLHIV with clinical suspicion of histoplasmosis (n = 1,343) or cryptococcosis (n = 3,110; 2,721 sera and 389 CSF) were tested. Of 1,343 patients suspected of having histoplasmosis, 269 (20%) were Histoplasma Ag positive.Of 3,110 patients tested using the Cryptococcus Ag assay, 329 (11%) were positive.Honduras reported the highest positivity rates (32% for Histoplasma Ag, and 16% for Cryptococcus Ag); Panama reported the largest number of patients testing positive using the Histoplasma Ag assay (n = 201); and Nicaragua reported the largest number of patients testing positive using the Cryptococcus Ag assay (n = 170). Conclusion:Here, we show how the implementation of rapid diagnostics assays impacted case detection and was useful for the care of people with advanced HIV. Rapid and accurate diagnosis could reduce mortality associated with histoplasmosis and cryptococcosis in PLHIV.

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“…This is important as the magnitude of the problem is at least comparable to the frequency by which histoplasmosis is encountered in neighbouring Guatemala. In a recently published study in Guatemala, the overall incidence of disseminated histoplasmosis in people living with HIV and a CD4 of <350 cells/mm 3 was 7.9% and as high as 19.7% with a CD4 cell count of <50 cells/mm 3 34 …”

Section: Resultsmentioning

confidence: 95%

“…with a CD4 cell count of <50 cells/mm 3 . 34 Finally, a recent modelling study that estimated the burden of histoplasmosis in people living with HIV in Latin America calculated an annual incidence of histoplasmosis of approximately 1.97 (1.95-1.99) per 100 people living with HIV in Honduras. 35 This would translate to 430-500 cases of disseminated histoplasmosis in patients living with HIV with 26 to 255 deaths per year considering different modelling scenarios for symptomatic disease and case fatality.…”

Section: Ta B L E 1 Demographics-population and Population At Risk Fo...mentioning

confidence: 99%

Burden of serious fungal infections in Honduras

Higuita

Bustillo

Denning

2022

Mycoses

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Background The burden of serious fungal infections in Honduras is unknown. The diagnosis of fungal diseases relies on almost exclusively on microscopy and culture limiting an accurate estimate of the burden of disease. Objectives The primary objective of the study was to estimate the burden of serious fungal infections in Honduras using previously described methods. Methods National and international demographic data on population, HIV, tuberculosis, asthma, COPD and cancer were obtained. A thorough literature search was done for all epidemiological studies and case series of serious fungal diseases. Using these risk populations and whatever incidence and prevalence could be found that was most pertinent to Honduras, a burden estimate was derived. Results The estimated number of serious fungal infection was estimated to be between 178,772 and 179,624 with nearly 2300 cases of these representing opportunistic infections in people living with HIV. The incidence of histoplasmosis and cryptococcosis in people living with HIV is high and estimated to be 4.3 and 4.6 cases per 100,000 population respectively. Approximately 12,247–13,099 cases of aspergillosis and 164,227 of other serious fungal infections were estimated to occur each year. Conclusion An accurate estimate of the burden of serious fungal infections in Honduras is unknown but based on our results, likely significant. Serious fungal infections represent an important public health problem in Honduras affecting approximately 1.8% of the population. There is a clear need for better access to diagnostic tools and antifungals to conduct research to better understand the impact of fungal diseases in Honduras.

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A Rapid Screening Program for Histoplasmosis, Tuberculosis, and Cryptococcosis Reduces Mortality in HIV Patients from Guatemala

Cited by 28 publications

References 21 publications

Incidence of Histoplasmosis in a Cohort of People with HIV: From Estimations to Reality

Incidence of Histoplasmosis in a Cohort of People with HIV: From Estimations to Reality

Implementation of rapid diagnostics assays for detection of histoplasmosis and cryptococcosis in central american people living with HIV

Burden of serious fungal infections in Honduras

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