galactomannan and AIDS-Related-Opportunistic-Infections

Invasive aspergillosis is a major cause of mortality in allogeneic bone marrow transplant recipients and patients treated for blood malignancies. The diagnostic tools, treatments and preventive strategies, essentially developed for neutropaenic patients, have not been assessed in populations whose immune systems are considered to be competent.. Beside the standard picture of chronic Aspergillus infection, the incidence of invasive aspergillosis is increasing in non neutropaenic patients, such as those with chronic lung diseases or systemic disease treated with long-term immunosuppressive drugs and solid organ transplant recipients. This study reviews the specific features of invasive aspergillosis in non neutropaenic subjects (NNS) and discusses the value of the diagnostic tools and treatment in this population.. A better understanding of the pathophysiology and the epidemiological characteristics of invasive aspergillosis would provide a means of adapting the staging and classification of the disease for NNS.. Invasive aspergillosis is under diagnosed in NNS who may already be colonised when they receive immunosuppressive treatment; this can lead to an adverse outcome in patients who are considered to be a moderate risk population.

Topics: AIDS-Related Opportunistic Infections; Antibodies, Fungal; Antifungal Agents; Aspergillosis; Aspergillus; Chronic Disease; Fungemia; Galactose; Humans; Immunocompromised Host; Immunosuppressive Agents; Lung Diseases; Mannans; Neutropenia; Organ Transplantation; Postoperative Complications; Pulmonary Aspergillosis; Radiography; Respiratory System; Risk Factors; Wound Infection

Invasive histoplasmosis is the most common AIDS-defining event in endemic regions such as South America. In non-endemic regions, less familiar to the diagnosis, invasive histoplasmosis can be mistakenly diagnosed as miliary tuberculosis leading to a high mortality rate. Here we present the case of an invasive histoplasmosis mistakenly diagnosed as tuberculosis. The diagnosis of histoplasmosis was considered later on, in light of patient's clinical deterioration and positive Aspergillus galactomannan antigens. This case highlights the importance of considering other opportunistic infections when facing a culture-negative miliary tuberculosis without clinical improvement despite anti-tuberculosis therapy. It also draws our attention to the tools available in non-endemic regions that can be helpful in the diagnosis of invasive histoplasmosis.

Topics: AIDS-Related Opportunistic Infections; Antigens, Fungal; Aspergillus; Galactose; Histoplasma; Histoplasmosis; Humans; Mannans; Tuberculosis, Miliary

To investigate the clinical characteristics, diagnosis, treatment and prognosis of penicilliosis among the patients with acquired immunodeficiency syndrome (AIDS) in non-endemic areas of China, and then to discuss its incubation period and the diagnostic performance of serum galactomannan test for penicilliosis.. Medical records and travel histories of penicilliosis patients in Zhongnan hospital from January 2006 to December 2013, and the interval from when the patients left the endemic area to the onset of the disease was analyzed. Serum galactomannan levels of penicilliosis patients and AIDS patients with fever were measured by the Platelia Aspergillus Enzyme Immunoassay Kit.. A total of 47 AIDS-associated penicilliosis were confirmed by fungal culture, which accounted for 4.8% of 981 AIDS-related admissions. The sensitivity and specificity of serum galactomannan test for penicilliosis were 95.8% (23/24) and 90.9% (30/33), respectively, (cutoff index = 1.0). Two independent predictors for early mortality (death within 12 weeks) of the patients (21.3%, 10/47) were a delayed diagnosis and no treatment with antifungal therapy. Among 14 patients who became ill after leaving endemic areas, ten patients presented with the onset symptoms within 12 months (from 11 days to 360 days). We found a patient living with asymptomatic P. marneffei fungemia who had not received any antifungal therapy until 18 months' follow up.. The co-infection of P. marneffei and HIV was not uncommon in the non-endemic areas of penicilliosis in China. There exists a latent form of infection for P. marneffei. The incubation period of penicilliosis may be quite different from one patient to another. In AIDS patients, the serum galactomannan test has utility for the diagnosis of penicilliosis. When patients with penicilliosis/AIDS were diagnosed early and treated with standardized antifungal therapy and combined antiretroviral therapy, their prognosis improved.

Topics: Acquired Immunodeficiency Syndrome; Adult; AIDS-Related Opportunistic Infections; Antifungal Agents; China; Coinfection; Female; Galactose; HIV; Humans; Male; Mannans; Mycoses; Penicillium; Prevalence; Young Adult

The diagnosis of histoplasmosis due to Histoplasma capsulatum var capsulatum is based on a direct examination identifying encapsulated yeast with narrow-based budding. Galactomannan antigenemia facilitates diagnosis, as well as the monitoring of patients receiving treatment. The case of a HIV-positive patient from Congo-Brazzaville with a disseminated form of African histoplasmosis highlighted the positive galactomannan antigen in this disease due to Histoplasma capsulatum var duboisii. Galactomannan antigenemia remained high with a very slow decrease during antifungal therapy and slow regression of clinical lesions. African histoplasmosis is a rare disease that is difficult to diagnose and rarely described in immunocompromised patients, in whom differential diagnosis can be common. This observation underlines the importance of the galactomannan antigen assay in patients who have travelled to endemic areas. As in the case of Histoplasma capsulatum var capsulatum, the positivity of the Aspergillus galactomannan antigen is very useful in the diagnosis and monitoring of African histoplasmosis.

Topics: Adult; AIDS-Related Opportunistic Infections; Antigens, Fungal; Aspergillus; Female; Galactose; Histoplasma; Histoplasmosis; HIV Infections; Humans; Immunoassay; Mannans; Predictive Value of Tests

In South America, disseminated histoplasmosis due to Histoplasma capsulatum var. capsulatum (H. capsulatum), is a severe and frequent opportunistic infection in AIDS patients. In areas outside the USA where specific-Histoplasma antigen detection is not available, the diagnosis is difficult. With the galactomannan antigen (GM) detection, a test commonly used for invasive aspergillosis diagnosis, there is a cross-reactivity with H. capsulatum that can be helpful for the diagnosis of histoplasmosis. The aim of this study was to evaluate the GM detection for the diagnosis of disseminated histoplasmosis in AIDS patients. The performance of the GM detection was evaluated with serum collected in French Guiana where H. capsulatum is highly endemic. Sera from AIDS patients with disseminated histoplasmosis occurring from 2002 to 2009 and from control HIV-positive patients without histoplasmosis were tested with the GM detection and Histoplasma-specific antibody detection (IEP). In 39 AIDS patients with proven disseminated histoplasmosis, the sensitivity of the Histoplasma IEP was only 35.9% and was linked to the TCD4+ lymphocyte level. For the GM detection, the sensitivity (Se) was 76.9% and specificity (Sp) was 100% with the recommended threshold for aspergillosis diagnosis (0.5). The test was more efficient with a threshold of 0.4 (Se: 0.82 [95% CI: 0.66-0.92], Sp: 1.00 [95% CI: 0.86-1.00], LR+: >10, LR-: 0.18). This study confirms that the GM detection can be a surrogate marker for the diagnosis of disseminated histoplasmosis in AIDS patients in endemic areas where Histoplasma EIA is not available.

Topics: Acquired Immunodeficiency Syndrome; Adult; AIDS-Related Opportunistic Infections; Antibodies, Fungal; Cohort Studies; Female; French Guiana; Galactose; Histoplasma; Histoplasmosis; Humans; Male; Mannans; Middle Aged; Sensitivity and Specificity; South America

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.

Topics: Acquired Immunodeficiency Syndrome; Adult; AIDS-Related Opportunistic Infections; Antifungal Agents; Antigens, Fungal; Aspergillus; Female; Galactose; Histoplasma; Histoplasmosis; HIV; Humans; Mannans