Histoplasmosis in HIV-Infected Patients: Epidemiological,Clinical and Necropsy Data from a Brazilian Teaching Hospital

Histoplasmosis occurs in 5–10% of HIV-infected patients in endemic areas and evolves to severe and disseminated infection with mortality rates over 50% in some regions. This report presents epidemiological, clinical and outcome data from HIV-infected patients with histoplasmosis confirmed by culture and/or at necropsy who were admitted to a Brazilian teaching hospital. Data from 65 patients were obtained from their respective medical and necropsy records. From 2005 to 2018, 36 HIV-infected patients were diagnosed with histoplasmosis confirmed by culture. At admission, most of these patients presented disseminated fungal infection, whereas 15 (41.7%) were simultaneously diagnosed with both HIV infection and histoplasmosis. Fever, weight loss, hepatosplenomegaly, respiratory and digestive symptoms were present in 86.2%, 50%, 44.4% and 41.7% of the patients, respectively. At admission, 24 patients had low CD4 T-cell count and high viral load values. Among the 30 patients who received antifungals, 16 (53.3%) were cured, 13 (43.3%) died, and one was lost to follow-up. Six patients died prior to therapy. From 1990 to 2018, 63 necropsies of patients with Histoplasma capsulatum infection were performed. Of these patients, 29 (46.0%) were HIV-infected individuals, including 21 (72.4%) who presented disseminated histoplasmosis and 21 (72.4%) who were diagnosed with histoplasmosis at necropsy. The epidemiological, clinical and outcome profiles presented herein are similar to those described elsewhere and reinforce the difficulties that are still present in limited-resource settings where advanced immunodeficiency, combined with severe fungal infection and late patient admissions, is related to poor outcomes.

     

Current clinical laboratory practice: investigation of plasma lipids--which tests and when?

Clinical interest in the lipoproteins stems mainly from the association between serum cholesterol concentrations and coronary heart disease. Investigations of lipoproteins should be performed in patients with premature coronary heart disease, with a strong family history of coronary heart disease, or with certain cutaneous stigmata of hyperlipoproteinaemia and when fasting serum samples are seen to be lipaemic. Family studies should be performed in appropriate cases to identify relatives at increased risk of developing coronary heart disease. Patients with conditions known to cause secondary hyperlipoproteinaemia should be investigated if they fall into one of these categories but only after treatment of the underlying condition. Non-specialist laboratories should be able to measure total cholesterol and triglyceride concentrations and high density lipoprotein cholesterol concentrations. Lipoprotein electrophoresis has a limited role in such laboratories and is not necessary as a routine procedure. Specialist laboratories should in addition be able to measure individual lipoproteins and identify apolipoprotein E phenotypes.     

骨髓中检出组织胞浆菌1例

组织胞浆菌（Histoplasma capsulatum）是一种深部真菌,可引起人体深部组织胞浆菌病。最近我们从1例患者骨髓涂片瑞氏染色、PAS染色、骨髓病理活检中检出组织胞浆菌,现予报道。     

Histoplasmosis: Epidemiology in Latin America

Histoplasmosis is a frequent health problem in Latin American countries, but the fact that it is not a reportable disease prevents reliable estimates of its real incidence and impact on public health. Epidemiologic and clinical data remain patchy in general, and in some countries the information available is very limited. Histoplasmosis has a significant public health impact in susceptible populations such as immunosuppressed individuals, in whom the disease is associated with poor outcomes. Limited availability of diagnostic tools in many regions of Latin America is an additional problem, as many patients are already severely ill by the time of the diagnosis. Efforts are therefore necessary to ensure early diagnosis and appropriate treatment, limit the severity of the disease manifestations, and reduce morbidity and mortality. This paper reviews important aspects of the epidemiology of histoplasmosis, the most clinically significant endemic mycosis in Latin America.     

Poverty,dirt, infections and non-atopic wheezing in children from a Brazilian urban center

Background

The causation of asthma is poorly understood. Risk factors for atopic and non-atopic asthma may be different. This study aimed to analyze the associations between markers of poverty, dirt and infections and wheezing in atopic and non-atopic children.

Methods

1445 children were recruited from a population-based cohort in Salvador, Brazil. Wheezing was assessed using the ISAAC questionnaire and atopy defined as allergen-specific IgE ≥0.70 kU/L. Relevant social factors, environmental exposures and serological markers for childhood infections were investigated as risk factors using multivariate multinomial logistic regression.

Results

Common risk factors for wheezing in atopic and non-atopic children, respectively, were parental asthma and respiratory infection in early childhood. No other factor was associated with wheezing in atopic children. Factors associated with wheezing in non-atopics were low maternal educational level (OR 1.49, 95% CI 0.98-2.38), low frequency of room cleaning (OR 2.49, 95% CI 1.27-4.90), presence of rodents in the house (OR 1.48, 95% CI 1.06-2.09), and day care attendance (OR 1.52, 95% CI 1.01-2.29).

Conclusions

Non-atopic wheezing was associated with risk factors indicative of poverty, dirt and infections. Further research is required to more precisely define the mediating exposures and the mechanisms by which they may cause non-atopic wheeze.     

Smith-Magenis syndrome: clinical evaluation in seven Brazilian patients

Smith-Magenis syndrome (SMS) is a complex congenital anomaly characterized by craniofacial anomalies, neurological and behavioral disorders. SMS is caused by a deletion in region 17p11.2, which includes the RAI1 gene (90% of cases), or by point mutation in the RAI1 gene (10% of cases). Laboratory diagnosis is through cytogenetic analysis by GTG banding and molecular cytogenetic analysis by FISH. We carried out an active search for patients in Associations of Parents and Friends of Exceptional Children (APAE) of S?o Paulo and genetic centers in Brazil. Forty-eight patients were screened for mental retardation, craniofacial abnormalities and stereotyped behavior with a diagnosis of SMS. In seven of them, chromosome banding at high resolution demonstrated chromosome 17p11.2 deletions, confirmed by FISH. We also made a meta-analysis of 165 cases reported between 1982 and 2010 to compare with the clinical data of our sample. We demonstrated differences between the frequencies of clinical signs among the cases reported and seven Brazilian cases of this study, such as dental anomalies, strabismus, ear infections, deep hoarse voice, hearing loss, and cardiac defects. Although the gold standard for diagnosis of SMS is FISH, we found that the GTG banding technique developed to evaluate chromosome 17 can be used for the SMS diagnosis in areas where the FISH technique is not available.     

Presumptive identification of nocardias in a clinical laboratory

One hundred and thirty-six cultures of aerobic streptomycetes were examined by simple cultural and microscopical methods. Nocardia spp. were recognized by their resistance to lysozyme and identified to the three important species by casein, xanthine and tyrosine hydrolysis tests.     

Gastrointestinal Histoplasmosis in a Hepatitis C-Infected Individual

Gastrointestinal histoplasmosis is a rare manifestation of this fungal infection, typically identified in immunocompromised patients, such as those with HIV/AIDS. Here, we report a case of disseminated histoplasmosis with gastrointestinal involvement in a Hepatitis C-infected patient. The fungal agent was confirmed to be Histoplasma capsulatum by a DNA probe assay performed on a bone marrow sample. We propose that this fungal disease should be kept on the differential of patients infected with the Hepatitis C virus, as it has been reported to have numerous damaging effects on the adaptive immune system.     

Blockboard with boron-treated veneers: laboratory decay and termite resistance tests

This study is evaluated by measuring the weight loss, and the ability of white- and brown-rot fungi and termites to attack untreated and boron-treated blockboard manufactured using untreated fir (Abies bornmulleriana M.) strips sandwiched between Ekaba (Tetraberlinia bifoliolata Harms.) veneers at final assembly. The veneers were treated with either boric acid or disodium octoborate tetrahydrate, or mixtures of these chemicals, and blockboard specimens were subjected to fungal decay resistance tests performed according to the Japanese Industrial Standard (JIS) A-9201 method using the brown-rot fungus Fomitopsis palustris (Berkeley et Curtis) Murrill and the white-rot fungus, Trametes versicolor (L. ex Fr.) Quel. Blockboard specimens were also tested against the subterranean termite Coptotermes formosanus Shiraki to determine termite resistance. Blockboard specimens with boron-treated veneers demonstrated increased durability against decay fungi and termite attack. However, sealing of untreated fir strips before decay resistance tests helped reduce significantly the weight losses in blockboard with either untreated or boron-treated veneers. Although blockboard is usually used in indoor applications, incorporation of boron-based biocides may be required for increasing resistance to fungal decay and termite attack and giving fire retardancy.     

Acetylcholinesterase molecular forms in serum and erythrocytes of laboratory animals

The distribution of the molecular forms of acetylcholinesterase in the blood of various animal species was examined. The globular tetrameric form was most frequently observed in serum but mouse serum also contained a globular monomer. Globular monomers (rat) dimers (mouse, dog, rabbit) and tetramers (dog) were found in erythrocytes. Interspecies differences make it difficult to formulate a cohesive theory as to the origin and function of blood-borne enzymes.