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Histoplasmosis and paracoccidioidomycosis in a non-endemic area: a review of cases and diagnosis.
J Travel Med. 2011 Jan-Feb; 18(1):26-33.JT

Abstract

BACKGROUND

Histoplasmosis and paracoccidioidomycosis (PCM) have increased in Spain in recent years, due firstly to the migration from endemic regions and secondly to travelers returning from these regions. In non-endemic areas, diagnosis of both diseases is hampered by the lack of experience, long silent periods, and the resemblance to other diseases such as tuberculosis and sarcoidosis.

METHODS

A total of 39 cases of imported histoplasmosis and 6 cases of PCM diagnosed in the Spanish Mycology Reference Laboratory since 2006 were analyzed. Microbiological diagnosis was performed using classical methods and also a specific real-time polymerase chain reaction (RT-PCR) assay for each microorganism.

RESULTS

We had 9 cases of probable histoplasmosis in travelers and 30 cases in immigrants, 29 of whom were defined as proven. Paracoccidioidomycosis (PCM) cases were either immigrants or people who had lived for a long period of time in endemic regions, all of whom were classified as proven cases. Cultures showed a good sensitivity in detecting Histoplasma capsulatum in immigrants with proven histoplasmosis (73%); however, growth was very slow. The fungus was never recovered in traveler patients. Paracoccidioides brasiliensis was isolated in a culture only in one case of the proven PCM. Serological methods were not very reliable in immunocompromised patients with histoplasmosis (40%). A PCR-based technique for histoplasmosis detected 55.5% of the cases in travelers (probable cases) and 89% of the cases in immigrants (proven). The PCR method for PCM detected 100% of the cases.

CONCLUSIONS

These kinds of mycoses are increasingly frequent in non-endemic areas, and newer and faster techniques should be used to reach an early diagnosis. The RT-PCR techniques developed appear to be sensitive, specific, and fast and could be helpful to detect those mycoses. However, it is also essential that physicians perform differential diagnosis in individuals coming from endemic areas.

Authors+Show Affiliations

Servicio de Micología, Instituto de Salud Carlos III, Carretera Majadahonda-Pozuelo Km 2, Majadahonda, Madrid, Spain. buitrago@isciii.esNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

21199139

Citation

Buitrago, Maria J., et al. "Histoplasmosis and Paracoccidioidomycosis in a Non-endemic Area: a Review of Cases and Diagnosis." Journal of Travel Medicine, vol. 18, no. 1, 2011, pp. 26-33.
Buitrago MJ, Bernal-Martínez L, Castelli MV, et al. Histoplasmosis and paracoccidioidomycosis in a non-endemic area: a review of cases and diagnosis. J Travel Med. 2011;18(1):26-33.
Buitrago, M. J., Bernal-Martínez, L., Castelli, M. V., Rodríguez-Tudela, J. L., & Cuenca-Estrella, M. (2011). Histoplasmosis and paracoccidioidomycosis in a non-endemic area: a review of cases and diagnosis. Journal of Travel Medicine, 18(1), 26-33. https://doi.org/10.1111/j.1708-8305.2010.00477.x
Buitrago MJ, et al. Histoplasmosis and Paracoccidioidomycosis in a Non-endemic Area: a Review of Cases and Diagnosis. J Travel Med. 2011 Jan-Feb;18(1):26-33. PubMed PMID: 21199139.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Histoplasmosis and paracoccidioidomycosis in a non-endemic area: a review of cases and diagnosis. AU - Buitrago,Maria J, AU - Bernal-Martínez,Leticia, AU - Castelli,Maria V, AU - Rodríguez-Tudela,Juan L, AU - Cuenca-Estrella,Manuel, Y1 - 2010/11/28/ PY - 2011/1/5/entrez PY - 2011/1/5/pubmed PY - 2011/3/1/medline SP - 26 EP - 33 JF - Journal of travel medicine JO - J Travel Med VL - 18 IS - 1 N2 - BACKGROUND: Histoplasmosis and paracoccidioidomycosis (PCM) have increased in Spain in recent years, due firstly to the migration from endemic regions and secondly to travelers returning from these regions. In non-endemic areas, diagnosis of both diseases is hampered by the lack of experience, long silent periods, and the resemblance to other diseases such as tuberculosis and sarcoidosis. METHODS: A total of 39 cases of imported histoplasmosis and 6 cases of PCM diagnosed in the Spanish Mycology Reference Laboratory since 2006 were analyzed. Microbiological diagnosis was performed using classical methods and also a specific real-time polymerase chain reaction (RT-PCR) assay for each microorganism. RESULTS: We had 9 cases of probable histoplasmosis in travelers and 30 cases in immigrants, 29 of whom were defined as proven. Paracoccidioidomycosis (PCM) cases were either immigrants or people who had lived for a long period of time in endemic regions, all of whom were classified as proven cases. Cultures showed a good sensitivity in detecting Histoplasma capsulatum in immigrants with proven histoplasmosis (73%); however, growth was very slow. The fungus was never recovered in traveler patients. Paracoccidioides brasiliensis was isolated in a culture only in one case of the proven PCM. Serological methods were not very reliable in immunocompromised patients with histoplasmosis (40%). A PCR-based technique for histoplasmosis detected 55.5% of the cases in travelers (probable cases) and 89% of the cases in immigrants (proven). The PCR method for PCM detected 100% of the cases. CONCLUSIONS: These kinds of mycoses are increasingly frequent in non-endemic areas, and newer and faster techniques should be used to reach an early diagnosis. The RT-PCR techniques developed appear to be sensitive, specific, and fast and could be helpful to detect those mycoses. However, it is also essential that physicians perform differential diagnosis in individuals coming from endemic areas. SN - 1708-8305 UR - https://www.unboundmedicine.com/medline/citation/21199139/Histoplasmosis_and_paracoccidioidomycosis_in_a_non_endemic_area:_a_review_of_cases_and_diagnosis_ L2 - https://academic.oup.com/jtm/article-lookup/doi/10.1111/j.1708-8305.2010.00477.x DB - PRIME DP - Unbound Medicine ER -