Histoplasmosis: Una micosis endémica. Visión general de la epidemiología, características clínicas, diagnóstico y tratamiento
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La histoplasmosis es una enfermedad fúngica endémica en América causada por un hongo dimórfico, Histoplasma capsulatum, que afecta a individuos inmunocompetentes y, de manera más significativa, a aquellos con déficits en el sistema inmunológico o en los extremos de la edad. Los niños son particularmente susceptibles a la enfermedad diseminada y a formas severas, con alta letalidad si no se tratan. Los síntomas más comunes incluyen fiebre, pérdida de peso y visceromegalia, aunque la enfermedad puede ser completamente asintomática, dependiendo de factores del huésped y del tamaño del inóculo inicial. La histopatología, la medición de antígenos y anticuerpos, el cultivo y las técnicas moleculares son fundamentales en el diagnóstico de la histoplasmosis, con eficacia variable en las diferentes formas clínicas. Cuando se indica tratamiento, las guías internacionales recomiendan una terapia de inducción intensiva con anfotericina B durante 2 a 4 semanas, seguida de itraconazol durante 12 meses como terapia de mantenimiento en formas diseminadas. El seguimiento debe asegurar la cura clínica y microbiológica y una disminución de los niveles de antigenuria para prevenir recaídas y garantizar el éxito terapéutico.
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Histoplasmosis. Arenas Guzman R (ed.). (2014). Micología médica ilustrada, 5e. McGrawHill. Https://accessmedicina.mhmedical.com/content.aspx?bookid=1448§ionid=96274908.
Bahr NC, Antinori S, Wheat LJ, Sarosi GA. (2015). Histoplasmosis infections worldwide: thinking outside of the Ohio River Valley. Curr Trop Med Rep 2(2):70-80. https://doi.org/10.1007/s40475-015-0044-0
Goodwin RA, Loyd JE, Des Prez RM. (1981). Histoplasmosis in normal hosts. Medicine 1981;60(4):231-66. https://doi.org/10.1097/00005792-198107000-00001
Riera Fernando, Celi Ana Paulina, Thompson Luis. (2023). Infecciones fúngicas sistémicas. Manual práctico, Asociación panamericana de infectología. 2023. 105-118.
Linder, K.A.; Kauffman, C.A. (2019). Histoplasmosis: Epidemiology, Diagnosis and Clinical Manifestations. Curr. Fungal Infect. Rep. 2019, 13, 120-128. https://doi.org/10.1007/s12281-019-00341-x
Bassey E Ekeng, Kevin Edim, Ikechukwu Amamilo, Zachary Panos, David W. Denning, Rita O. Oladele. (2021). Histoplasmosis in children: HIV/AIDS not a major driver. Journal of Fungi. Open Access Mycology Journal 2021;7:530. https://doi.org/10.3390/jof7070530
Arnaldo Lopes Colombo, Angela Tobón, Angela Restrepo, Flavio Queiroz-Telles, Marcio Nucci. (2011). Epidemiology of endemic systemic fungal infections in Latin America. Medical Mycology. https://doi.org/10.3109/13693786.2011.577821
Carmona Fonseca J. (1971). Análisis estadístico y ecológicoepidemiológico de la sensibilidad a la histoplasmina en Colombia. Antioquia Med 1971;21(1):109-54.
Oladele RO, Ayanlowo OO, Richardson MD, Denning DW. (2018). Histoplasmosis in Africa: an emerging or a neglected disease? PLoS Negl Trop Dis 12(1). https://doi.org/10.1371/journal.pntd.0006046
Confalonieri ML, Gandola L, Aiolfi S, Mazzoni A. (1994). Histoplasmin sensitivity among a student population in Crema, Po Valley, Italy. New Microbiol 17(2):151-153.
van Gelderen de Komaid A, Durán E, Borges de Kestelman I. Histoplasmosis and Paracoccidioidomycosis in northwestern Argentina III. Epidemiological survey in Vipos, La Toma, and Choromoro - Trancas, Tucumán, Argentina. Eur J Epidemiol. 1999 Apr;15(4):383-8. https://doi.org/10.1023/A:1007543016854
Loaiza-Oliva M, Gamarra S, Agusti J, Gaite L, Paladini JH, Martínez V, Arriola M, Gaite JA, Garcia-Effron G. High histoplasmosis incidence in kidney transplant recipients in Santa Fe city, Argentina. Med Mycol. 2024 Nov 12;62(11):myae099. https://doi.org/10.1093/mmy/myae099
Almeida MA, Almeida-Silva F, Guimaraes AJ, Almeida-Paes R, Zancopé- Oliveira RM. The occurrence of histoplasmosis in Brazil: A systematic review. Int J Infect Dis. 2019 Sep;86:147-156. https://doi.org/10.1016/j.ijid.2019.07.009
Rodrigues AM, Beale MA, Hagen F, Fisher MC, Terra PPD, de Hoog S, Brilhante RSN, de Aguiar Cordeiro R, de Souza Collares Maia Castelo- Branco D, Rocha MFG, Sidrim JJC, de Camargo ZP. The global epidemiologyof emerging Histoplasma species in recent years. Stud Mycol. 2020 Mar 2;97:100095. https://doi.org/10.1016/j.simyco.2020.02.001
Sahaza JH, Duarte-Escalante E, Canteros C, Rodríguez-Arellanes G, Reyes-Montes MR, Taylor ML. Analyses of the genetic diversity and population structures of Histoplasma capsulatum clinical isolates from Mexico, Guatemala, Colombia and Argentina, using a randomly amplified polymorphic DNA-PCR assay. Epidemiol Infect. 2019 Jan;147:e204. https://doi.org/10.1017/S0950268819000931
Arauz AB, Papineni P. (2021). Histoplasmosis. Infect Dis Clin North Am. 2021 Jun;35(2):471-491. https://doi.org/10.1016/j.idc.2021.03.011
Ashraf N, Kubat RC, Poplin V, et al. (2020). Re-drawing the maps for endemic Mycosis. Mycophatologia 2020;185:843-865. https://doi.org/10.1007/s11046-020-00431-2
Gomez LF, Perez LC, Mc Ewen JG, Zuluaga L. Peláez CA, Acevedo JM., et al. (2019). Capacity of Histoplasma capsulatum to survive the composting process. Applied and Environmental soil Science. 2019. https://doi.org/10.1155/2019/5038153
Ekeng B E, Edem K, Amamilo I., Panos Z., W. Denning D., Oladele RO. (2021). Histoplasmosis in Children, HIV/AIDS Not a Major Driver. Journal of fungi (Basel, Switzerland), 2021;7(7): 530. https://doi.org/10.3390/jof7070530
Diego H Cáceres, Beatriz L Gómez, Angela Restrepo y Angela M Tobón. (2012). Histoplasmosis y SIDA: factores de riesgo clínicos y de laboratorio asociados al pronóstico de la enfermedad. Infectio 2012;16 (sup 3):44-50. https://doi.org/10.1016/S0123-9392(12)70026-7
Laurent Cannous, Arthur Surel, Hatem Kallel, et al. (2023). Factors related to mortality in critically ill histoplasmosis: a multicenter retrospective study in Guadeloupe and French Guyana. Annals of Intensive Care 2023;13:30. https://doi.org/10.1186/s13613-023-01128-7
Sepulveda, V.E.; Marquez, R.; Turissini, D.A.; Goldman, W.E.; Matute, D.R. (2017). Genome sequences reveal cryptic speciation in the human pathogen Histoplasma ca] psulatum. mBio 2017, 8, e01339-17. https://doi.org/10.1128/mBio.01339-17
Kasuga T, White TJ, Koenig G, White TJ., Koenig G., McEwen J., et al. (2003). Phylogeography of the fungal pathogen Histoplasma capsulatum. Mol Ecol 2003;12(12):3383-401. https://doi.org/10.1046/j.1365-294X.2003.01995.x
Teixeira MM, Patane JS, Taylor M, Gómez BL., Theodoro R., Hoog S., et al. (2016). Worldwide phylogenetic distributions and population dynamics of the genus Histoplasma. PLos Negl Trop Dis 2016. https://doi.org/10.1371/journal.pntd.0004732
Arango M, Castañeda E, Agudelo CI, De Bedout CI., Agudelo C., Angela T., et al. (2011). The Colombian Histoplasmosis Study Group Histoplasmosis: Results of the Colombian National Survey, 1992-2008. Biomédica. 2011; 31:344-356. https://doi.org/10.7705/biomedica.v31i3.348
Wheat LJ, Azar MM, Bahr NC, Spec A, Relich RF, Hage C. (2016). Histoplasmosis. Infect Dis Clin N Am 30(1):207-227. https://doi.org/10.1016/j.idc.2015.10.009
Holbrook ED, Rappleye CA. (2008). Histoplasma capsulatum pathogenesis: making a lifestyle switch. Curr Opin Microbiol. 2008;11:318-24. https://doi.org/10.1016/j.mib.2008.05.010
Goodwin RA, Shapiro JL, Thurman GH, Thurman SS., Prez RM. (1980). Disseminated Histoplasmosis: Clinical and pathogenic correlations. Medicine 1980;59(1):1-33. https://doi.org/10.1097/00005792-198001000-00001
Deep GS Jr. (2020). Histoplasma capsulatum. In: Bennett JE, Dolin R, Blaser MJ, editors. Mandell, Douglas and Bennett's principles and practice of infectious diseases 9th ed. Philadelphia, USA: Elsevier;2020 p 31-62-3176.
Kauffman CA. (2023). Pathogenesis and clinical manifestations of disseminated histoplasmosis [Internet]. UpToDate. 2023. Disponible en: https://www.uptodate.com/contents/pathogenesis-and-clinicalmanifestations-of-disseminated-histoplasmosis.
Nicolas Barros, Joseph L Wheat and Chadi Hage. (2023). Pulmonary Histoplasmosis: A clinical Update. Journal of Fungi 2023;9:236. https://doi.org/10.3390/jof9020236
David Jimenez M, Carlos Alberto Hinestroza, Andres David Aránzazu, Ochoa JA., (2022). Histoplasmosis pulmonar cavitada en un paciente pediátrico: reporte de caso. Neumol Pediatr 2022;17(4):145-147. https://doi.org/10.51451/np.v17i4.516
Kennedy CC, Limper AH. (2007). Redefining the clinical spectrum of chronic pulmonary histoplasmosis: a retrospective case series of 46 patients. Medicine (Baltimore) 2007;86(4):252-258. https://doi.org/10.1097/MD.0b013e318144b1d9
Baker J, Kosmidis C, Rozaliyani A, Wahyuningsih R, Denning DW. (2020). Chronic pulmonary Histoplasmosis a scoping literatura review. Open Forum Infect Dis 2020. https://doi.org/10.1093/ofid/ofaa119
Salzer HJF, Burchard G, Cornely OA, Lange C, Rolling T, Schmiedel S, et al. (2018). Diagnosis and Management of Systemic Endemic Mycoses Causing Pulmonary Disease. Respiration. 2018;96(3):283-301. https://doi.org/10.1159/000489501
Albers EL, Pugh ME, Hill KD, Wang L, Loyd JE, Doyle TP. Percutaneous vascular stent implantation as treatment for central vascular obstruction due to fibrosing mediastinitis. Circulation. 2011 Apr 5;123(13):1391-9. https://doi.org/10.1161/CIRCULATIONAHA.110.949180
López LF, Valencia Y, Tobón AM, Velásquez O, Santa CD, Cáceres DH. (2016). Childhood histoplasmosis in Colombia: Clinical and laboratory observations of 45 patients. Med. Mycol. 2016;54:677-683. https://doi.org/10.1093/mmy/myw020
Arango M, Castañeda E, Agudelo CI, De Bedout C, Agudelo CA, Tobón A, et al. (2011) Colombian Histoplasmosis Study Group. Histoplasmosis: results of the Colombian national survey, 1992-2008. Biomedica. 2011 Jul- Sep;31(3):344-56. https://doi.org/10.7705/biomedica.v31i3.348
Emilie Guemas, Loic Sobanska and Magalie Delmar. (2020). Histoplasma capsulatum and histoplasmosis: Current for the diagnosis 2020 https://doi.org/10.5772/intechopen.92782
Wheat J, Myint T, Guo Y, Kemmer P, Hage C, Terry C, et al. (2018). Central nervous system histoplasmosis: Multicenter retrospective study on clinical features, diagnostic approach and outcome of treatment. Medicine (Baltimore). 2018 Mar;97(13):e0245. https://doi.org/10.1097/MD.0000000000010245
Jabr R, El Atrouni W, Male HJ, Hammoud KA. (2019). Histoplasmosis associated hemophagocytic lymphohistiocytosis: A review of the literature. Can J Infect Dis Med Microbiol 2019;1-8. https://doi.org/10.1155/2019/7107326
Caceres DH, Gómez BL, Tobón AM, Restrepo A, Chiller T, Lindsley MD, et al. (2023). Tackling Histoplasmosis Infection in People Living with HIV from Latin America: From Diagnostic Strategy to Public Health Solutions. J Fungi (Basel). 2023 May 11;9(5):558. https://doi.org/10.3390/jof9050558
Tobon AM, Agudelo CA, Rosero DS, Ochoa JE, De Bedout C, et al. (2005). Disseminated histoplasmosis: a comparative study between patients with acquired immunodeficiency syndrome and non-human immunodeficiency virus-infected individuals. Am J Trop Med Hyg. 2005 Sep;73(3):576-82. https://doi.org/10.4269/ajtmh.2005.73.576
Toscanini MA, Nusblat AD, Cuestas ML. (2021). Diagnosis of histoplasmosis: current status and perspectives. Appl Microbiol Biotechnol. 2021 Mar;105(5):1837-1859. https://doi.org/10.1007/s00253-021-11170-9
Azar MM, Loyd JL, Relich RF, Wheat LJ, Hage CA. (2020). Current Concepts in the Epidemiology, Diagnosis, and Management of Histoplasmosis Syndromes. Semin Respir Crit Care Med. 2020 Feb;41(1):13-30. https://doi.org/10.1055/s-0039-1698429
Donnelly JP, Chen SC, Kauffman CA, Steinbach WJ, Baddley JW, Verweij PE, et al. (2020). Revision and Update of the Consensus Definitions of Invasive Fungal Disease From the European Organization for Research and Treatment of Cancer and the Mycoses Study Group Education and Research Consortium. Clin Infect Dis. 2020 Sep 12;71(6):1367-1376. https://doi.org/10.1093/cid/ciz1008
Hage CA, Azar MM, Bahor N, Loyd J, Wheat LJ. (2015). Histoplasmosis: Up-to-Date Evidence- Based Approach to diagnosis and Management. Semin Respir Crit Care Med 2015;36(5):729-45. https://doi.org/10.1055/s-0035-1562899
Caceres DH, Zuluaga A, Arango-Bustamante K, De Bedout C, Tobon AM, Restrepo A, Gomez BL, Cano LE, Gonzalez A. (2015). Implementation of a training course increased the diagnosis of histoplasmosis in Colombia. Am J Trop Med Hyg 93(3):662-667. https://doi.org/10.4269/ajtmh.15-0108
Caceres DH, Knuth M, Derado G, Lindsley MD. (2019). Diagnosis of Progressive Disseminated Histoplasmosis in Advanced HIV: A Meta- Analysis of Assay Analytical Performance. J Fungi (Basel). 2019 Aug 18;5(3):76. https://doi.org/10.3390/jof5030076
World Health Organization/Panamerican Health Organization. Guidelines for Diagnosing and Managing Disseminated histoplasmosis among people living with HIV. April 2020.
Almeida MA, Damasceno LS, Pizzini CV, Muniz M, Almeida-Paes R, Zancope-Oliveira RM. (2019). Role of Western blot assay for the diagnosis of histoplasmosis in AIDS patients from a National Institute of Infectious Diseases in Rio de Janeiro, Brazil. Mycoses 62(3):261-267. https://doi.org/10.1111/myc.12877
Kauffman CA, et al. (2008). Diagnosis of histoplasmosis in immunosuppressed patients. Curr Opin Infect Dis 21(4):421-425. https://doi.org/10.1097/QCO.0b013e328306eb8d
Gomez, B. L., & Thompson III, G. R. (2019). Histoplasma, Blastomyces,Coccidioides, Paracoccidioides and other dimorphic fungi causing systemic mycoses. En Manual of Clinical Microbiology (12 ed., Vol. 2, pp. 2187-2209). American Society for Microbiology. https://lccn.loc.gov/2018057849.
de Freitas RS, Kamikawa CK, Pardini Vicentini A. (2018). Fast protocol for the production of Histoplasma capsulatum antigens for antibody detection in the immunodiagnosis of histoplasmosis. Rev Iberoam Micol 35(1):27-31. https://doi.org/10.1016/j.riam.2017.04.004
Richer SM, Smedema ML, Durkin MM, Herman KM, Hage CA, Fuller D, et al (2016). Improved Diagnosis of Acute Pulmonary Histoplasmosis by Combining Antigen and Antibody Detection. Clin Infect Dis. 2016 Apr 1;62(7):896-902. https://doi.org/10.1093/cid/ciw007
Caceres DH, Scheel CM, Tobon AM, Ahlquist Cleveland A, Restrepo A, Brandt ME, Chiller T, et al (2014). Validation of an enzyme-linked immunosorbent assay that detects Histoplasma capsulatum antigenuria in Colombian patients with AIDS for diagnosis and follow-up during therapy. Clin Vaccine Immunol. 2014 Sep;21(9):1364-8. https://doi.org/10.1128/CVI.00101-14
Wheat J, Wheat H, Connolly P, Kleiman M, Supparatpinyo K, Nelson K, et al (1997). Cross-reactivity in Histoplasma capsulatum variety capsulatum antigen assays of urine samples from patients with endemic mycoses. Clin Infect Dis. 1997 Jun;24(6):1169-71. https://doi.org/10.1086/513647
Caceres DH, Gomez BL, Tobon AM, Chiller TM, Lindsley MD. (2020). Evaluation of a Histoplasma antigen lateral flow assay for the rapid diagnosis of progressive disseminated histoplasmosis in Colombian patients with AIDS. Mycoses 63(2):139-144. https://doi.org/10.1111/myc.13023
Bialek R, Feucht A, Aepinus C, Just-Nubling G, Robertson VJ, Knobloch J, Hohle R. Evaluation of two nested PCR assays for detection of Histoplasma capsulatum DNA in human tissue. J Clin Microbiol. 2002 May;40(5):1644-7. https://doi.org/10.1128/JCM.40.5.1644-1647.2002
Scheel CM, Zhou Y, Theodoro RC, Abrams B, Balajee SA, Litvintseva AP. Development of a loop-mediated isothermal amplification method for detection of Histoplasma capsulatum DNA in clinical samples. J Clin Microbiol. 2014 Feb;52(2):483-8. https://doi.org/10.1128/JCM.02739-13
American Academy of Pediatrics. Histoplasmosis. David W. Kimberlin, MD, editor. Red Book: 2021-2024 Report of the Committee on Infectious Diseases. 32th ed. American Academy of Pediatrics; 2021-2024. p. 466-470.
Wheat LJ, Freifeld AG, Kleiman MB, Baddley JW, McKinsey DS, Loyd JE, et al. (2009). Clinical practice guidelines for the management of patients with histoplasmosis: 2007 update by the Infectious Diseases Society of America. Clin Infect Dis. 2009;45:807-25. https://doi.org/10.1086/521259
Johnson PC, Wheat LJ, Cloud GA, Goldman M, Lancaster D, Bamberger DM, et al (2002). Safety and efficacy of liposomal amphotericin B compared with conventional amphotericin B for induction therapy of histoplasmosis in patients with AIDS. Ann Intern Med. 2002 Jul 16;137(2):105-9. https://doi.org/10.7326/0003-4819-137-2-200207160-00008
Diagnosing and managing disseminated histoplasmosis among people living with HIV. Washington, DC: Pan American Health Organization and World Health Organization; 2020. License: CCBY-NC-SA 3.0 IGO https://iris.paho.org/handle/ 10665.2/52304.
Restrepo A, Tobon A, Clarck B, et al. (2007). Salvage treatment of histoplasmosis with Posaconazole. J Infect 2007;54(4):319-27. https://doi.org/10.1016/j.jinf.2006.05.006