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      Brote de histoplasmosis en el contexto de la pandemia por COVID-19 Translated title: Histoplasmosis outbreak in the context of the COVID-19 pandemic

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          Abstract

          RESUMEN La histoplasmosis es una micosis profunda de distribución mundial causada por el Histoplasma capsulatum var. capsulatum. Se caracteriza por una variabilidad clínica que depende principalmente de la carga fúngica, del estado inmunológico del paciente y de la virulencia del germen. Se describe un brote de histoplasmosis pulmonar aguda en militares, producido en el contexto epidemiológico de la COVID-19. El episodio tuvo lugar a partir de actividad laboral en cuevas donde participaron cuatro militares, tres de los cuales desarrollaron síntomas y fueron admitidos en el Hospital Dr. Gustavo Aldereguía Lima de Cienfuegos en enero de 2022. La información fue obtenida a través de la entrevista médica y la historia clínica. Se evidenció que en el contexto epidemiológico de la pandemia por COVID-19 no se debe subestimar el diagnóstico de otras enfermedades respiratorias, incluidas las micosis endémicas.

          Translated abstract

          ABSTRACT Histoplasmosis is a deep mycotic infection of worldwide distribution caused by Histoplasma capsulatum var. capsulatum. It is characterized by clinical variability that depends mainly on the fungal load, the patient's immune status and the virulence of the germ. We describe an outbreak of acute pulmonary histoplasmosis among military officers, which occurred in the epidemiological context of COVID-19. The episode occurred during work activities in caves in which four soldiers participated, three of whom developed symptoms and were admitted to the "Dr. Gustavo Aldereguía Lima" Hospital in Cienfuegos in January 2022. The information was obtained through medical interviews and clinical records. It was evidenced that in the epidemiological context of the COVID-19 pandemic, the diagnosis of other respiratory diseases, including endemic mycoses, should not be underestimated.

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          Características clínico-epidemiológicas de la COVID-19

          RESUMEN Introducción: La COVID-19 es causada por el nuevo coronavirus que se descubrió en la ciudad de Wuhan, provincia de Hubei, China a finales de 2019. Objetivo: Describir las características clínico-epidemiológicas de la COVID-19. Material y Método: Se realizó una revisión bibliográfica a partir de un total de 33 referencias bibliográficas. Se utilizaron artículos e información de revistas nacionales e internacionales de las bases de datos OMS, OPS, Infomed. Se analizó la calidad, fiabilidad y validez de los artículos seleccionados para realizar una adecuada revisión. Desarrollo: La transmisión del SARS-COV-2 proveniente de una fuente animal a los primeros casos humanos no se ha confirmado. La vía de transmisión entre humanos más aceptada es de persona a persona por vía respiratoria, con un periodo de incubación de 1 a 14 días. Se presenta en la mayoría de casos con un cuadro clínico correspondiente a una infección respiratoria alta autolimitada, con variedad de sintomatología según grupos de riesgo, presentando una rápida progresión a una neumonía grave y fallo multiorgánico, generalmente fatal en personas de la tercera edad y con presencia de comorbilidades. Conclusiones: Estamos en presencia de una pandemia en la que el pilar más importante para combatirla es la prevención: tomar las medidas necesarias para detener la transmisión, lograr una atención diferenciada a los grupos de riesgo, realizar todas las acciones pertinentes con el fin de identificar y neutralizar los focos de propagación y lograr que la población se una al sistema de salud de cada nación y coopere para combatir esta enfermedad.
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            Fungal co-infection in COVID-19 patients: should we be concerned?

            Critically ill COVID-19 patients have higher pro-inflammatory (IL-1, IL-2, IL-6, tumor necrosis alpha) and anti-inflammatory (IL-4, IL-10) cytokine levels, less CD4 interferon-gamma expression, and fewer CD4 and CD8 cells. This severe clinical situation increases the risk of serious fungal infections, such as invasive pulmonary aspergillosis, invasive candidiasis or Pneumocystis jirovecii pneumonia. However, few studies have investigated fungal coinfections in this population. We describe an update on published reports on fungal coinfections and our personal experience in three Spanish hospitals. We can conclude that despite the serious disease caused by SARS-CoV-2 in many patients, the scarcity of invasive mycoses is probably due to the few bronchoscopies and necropsies performed in these patients because of the high risk in aerosol generation. However, the presence of fungal markers in clinically relevant specimens, with the exception of bronchopulmonary colonization by Candida, should make it advisable to early implement antifungal therapy.
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              Diagnosis of histoplasmosis

              Endemic mycoses can be challenging to diagnose and accurate interpretation of laboratory data is important to ensure the most appropriate treatment for the patients. Although the definitive diagnosis of histoplasmosis (HP), one of the most frequent endemic mycoses in the world, is achieved by direct diagnosis performed by micro and/or macroscopic observation of Histoplasma capsulatum (H. capsulatum), serologic evidence of this fungal infection is important since the isolation of the etiologic agents is time-consuming and insensitive. A variety of immunoassays have been used to detect specific antibodies to H. capsulatum. The most applied technique for antibody detection is immunodiffusion with sensitivity between 70 to 100 % and specificity of 100%, depending on the clinical form. The complement fixation (CF) test, a methodology extensively used on the past, is less specific (60 to 90%). Detecting fungal antigens by immunoassays is valuable in immunocompromised individuals where such assays achieve positive predictive values of 96-98%. Most current tests in diagnostic laboratories still utilize unpurified antigenic complexes from either whole fungal cells or their culture filtrates. Emphasis has shifted, however, to clinical immunoassays using highly purified and well-characterized antigens including recombinant antigens. In this paper, we review the current conventional diagnostic tools, such as complement fixation and immunodiffusion, outline the development of novel diagnostic reagents and methods, and discuss their relative merits and disadvantages to the immunodiagnostic of this mycosis.
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                Author and article information

                Journal
                mtr
                Revista Cubana de Medicina Tropical
                Rev Cubana Med Trop
                Centro Nacional de Información de Ciencias Médicas (Ciudad de la Habana, , Cuba )
                0375-0760
                1561-3054
                April 2023
                : 75
                : 1
                : e942
                Affiliations
                [1] Cienfuegos orgnameHospital Provincial Gustavo Aldereguía Lima (GAL) Cuba
                Article
                S0375-07602023000100002 S0375-0760(23)07500100002
                0bf09c63-173f-4424-8142-2655d9b7c3ec

                This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

                History
                : 22 February 2023
                : 11 August 2022
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 18, Pages: 0
                Product

                SciELO Cuba

                Categories
                PRESENTACIÓN DE CASO

                Histoplasma capsulatum var. capsulatum,coronavirus,epidemic outbreak,histoplasmosis,brote epidémico

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