Aspergillosis: Case Series from the Central Public Health Laboratory-Ministry of Health. Asunción, Paraguay. Period 2000 - 2019
DOI:
https://doi.org/10.17533/udea.iatreia.309Keywords:
Aspergillosis, Chronic Obstructive Pulmonary Disease, Paraguay, TuberculosisAbstract
Introduction: Aspergillosis is an opportunistic mycosis with significant impact on immunocompromised patients; available data in Paraguay are scarce.
Objectives: To characterize patients diagnosed with aspergillosis whose samples were sent to the Mycology section of the Central Public Health Laboratory during the period 2000-2019.
Methods: A descriptive, retrospective study of clinical records from patients with positive specimens for Aspergillus genus.
Results: Fifty-four patients were diagnosed with aspergillosis: Otomycosis 21 (38.9%), chronic pulmonary aspergillosis 17 (31.5%), acute and chronic sinusitis 5 (9.2%), invasive aspergillosis 4 (7.4%), onychomycosis 3 (5.6%), allergic bronchopulmonary aspergillosis 2 (3.7%), and keratitis 2 (3.7%). There were 56 isolates: Aspergillus section Fumigati 26 (46.4%), A. section Flavi 15 (26.8%), A. section Nigri 13 (23.2%), A. section Terrei 1 (1.8%), and Aspergillus glaucus 1 (1.8%). Microbiological diagnostic methods included fresh examination, staining, culture, and serology testing.
Conclusions: Multiple cases of aspergillosis were reported over a 20-year period. Otomycosis, predominantly in adults, was the most prevalent form of aspergillosis. In chronic rhinopulmonary forms, tuberculosis, tumors, chronic obstructive disease, cystic fibrosis, and asthma were the predisposing factors. Invasive aspergillosis was predominantly observed in pediatric patients, where autoimmune diseases and leukemias were the primary risk factors. Aspergillus section Fumigati was the predominant isolate, followed by Aspergillus section Flavi and Aspergillus section Nigri.
Downloads
References
(1) Segal BH. Aspergillosis. N Engl J Med [Internet]. 2009;360(18):1870-1884. https://doi.org/10.1056/NEJMra0808853
(2) Bongomin F, Gago S, Oladele R, Denning D. Global and Multi-National Prevalence of Fungal Diseases – Estimate Precision. J fungi (Basel) [Internet]. 2017;3(4):57. https://doi.org/10.3390/jof3040057
(3) Ferreira-Gomes FJ, Motta RR. Incidences of Aspergillus sp. infections in Brazil. Contrib cienc soc [Internet] 2023;16(12):29142–54. https://doi.org/10.55905/revconv.16n.12-004
(4) Valenzuela P, Legarraga P, Rabagliati R. Epidemiología de la enfermedad fúngica invasora por hongos filamentosos en el período 2005 a 2015, en un hospital universitario en Santiago, Chile Rev chil infectol [Internet]. 2019;36(6):732-41. https://doi.org/10.4067/S0716-10182019000600732
(5) Rabagliati R, Fuentes G, Guzmán AM, Orellana E, Oporto J, Aedo I, et al. Enfermedad fúngica invasora en pacientes hemato-oncológicos y receptores de trasplante de precursores hematopoyéticos bajo la perspectiva de los criterios diagnósticos EORTC/MSG. Rev chil infectol [Internet]. 2009;26(3):212-9. https://doi.org/10.4067/S0716-10182009000400002
(6) Valencia Y, Cáceres DH, de-Bedout C, Cano LE, Restrepo Á. Frequency of Invasive Fungal Disease in Adults: Experience of a Specialized Laboratory in Medellín, Colombia (2009-2015). J Fungi (Basel) [Internet]. 2020;6(1):39. https://doi.org/10.3390/jof6010039
(7) Goyeneche A, Rodríguez-Oyuela J, Sánchez G, Firacative C. Clinical and Epidemiological Profile of Patients with Invasive Aspergillosis from a Fourth Level Hospital in Bogota, Colombia: A Retrospective Study. J Fungi (Basel) [Internet]. 2021;7(12):1092. https://doi.org/10.3390/jof7121092
(8) Román-Montes CM, Gonzalez-Lara MF, Ponce de Leon A, Valenzuela-Almada MO, Rangel-Cordero A. 1696. Epidemiology, Clinical Characteristics and Outcomes of Invasive Aspergillosis in a Tertiary Care Hospital in Mexico. Open Forum Infect Dis [Internet]. 2019;6(Supp 2):S621. https://doi.org/10.1093/ofid/ofz360.1560
(9) Notejane M, Barrios P, Lombardo V, Nogueira V, Fernández N, Giachetto G. Infecciones fúngicas invasivas en niños hospitalizados en un centro de referencia de Uruguay. Arch Pediatr Urug [Internet]. 2023;94(1):e205. Disponible en: http://www.scielo.edu.uy/scielo.php?script=sci_arttext&pid=S1688-12492023000101205
(10) Lemus-Espinoza D, Maniscalchi MT. Micosis sistémicas en pacientes del estado Anzoátegui, Venezuela, 2009-2018. RSVM [Internet]. 2021;41(1-2):27-32. Disponible en: http://saber.ucv.ve/ojs/index.php/rev_vm/article/view/23965
(11) Cadena J, Thompson GR, Patterson TF. Aspergillosis: Epidemiology, Diagnosis, and Treatment. Infect Dis Clin North Am [Internet]. 2021;35(2):415-34. https://doi.org/10.1016/j.idc.2021.03.008
(12) Kanaujia R, Singh S, Rudramurthy SM. Aspergillosis: an Update on Clinical Spectrum, Diagnostic Schemes, and Management. Curr Fungal Infect Rep [Internet]. 2023;17:144-155. https://doi.org/10.1007/s12281-023-00461-5
(13) Sarigüzel FM, Koç AN, Sağiroğlu P, Atalay MA, Borlu A, Canöz Ö, et al. Molecular epidemiology and antifungal susceptibilities of Aspergillus species isolated from patients with invasive aspergillosis. Rev Assoc Med Bras (1992) [Internet]. 2023;69(1):44-50. https://doi.org/10.1590/1806-9282.20220441
(14) Barraza M, Barnafi N, Ortiz G, Torres JP, Coria P, Catalán P, et al. Evaluation of the prescription, consumption and costs of antifungal drugs in a pediatric hospital in Chile Rev Chilena Infectol [Internet]. 2018;35(4):351-7. https://doi.org/10.4067/s0716-10182018000400351
(15) De Hoog GS, Guarro J, Gené J, Figueras MJ. Atlas of clinical fungi. 2ª ed. Reus, España: Centraabureau voor Schimmelcultures; 2000. Available from: https://www.atlasclinicalfungi.org/
(16) Koneman E, Roberts G. Micología práctica de laboratorio. 3ª ed. Buenos Aires: Panamericana; 1987.
(17) Linstrom C, Lucente F. Diseases of the external ear. In: Bailey J, Johnson T, Newlands D, editors. Head & neck surgery-otolaryngology. Philadelphia, PA: Lippincott Williams & Wilkins; 2014. p. 1987-2002.
(18) Ali K, Hamed M, Hassan H, Esmail A, Sheneef A. Identification of fungal pathogens in otomycosis and their drug sensitivity: our experience. Int Arch Otorhinolaryngol [Internet]. 2018;22(4):400-3. https://doi.org/10.1055/s-0038-1626702
(19) Satish HS, Viswanatha B, Manjuladevi M. A clinical study of otomycosis. IORS J Dental Med Sci [Internet]. 2013;5(2):57–62. https://doi.org/10.9790/0853-0525762
(20) Alarid-Coronel J, Celis-Aguilar E, Escobar-Aispuro L, Muñoz-Estrada V. Otomycosis in inmuno competent patients: clinical and mycological features. Our experience with 40 cases. Clin Otolaryngol [Internet]. 2018:43(1):373-7. https://doi.org/10.1111/coa.12966
(21) Jimenez-García L, Celis-Aguilar E, Díaz-Pavón G, Muñoz-Estrada V, Castro-Urquizo Á, Hernández-Castillo N, et al. Efficacy of topical clotrimazole vs. topical tolnaftate in the treatment of otomycosis. A randomized controlled clinical trial. Braz J Otorhinolaryngol [Internet]. 2020;86(3):300-7. https://doi.org/10.1016/j.bjorl.2018.12.007
(22) Olum R, Osaigbovo II, Baluku JB, Stemler J, Kwizera R, Bongomin F. Mapping of chronic pulmonary aspergillosis in Africa. J Fungi (Basel) [Internet]. 2021;7(10):790. https://doi.org/10.3390/jof7100790
(23) Guinea J, Torres-Narbona M, Gijón P, Muñoz P, Pozo F, Peláez T, et al. Pulmonary aspergillosis in patients with chronic obstructive pulmonary disease: Incidence, risk factors, and outcome. Clin Microbiol Infect [Internet]. 2010;16(7):870–7. https://doi.org/10.1111/j.1469-0691.2009.03015.x
(24) Denning D, Pleuvry A, Cole D. Global burden of chronic pulmonary aspergillosis as a sequel to pulmonary tuberculosis. Bull World Health Organ [Internet]. 2011:89(12):864-72. https://doi.org/10.2471/BLT.11.089441
(25) Ministerio de Salud Pública y Bienestar Social. Indicadores Básicos de Salud [Internet]. Asunción, Paraguay; 2019. Disponible en: http://portal.mspbs.gov.py/digies/wp-content/uploads/2020/01/Indicadores-Basicos-de-Salud-IBS-2019.pdf
(26) Macedo-Viñas M, Denning D. Estimating the burden of serious fungal infections in Uruguay. J Fungi (Basel) [Internet]. 2018;4(1):37. https://doi.org/10.3390/jof4010037
(27) Ministerio de Salud Pública y Bienestar Social. Cada año, más de 10 mil paraguayos son diagnosticados con EPOC [Internet]. Asunción: Gobierno del Paraguay; 2020. [Consultado 2024 jun 03]. Disponible en: https://www.mspbs.gov.py/portal/22151/cada-antildeo-mas-de-10-mil-paraguayos-son-diagnosticados-con-epoc.html
(28) Denning D, Cadranel J, Beigelman-Aubry C, Ader F, Chakrabarti A, Blot S, et al. Chronic pulmonary aspergillosis: rationale and clinical guidelines for diagnosis and management. Eur Respir J [Internet]. 2016;47:45–68. https://doi.org/10.1183/13993003.00583-2015
(29) Uffredi ML, Mangiapan G, Cadranel J, Kac G. Significance of Aspergillus fumigatus isolation from respiratory specimens of nongranulocytopenic patients. Eur J Clin Microbiol Infect Dis [Internet]. 2003;22:457–62. https://doi.org/10.1007/s10096-003-0970-y
(30) Barac A, Kosmidis C, Alastruey-Izquierdo A, Salzer HJF. Chronic pulmonary aspergillosis update: a year in review. Med Mycol [Internet]. 2019;57:S104–9. https://doi.org/10.1093/mmy/myy070
(31) Kosmidis C, Denning DW. The clinical spectrum of pulmonary aspergillosis. Thorax [Internet]. 2015;70(3):270–7. https://doi.org/10.1136/thoraxjnl-2014-206291
(32) Oladele RO, Irurhe NK, Foden P, Akanmu AS, Gbaja-Biamila T, Nwosu A, et al. Chronic pulmonary aspergillosis as a cause of smear-negative TB and/or TB treatment failure in Nigerians. Int J Tuberc Lung Dis [Internet]. 2017;21(9):1056–61. https://doi.org/10.5588/ijtld.17.0060
(33) Rozaliyani A, Rosianawati H, Handayani D, Agustin H, Zaini J, Syam R, et al. Chronic pulmonary aspergillosis in post tuberculosis patients in Indonesia and the role of LDBio Aspergillus ICT as part of the diagnosis scheme. J Fungi [Internet]. 2020;6(4):318. https://doi.org/10.3390/jof6040318
(34) Namusobya M, Bongomin F, Mukisa J, Olwit WK, Batte C, Mukashyaka C, et al. Chronic pulmonary aspergillosis in patients with active pulmonary tuberculosis with persisting symptoms in Uganda. Mycoses [Internet]. 2022;65(6):625–34. https://doi.org/10.1111/myc.13444
(35) Agarwal R, Vishwanath G, Aggarwal AN, Garg M, Gupta D, Chakrabarti A. Itraconazole in chronic cavitary pulmonary aspergillosis: a randomised controlled trial and systematic review of literature. Mycoses [Internet]. 2013;56(5):559–70. https://doi.org/10.1111/myc.12075
(36) Saito T, Fujiuchi S, Tao Y, Sasaki Y, Ogawa K, Suzuki K, et al. Efficacy and safety of voriconazole in the treatment of chronic pulmonary aspergillosis: experience in Japan. Infection [Internet]. 2012;40:661–7. https://doi.org/10.1007/s15010-012-0322-x
(37) Restrepo-Gualteros SM, Jaramillo-Barberi LE, Rodríguez-Martínez CE, Camacho-Moreno G, Niño G. Aspergilosis pulmonar invasiva: reporte de un caso. Biomed [Internet]. 2015;35(2):171–6. Disponible en: https://revistabiomedica.org/index.php/biomedica/article/view/2357/2719
(38) Blazicevich L, Camacho LMC, Carrizosa J, Cornejo W. Hallazgos clínicos y radiológicos de dos casos de aspergilosis del sistema nervioso central en niños. Rev Neurol [Internet]. 2003;36(7):632–5. https://doi.org/10.33588/rn.3607.2002436
(39) Botero V, García VH, Delgado A, Aristizabal AM, Gomez C, Caicedo LA, et al. Aspergilosis pulmonar invasora en pacientes pediátricos con trasplante hepático, a propósito de una sobreviviente. Rev Chil Pediatría [Internet]. 2018;89(2):241–5. https://doi.org/10.4067/S0370-41062018000200241
(40) Vargas-Soler J, Morales-Camacho WJM, Flórez-Rodríguez CXF, Navarro-Mejía JA, Guerrero CF, Morales-Camacho MA. Aspergillus flavus endocarditis in an immunocompetent child. Case Rep. Med Mycol Case Rep [Internet]. 2018;22:48–51. https://doi.org/10.1016/j.mmcr.2018.08.003
(41) Camargo JF, Husain S. Immune correlates of protection in human invasive aspergillosis. Clin Infect Dis [Internet]. 2014;59(4):569–77. https://doi.org/10.1093/cid/ciu337
(42) Merad Y, Derrar H, Belmokhtar Z, Belkacemi M. Aspergillus genus and its various human superficial and cutaneous features. Pathogens [Internet]. 2021;10(6):643. https://doi.org/10.3390/pathogens10060643
(43) Wang W, Zhao CY, Zhou JY, Wang YD, Shen C, Zhou DF, et al. Invasive pulmonary aspergillosis in patients with HBV-related liver failure. Eur J Clin Microbiol Infect Dis [Internet]. 2011;30:661–7. https://doi.org/10.1007/s10096-010-1137-2
(44) Vonberg RP, Gastmeier P. Nosocomial aspergillosis in outbreak settings. J Hosp Infect [Internet]. 2006;63(3):246–54. https://doi.org/10.1016/J.JHIN.2006.02.014
(45) Patterson TF, Thompson GR, Denning DW, Fishman JA, Hadley S, Herbrecht R, et al. Practice Guidelines for the Diagnosis and Management of Aspergillosis: Update by the Infectious Diseases Society of America. Clin Infect Dis [Internet]. 2016;63(4):e1–e60. https://doi.org/10.1093/cid/ciw326
(46) Lestrade PPA, Meis JF, Melchers WJG, Verweij PE. Triazole resistance in Aspergillus fumigatus: recent insights and challenges for patient management. Clin Microbiol and Infect [Internet]. 2019;25(7):799–806. https://doi.org/10.1016/j.cmi.2018.11.027
(47) Resendiz-Sharpe A, Dewaele K, Merckx R, Bustamante B, Vega-Gomez MC, Rolon M, et al. Triazole-resistance in environmental Aspergillus fumigatus in Latin America and African Countries. J Fungi (Basel) [Internet]. 2021;7(4):292. https://doi.org/10.3390/jof7040292
Published
How to Cite
Issue
Section
License
Copyright (c) 2024 Iatreia
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
Papers published in the journal are available for use under the Creative Commons license, specifically Attribution-NonCommercial-ShareAlike 4.0 International.
The papers must be unpublished and sent exclusively to the Journal Iatreia; the author uploading the contribution is required to submit two fully completed formats: article submission and authorship responsibility.
