TITLE:
Invasive Infections for Endemic Fungi in Pediatrics in Guatemala
AUTHORS:
Julio Werner Juárez Lorenzana, María Luisa Navarro Gómez, Andrea Palma
KEYWORDS:
Cryptococcosis, Histoplasmosis, Coccidioidomycosis, Invasive Infection, Pediatrics, Immunodeficiency, HIV (Human Immunodeficiency Virus)
JOURNAL NAME:
World Journal of AIDS,
Vol.8 No.3,
August
23,
2018
ABSTRACT: Background: Invasive fungal infections are common opportunistic diseases in
patients with AIDS, other conditions related to immunodeficiency and healthy
infants. Most publications on this subject are related to industrialized
countries, and in adult population, with limited data in Latin America (except
for Brazil, Colombia, and Argentina), and especially in pediatric population.
These patients present a variety of clinical manifestations representing a
diagnostic and therapeutic challenge for the health system. Objective:
The objective of the study is to describe the epidemiological and laboratory
characteristics of children with invasive fungal infections in Guatemala. Methods:
A review of the microbiology service database was carried out at Roosevelt
Hospital in Guatemala. Positive cultures were taken from children under 15
years of age, in a period of seven years, from 2007 to 2014, with its
corresponding medical history. Results: Finally, 23 isolates were documented but
only 15 patients were included in the study with complete information; 10 Histoplasma capsulatum cases, 4 Cryptococcus
neoformans cases and 1 Coccidioidessp case. The average
age was 7 years old for Histoplasma and 9 years old for Criptococo, with an age
range from 6 months to 14 years. Around 60% of the patients were older
than 5 years, of which, more than two-thirds were HIV positive children without
antiretroviral therapy, who presented an invasive fungal infection at the time
of HIV diagnosis. These infections are endemic in Guatemala, so the
distribution was mostly uniform. Around 80% of the patients had some disease
related to immunodeficiency and 70% were infected with human immunodeficiency
virus (HIV). The microbiological isolation was from blood, bone marrow, lymph
nodes, cerebrospinal fluid and urine. The predominant laboratory findings were
decrease in hematological series. The most frequent clinical syndromes were
fever, adenomegaly, hepatosplenomegaly, respiratory, gastrointestinal,
neurological and weight loss.
Mortality
rate was 53% (from them, 62% were HIV positive). From these patients, an87% did
not receive antifungal treatment in time due to late diagnosis of the
infection. Conclusions: These infections should be considered when
treating pediatric patients from tropical regions, with nonspecific systemic
symptoms and signs, lymph node involvement and hematological alterations
related to the mononuclear phagocytic system, mainly if they are patients
infected by HIV in an advanced stage, infants, or children with a disease that
weakens the immune system. When there is a high suspicion of a fungal
infection, screening for HIV is mandatory; cultures should be taken early and
together with rapid diagnostic tests. An antifungal treatment should be started
immediately and then modified accordingly to laboratory results.