{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T13:20:07Z","timestamp":1790774407476,"version":"4.1.0"},"reference-count":24,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2019,6,9]],"date-time":"2019-06-09T00:00:00Z","timestamp":1560038400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JoF"],"abstract":"<jats:p>The buffy coat is obtained routinely for disseminated histoplamosis (DH) diagnosis in Cear\u00e1, Brazil. The aim of this study is to describe the accuracy of staining smears for Histoplasma in the buffy coat of AIDS-patients with DH. From 2012\u20132013, all results of stained buffy coat smears and culture for fungi performed at S\u00e3o Jos\u00e9 Hospital were recorded. In total, 489 buffy coats of 361 patients were studied; 19\/361 (5.3%; 95%CI = 2.9\u20137.6%) had positive direct examination stained smears for Histoplasma and 61\/361 (16.9%; 95%CI = 13.0\u201320.8%) had growth in culture. For those with positive Histoplasma cultures, the CD4 count was significantly lower (139.3 vs. 191.7cells\/\u00b5L; p = 0.014) than others, and death was 18%. The sensitivity and specificity of stained smears was 25.9% and 100%, respectively. A second test, performed up to 36 days from the first one, increased the sensitivity of stained smears to 32.2%. Stained smears of buffy coat have low accuracy; nonetheless, they are easy to perform and can give a quick diagnosis in low-resource endemic areas. Despite the decrease in mortality, it is not yet to the low levels observed in areas that have better and more efficient methods.<\/jats:p>","DOI":"10.3390\/jof5020047","type":"journal-article","created":{"date-parts":[[2019,6,10]],"date-time":"2019-06-10T03:16:51Z","timestamp":1560136611000},"page":"47","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Accuracy of Buffy Coat in the Diagnosis of Disseminated Histoplasmosis in AIDS-Patients in an Endemic Area of Brazil"],"prefix":"10.3390","volume":"5","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3301-3057","authenticated-orcid":false,"given":"Terezinha M. J. Silva","family":"Leit\u00e3o","sequence":"first","affiliation":[{"name":"Departamento de Sa\u00fade Comunit\u00e1ria, Faculdade de Medicina, Universidade Federal do Cear\u00e1, Rodolfo T\u00e9ofilo, Fortaleza, Cear\u00e1 60430-160, Brasil"},{"name":"Hospital S\u00e3o Jos\u00e9 de Doen\u00e7as Infecciosas, Parquel\u00e2ndia, Fortaleza, Cear\u00e1 60455-610, Brasil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio M. P.","family":"Oliveira Filho","sequence":"additional","affiliation":[{"name":"Departamento de Sa\u00fade Comunit\u00e1ria, Faculdade de Medicina, Universidade Federal do Cear\u00e1, Rodolfo T\u00e9ofilo, Fortaleza, Cear\u00e1 60430-160, Brasil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jos\u00e9 Evaldo P.","family":"Sousa Filho","sequence":"additional","affiliation":[{"name":"Departamento de Sa\u00fade Comunit\u00e1ria, Faculdade de Medicina, Universidade Federal do Cear\u00e1, Rodolfo T\u00e9ofilo, Fortaleza, Cear\u00e1 60430-160, Brasil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8628-968X","authenticated-orcid":false,"given":"Bruno M.","family":"Tavares","sequence":"additional","affiliation":[{"name":"Hospital S\u00e3o Jos\u00e9 de Doen\u00e7as Infecciosas, Parquel\u00e2ndia, Fortaleza, Cear\u00e1 60455-610, Brasil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jac\u00f3 R. L.","family":"Mesquita","sequence":"additional","affiliation":[{"name":"Hospital S\u00e3o Jos\u00e9 de Doen\u00e7as Infecciosas, Parquel\u00e2ndia, Fortaleza, Cear\u00e1 60455-610, Brasil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lu\u00eds Arthur B. G.","family":"Farias","sequence":"additional","affiliation":[{"name":"Departamento de Sa\u00fade Comunit\u00e1ria, Faculdade de Medicina, Universidade Federal do Cear\u00e1, Rodolfo T\u00e9ofilo, Fortaleza, Cear\u00e1 60430-160, Brasil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rosa S.","family":"Mota","sequence":"additional","affiliation":[{"name":"Departamento de Sa\u00fade Comunit\u00e1ria, Faculdade de Medicina, Universidade Federal do Cear\u00e1, Rodolfo T\u00e9ofilo, Fortaleza, Cear\u00e1 60430-160, Brasil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9397-3204","authenticated-orcid":false,"given":"Mathieu","family":"Nacher","sequence":"additional","affiliation":[{"name":"Centre d\u2019Investigation Clinique 1424 Antilles-Guyane, Inserm, Centre Hospitalier de Cayenne, 97 300 Cayenne, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1425-5912","authenticated-orcid":false,"given":"Lisandra S.","family":"Damasceno","sequence":"additional","affiliation":[{"name":"Hospital S\u00e3o Jos\u00e9 de Doen\u00e7as Infecciosas, Parquel\u00e2ndia, Fortaleza, Cear\u00e1 60455-610, Brasil"},{"name":"Faculdade de Medicina, Centro Universit\u00e1rio Unichristus, Coc\u00f3, Fortaleza, Cear\u00e1 60190-060, Brasil"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2019,6,9]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"207","DOI":"10.1016\/j.idc.2015.10.009","article-title":"Histoplasmosis","volume":"30","author":"Wheat","year":"2016","journal-title":"Infect. Dis. Clin. N. Am."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"370","DOI":"10.3201\/eid2203.151117","article-title":"Epidemiology of histoplasmosis outbreaks, United States, 1938\u20132013","volume":"22","author":"Benedict","year":"2016","journal-title":"Emerg. Infect. Dis."},{"key":"ref_3","first-page":"225","article-title":"Surface Architecture of Histoplasma Capsulatum","volume":"2","author":"Cerqueira","year":"2011","journal-title":"Front. Microbiol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"227","DOI":"10.1590\/0037-8682-0327-2015","article-title":"Spatial distribution of disseminated histoplasmosis and AIDS co-infection in an endemic area of Northeastern Brazil","volume":"49","author":"Correia","year":"2016","journal-title":"Rer. Soc. Bras. Med. Trop."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"406","DOI":"10.1111\/myc.12175","article-title":"Disseminated histoplasmosis in HIV-infected patients: Determinants of relapse and mortality in a north-eastern area of Brazil","volume":"57","author":"Damasceno","year":"2014","journal-title":"Mycoses"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"167","DOI":"10.1097\/QAD.0000000000000961","article-title":"Disseminated histoplasmosis in Central and South America, the invisible elephant: The lethal blind spot of international health organizations","volume":"30","author":"Nacher","year":"2016","journal-title":"AIDS"},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Nacher, M., Adenis, A., Mc Donald, S., Gomes, M.D.S.M., Singh, S., Lima, I.L., Leite, R.M., Hermelijn, S., Wongsokarijo, M., and Eer, M.V. (2013). Disseminated histoplasmosis in HIV-infected patients in South America: A neglected killer continues on its rampage. PLoS Negl. Trop. Dis., 7.","DOI":"10.1371\/journal.pntd.0002319"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1612","DOI":"10.1128\/JCM.02430-16","article-title":"Laboratory diagnostics for histoplasmosis","volume":"55","author":"Azar","year":"2017","journal-title":"J. Clin. Microbiol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1016\/S0732-8893(02)00367-X","article-title":"Diagnosis of histoplasmosis by antigen detection based upon experience at the histoplasmosis reference laboratory","volume":"43","author":"Wheat","year":"2002","journal-title":"Diagn. Microbiol. Infect. Dis."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"443","DOI":"10.1097\/01.qco.0000244049.15888.b9","article-title":"American histoplasmosis in developing countries with a special focus on patients with HIV: Diagnosis, treatment, and prognosis","volume":"19","author":"Couppie","year":"2006","journal-title":"Curr. Opin. Infect. Dis."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"479","DOI":"10.1590\/0037-8682-0425-2017","article-title":"Predictive factors for disseminated histoplasmosis in AIDS patients with fever admitted to a reference hospital in Brazil","volume":"51","author":"Ramos","year":"2018","journal-title":"Rer. Soc. Bras. Med. Trop."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"484","DOI":"10.1016\/j.trstmh.2012.05.003","article-title":"Histoplasmosis in HIV-positive patients in Cear\u00e1, Brazil: Clinical-laboratory aspects and in vitro antifungal susceptibility of Histoplasma capsulatum isolates","volume":"106","author":"Brilhante","year":"2012","journal-title":"Trans. R. Soc. Trop. Med. Hyg."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"729","DOI":"10.1055\/s-0035-1562899","article-title":"Histoplasmosis: Up-to-date evidence-based approach to diagnosis and management","volume":"36","author":"Hage","year":"2015","journal-title":"Semin. Respir. Crit. Care Med."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Nacher, M., Blanchet, D., Bongomin, F., Chakrabarti, A., Couppi\u00e9, P., Demar, M., Denning, D.W., Djossou, F., Epelboin, L., and Govender, N. (2018). Histoplasma capsulatum antigen detection tests as an essential diagnostic tool for patients with advanced HIV disease in low and middle income countries: A systematic review of diagnostic accuracy studies. PLoS Negl. Trop. Dis., 12.","DOI":"10.1371\/journal.pntd.0006802"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"115","DOI":"10.1128\/CMR.00027-06","article-title":"Histoplasmosis: A clinical and laboratory update","volume":"20","author":"Kauffman","year":"2007","journal-title":"Clin. Microbiol. Rev."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1813","DOI":"10.1086\/588660","article-title":"Revised definitions of invasive fungal disease from the European Organization for Research and Treatment of Cancer\/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group (EORTC\/MSG) Consensus Group","volume":"46","author":"Donnelly","year":"2008","journal-title":"Clin. Infect. Dis."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"e13","DOI":"10.1056\/NEJMicm1809792","article-title":"Disseminated Histoplasmosis","volume":"380","author":"Sevestre","year":"2019","journal-title":"N. Engl. J. Med."},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Nacher, M., Adenis, A., Sambourg, E., Huber, F., Abboud, P., Epelboin, L., Epelboin, L., Mosnier, E., Vantilcke, V., and Dufour, J. (2014). Histoplasmosis or tuberculosis in HIV-infected patients in the amazon: What should be treated first?. PLoS Negl. Trop. Dis., 8.","DOI":"10.1371\/journal.pntd.0003290"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1590\/S0037-86822010000100007","article-title":"Clinical and evolutionary characteristics of 134 patients with disseminated histoplasmosis associated with AIDS in the State of Ceara","volume":"43","author":"Pontes","year":"2010","journal-title":"Rev. Soc. Bras. Med. Trop."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"600","DOI":"10.4269\/ajtmh.2006.74.600","article-title":"Risk factors for death in acquired immunodeficiency syndrome\u2013associated disseminated histoplasmosis","volume":"74","author":"Takeda","year":"2006","journal-title":"Am. J. Trop. Med Hyg."},{"key":"ref_21","unstructured":"Cano-Torres, J.O., Olmedo-Reneaum, A., Esquivel-S\u00e1nchez, J.M., Camiro-Zu\u00f1iga, A., P\u00e9rez-Carrisoza, A., Madrigal-Iberri, C., Flores-Miranda, R., Ram\u00edrez-Gonz\u00e1lez, L.E., and Belaunzar\u00e1n-Zamudio, P.F. (2019). Progressive disseminated histoplasmosis in Latin America and the Caribbean in people receiving highly active antiretroviral therapy for HIV infection: A systematic review. Med. Mycol., 143."},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Adenis, A., Nacher, M., Hanf, M., Vantilcke, V., Boukhari, R., Blachet, D., Demar, M., Aznar, C., Carme, B., and Couppie, P. (2014). HIV-associated histoplasmosis early mortality and incidence trends: From neglect to priority. PLoS Negl. Trop. Dis., 8.","DOI":"10.1371\/journal.pntd.0003100"},{"key":"ref_23","first-page":"S158","article-title":"Evaluation of a Histoplasma antigen Lateral Flow Assay for the rapid diagnosis of progressive disseminated histoplasmosis in AIDS patients","volume":"56","author":"Caceres","year":"2018","journal-title":"Med. Mycol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"448","DOI":"10.1093\/cid\/cir435","article-title":"A multicenter evaluation of tests for diagnosis of histoplasmosis","volume":"53","author":"Hage","year":"2011","journal-title":"Clin. Infect. Dis."}],"container-title":["Journal of Fungi"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2309-608X\/5\/2\/47\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T12:57:09Z","timestamp":1760187429000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2309-608X\/5\/2\/47"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,6,9]]},"references-count":24,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2019,6]]}},"alternative-id":["jof5020047"],"URL":"https:\/\/doi.org\/10.3390\/jof5020047","relation":{},"ISSN":["2309-608X"],"issn-type":[{"value":"2309-608X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,6,9]]}}}