Advertisement

AIDS-Related Mycoses in the Paediatric Population

  • B. E. Ekeng
  • O. O. Olusoga
  • R. O. OladeleEmail author
Pediatric Fungal Infections (D Corzo-Leon, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Pediatric Fungal Infections

Abstract

Purpose of Review

Fungal infections account for significant morbidity and mortality in HIV-infected children particularly in developing countries where there is lack of skilled personnel and infrastructure to make the appropriate diagnosis. This is further compounded by poor availability and accessibility of the antifungals needed to treat these infections. The purpose of this review is to highlight the paucity of data on AIDS-related mycoses in the paediatric age group and make appropriate recommendations to address challenges associated with mycoses in this population.

Recent Findings

These infections are categorised in two broad groups in this population: mucocutaneous, which commonly affects nutrition and adherence to therapy and invasive fungal infections which are life-threatening. A literature search revealed a total of 29 published literatures across all AIDS-related mycoses in the paediatric population.

Summary

Research to determine the true burden of the problem and greater funding with implementation of a package of care that will result in substantial reductions in morbidity and mortality in relation to AIDS-related mycoses in children are needed. It is imperative that the programmatic optimal package of care for children with advanced HIV disease is designed and implemented.

Keywords

Mycoses Paediatric Advanced HIV disease HIV/AIDS LMICs 

Notes

Compliance with Ethical Standards

Conflict of Interest

Bassey Ekeng, Omosalewa Olusoga and Rita Oladele declare no conflicts of interest relevant to this manuscript.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    • Ford N, Meintjes G, Calmy A, Bygrave H, Migone C, Vitoria M, et al. Managing advanced HIV disease in a public health approach. Clin Infect Dis. 2018;66(S2):S106–10 This is a review article that highlights the challenges of opportunistic infections with advanced HIV disease.PubMedPubMedCentralCrossRefGoogle Scholar
  2. 2.
    •• Guidelines for managing advanced HIV disease and rapid initiation of antiretroviral therapy, July 2017. Geneva: World Health Organization; 2017. Licence: CC BY-NC-SA 3.0 IGO. This is the current guidelines for diagnosing, therapeutic and preventive management of opportunistic infections in advanced HIV disease. Google Scholar
  3. 3.
    Armstrong-James D, Meintjes G, Brown GD. A neglected epidemic: Fungal infections in HIV/AIDS. Trends Microbiol. 2014;22(3).PubMedCrossRefGoogle Scholar
  4. 4.
    Marques SA, Robles AM, Tortorano AM, Tuculet MA, Negroni R, Mendes RP. Mycoses associated with AIDS in the Third World. Med Mycol. 2000;38(Supplement 1):269–79.PubMedCrossRefGoogle Scholar
  5. 5.
    •• Frigati L, Archary M, Rabie H, Penazzato M, Ford N. Priorities for decreasing morbidity and mortality in children with advanced HIV disease. Clin Infect Dis. 2018;66(S2):S147–S51 Very important review highlighting the knowledge gaps, offering possible solutions and challenging the status quo. PubMedPubMedCentralCrossRefGoogle Scholar
  6. 6.
    Brown GD, Meintjes G, Kolls JK, Gray C, Horsnell W. AIDS-related mycoses: the way forward. Trends Microbiol. 2014;22(3):107–9.  https://doi.org/10.1016/j.tim.2013.12.008.CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    King J, Pana Z, Lehrnbecher T, Steinbach WJ, Warris A. Recognition and clinical presentation of invasive fungal disease in neonates and children. Journal of the Paediatric Infectious Diseases Society. 2017;6(S1):S12–21.CrossRefGoogle Scholar
  8. 8.
    Katragkou A, Fisher BT, Groll AH, Roilides E, Walsh TJ. Diagnostic imaging and invasive fungal diseases in children. J Paediatr Infect Dis Soc. 2017;6(1):S22–31.  https://doi.org/10.1093/jpids/pix055.CrossRefGoogle Scholar
  9. 9.
    Seth R, Xess I, Jana M. Diagnosis of invasive fungal infections in children. Indian Paediatr. 2019;56.PubMedCrossRefGoogle Scholar
  10. 10.
    Mendiratta V, Mittal S, Jain A, Chande R. Mucocutaneous manifestations in children with human immunodeficiency virus infection. Indian Journal of Dermatology, Venereology and Leprol. 2010;76:458–66.  https://doi.org/10.4103/0378-6323.69041.CrossRefGoogle Scholar
  11. 11.
    Sing Y, Govender D. Infections in the HIV-infected child. Diagn Histopathol. 2009;15(5):251–63.CrossRefGoogle Scholar
  12. 12.
    Gona P, Van Dyke RB, Williams PL, et al. Incidence of opportunistic and other infections in HIV-infected children in the HAART era. J Am Med Assoc. 2006;296(3):292–300.CrossRefGoogle Scholar
  13. 13.
    Chiou CC, Groll AH, Mavrogiorgos N, Wood LV, Walsh TJ. Esophageal candidiasis in human immunodeficiency virus-infected pediatric patients after the introduction of highly active antiretroviral therapy. Paediatr Infect Dis J. 2002;21(5):388–92.CrossRefGoogle Scholar
  14. 14.
    Walsh TJ, Gonzalez C, Roilides E, et al. Fungemia in children infected with the human immunodeficiency virus: new epidemiologic patterns, emerging pathogens, and improved outcome with antifungal therapy. Clin Infect Dis. 1995;20(4):900–6.PubMedCrossRefGoogle Scholar
  15. 15.
    Dankner WM, Lindsey JC, Levin MJ, Paediatric ACTGPT. Correlates of opportunistic infections in children infected with the human immunodeficiency virus managed before highly active antiretroviral therapy. Paediatr Infect Dis J. 2001;20(1):40–8.CrossRefGoogle Scholar
  16. 16.
    Leibovitz E, Rigaud M, Chandwani S, et al. Disseminated fungal infections in children infected with human immunodeficiency virus. Paediatr Infect Dis J. 1991;10(12):888–94.Google Scholar
  17. 17.
    Gonzalez CE, Venzon D, Lee S, Mueller BU, Pizzo PA, Walsh TJ. Risk factors for fungemia in children infected with human immunodeficiency virus: a case-control study. Clin Infect Dis. 1996;23(3):515–21.PubMedCrossRefGoogle Scholar
  18. 18.
    Wasserman S, Engel ME, Griesel R, Mendelson M. Burden of pneumocystis pneumonia in HIV-infected adults in sub-Saharan Africa: a systemic review and meta-analysis. BMC Infetious Diseases. 2016;16(1):482.CrossRefGoogle Scholar
  19. 19.
    Walzer PD, Evans HE, Copas AJ, Edwards SG, Grant AD, Miller RF. Early predictors of mortality from Pneumocystis jirovecii pneumonia in HIV-infected patients: 1985–2006. Clin Infect Dis. 2008;46:625–33.PubMedPubMedCentralCrossRefGoogle Scholar
  20. 20.
    Elvin KM, Lumbwe CM, Luo NP, Bjorkman A, Kallenius G, Linder E. Pneumocystis carinii is not a major cause of pneumonia in HIV infected persons in Lusaka, Zambia. Tropical Med Hygiene. 1989;83(4):553–555s.CrossRefGoogle Scholar
  21. 21.
    Abouya YL, Beaumel A, Lucas S, Dago-Akribi A, Coulibaly G, Konan JB, et al. Pneumocystis carinii pneumonia. An uncommon cause of death in African patients with acquired immunodeficiency syndrome. American Review of Respiratory Disease returns. 1992;145(3):617–201992.CrossRefGoogle Scholar
  22. 22.
    Mayer KH, Fisk DT, Meshnick S, Kazanjian PH. Pneumocystis carinii pneumonia in patients in the developing world who have acquired immunodeficiency syndrome. Clin Infect Dis. 2003;36(1):70–8.CrossRefGoogle Scholar
  23. 23.
    Morris A, Lundgren JD, Masur H, Walzer PD, Hanson DL, Frederick T, et al. Current epidemiology of pneumocystis pneumonia. Emerg Infect Dis. 2004;10(10):1713–20.PubMedPubMedCentralCrossRefGoogle Scholar
  24. 24.
    Lucas S, Goodgame R, Kocjan G, Serwadda D. Absence of Pneumocystosis in Ugandian AIDS patients. AIDS. 1989;3(1):47–8.PubMedCrossRefPubMedCentralGoogle Scholar
  25. 25.
    Karstaedt AS. AIDS-the Baragwanath experience. Part 111. HIV infection in adults at Baragwanath Hospital. South African Med. 1992;82(2):95–7.Google Scholar
  26. 26.
    Carme B, Mboussa J, Andzin, Mbouni E, Mpele P, Datry A. Pneumocystis carinii is rare in AIDS in Central Africa. Transactions of the Royal Society of Tropical Medicine and Hygiene. 1991;85(1):80.PubMedCrossRefPubMedCentralGoogle Scholar
  27. 27.
    Lucas SB, Odida M, Wabinga H. The pathology of severe morbidity and mortality caused by HIV infection in Africa. AIDS. 1991;5:S143.PubMedPubMedCentralGoogle Scholar
  28. 28.
    Atzori C, Bruno A, Chichino G, Gatti S, Scaglia M. Pneumocystis carinii pneumonia and tuberculosis in Tanzanian patients infected with HIV. Trans R Soc Trop Med Hyg. 1993;87(1):55–6.PubMedCrossRefPubMedCentralGoogle Scholar
  29. 29.
    Malin AS, Gwanzura LKZ, Robertson VJ, Musvaire P, Mason PR, Klein S. Pneumocystis carinii pneumonia in Zimbabwe. Lancet. 1995;346(8985):1258–61.PubMedCrossRefPubMedCentralGoogle Scholar
  30. 30.
    Dankner WM, Lindsey JC, Levin MJ, Paediatric ACTGPT. Correlates of opportunistic infections in children infected with the human immunodeficiency virus managed before highly active antiretroviral therapy. Paediatr Infect Dis J. 2001;20(1):40–8.CrossRefGoogle Scholar
  31. 31.
    Norton KI, Kattan M, Rao JS, Cleveland R, Trautwein L, Mellins RB, et al. Chronic radiographic lung changes in children with vertically transmitted HIV-1 infection. Am J Roentgenol. 2001;18;176(6):1553–8.CrossRefGoogle Scholar
  32. 32.
    Nathoo K, Gondo M, Gwanzura L, Mhlanga B, Mavetera T, Mason P. Fatal Pneumocystis carinii pneumonia in HIV-seropositive infants in Harare, Zimbabwe. Transactions of the Royal Society of Tropical Medicine and Hygiene. 2001;95:37–9.  https://doi.org/10.1016/S0035-9203(01)90325-6.CrossRefPubMedGoogle Scholar
  33. 33.
    Lucas SB, Peacock CS, Hounnou A, et al. Disease in children infected with HIV in Abidjan Cote d’voire. Br Med J. 1996;312:335–8.CrossRefGoogle Scholar
  34. 34.
    Ansari NA, Kombe AH, Kenyon TA, Mazhani L, Binkin N, Tappero JW, et al. Pathology and causes of death in a series of human immunodeficiency virus-positive and -negative pediatric referral hospital admissions in Botswana. Pediatr Infect Dis J. 2003;22:43–7 Vol. 22, No. 1.PubMedCrossRefGoogle Scholar
  35. 35.
    Masur H, Kaplan JE, Holmes KK. Guidelines for preventing opportunistic infections among HIV-infected persons—2002. Recommendations of the U.S. Public Health Service and the Infectious Diseases Society of America. In: The Morbidity and Mortality Weekly Report Recommendations and Reports; 2002, Jun 12:51(RR-8). p. 1–52.Google Scholar
  36. 36.
    Vargas SL, Huges WT, Santolaya ME, Ulloa AV, Ponce CA, Cabrera CE, et al. Search for primary infection by Pneumocystis carinii in a cohort of normal, healthy infants. Clin Infect Dis. 2001;32(6):855–61.PubMedCrossRefGoogle Scholar
  37. 37.
    Lanaspa M, Callaghan-Gordo CO, Machevo S, Madrid L, Nhampossa T, Acácio S, et al. High prevalence of Pneumocystis jirovecii pneumonia among Mozambican children < 5 years of age admitted to hospital with clinical severe pneumonia, Clinical Microbiology and Infection. 2015;21:1018.e9–1018.e15.  https://doi.org/10.1016/j.cmi.2015.07.011.PubMedCrossRefPubMedCentralGoogle Scholar
  38. 38.
    • Lowe DM, Rangaka MX, Gordon F, James CD, et al. Pneumocystis jirovecii pneumonia in tropical and low and middle income countries: a systemic review and meta-regression. Plos one. 2013;8(8):e69969 This systematic review is focussed on resource-limited settings where the highest burden of advanced HIV disease is and it addresses PCP which is an AIDS defining infection. PubMedPubMedCentralCrossRefGoogle Scholar
  39. 39.
    •• Panel on Opportunistic Infections in HIV-Exposed and HIV-Infected Children. Guidelines for the prevention and treatment of opportunistic infections in HIV-exposed and HIV-infected children. Department of Health and Human Services. Available at http://aidsinfo.nih.gov/contentfiles/lvguidelines/oi_guidelines_pediatrics.pdf. This panel focussed exclusively on OIs in advanced HIV disease in children; it proffers evidenced-based guidelines for management.
  40. 40.
    Oren I, Hardak E, Finkelstein R, Yigla M, Sprecher H. Polymerase chain reaction-based detection of Pneumocystis jirovecii in bronchoalveolar lavage fluid for the diagnosis of pneumocystis pneumonia. Am J Med Sci. 2011;342:182–5.PubMedCrossRefGoogle Scholar
  41. 41.
    Onishi A, Sugiyama D, et. al. Diagnostic accuracy of serum 1,3-beta-D-glucan for pneumocystis jirovecii pneumonia, invasive candidiasis, and invasive aspergillosis: systemic review and meta-analysis. J Clin Microbiol2012;50(1), 7-15Google Scholar
  42. 42.
    Smith PB, et al. Quantification of 1,3-beta-d-glucan levels in children: preliminary data for diagnostic use of beta-glucan assay in a paediatric setting. Clin Vaccine Immunol. 2007;14:924–5.PubMedPubMedCentralCrossRefGoogle Scholar
  43. 43.
    Jay Koll AIDS mycoses meeting, Cape Town, 2019Google Scholar
  44. 44.
    • Meiring ST, Quan VC, Cohen C, Dawood H, Karstaedt AS, McCarthy KM, et al. A comparison of cases of paediatric-onset and adult-onset cryptococcosis detected through population-based surveillance, 2005–2007. AIDS 2012, 26:2307–2314. This study highlights the low rates of cryptococcosis in the paediatric population. PubMedCrossRefGoogle Scholar
  45. 45.
    Anígilájé EA, Olutola A, Dabit O, Adeoti AO, Emebolu AJ, et al. There is no cryptococcal antigenaemia among a cohort of children with advanced HIV infection in an antiretroviral therapy programme in Makurdi, Nigeria. J AIDS Clin Res. 2013;4:261.  https://doi.org/10.4172/2155-6113.1000261.CrossRefGoogle Scholar
  46. 46.
    Ezeanolue EE, Nwizu C, Greene GS, Amusu O, Chukwuka C, Ndembi N, et al. Geographical variation in prevalence of cryptococcal antigenemia among HIV-infected treatment-naïve patients in Nigeria: a multicenter cross-sectional study. Journal of acquired immune deficiency syndromes. 2016;1;73(1):117.CrossRefGoogle Scholar
  47. 47.
    French N, Gray K, Watera C, Nakiyingi J, Lugada E, Moore M, et al. Cryptococcal infection in a cohort of HIV-1-infected Ugandan adults. AIDS. 2002;16(7):1031–8.PubMedCrossRefGoogle Scholar
  48. 48.
    Rajasingham R, Smith RM, Park BJ, Jarvis JN, Govender NP, Chiller TM, et al. Global burden of disease of HIV-associated cryptococcal meningitis: an update analysis. Lancet. 2017;17(8):873–81.PubMedCrossRefGoogle Scholar
  49. 49.
    Nacher M, Adenis A, Blanchet D, Vantilcke V, Demar M, Basurko C, et al. Risk factors for disseminated histoplasmosis in a cohort of HIV-infected patients in French Guiana. PLoS Negl Trop Dis. 2014;30;8(1):e2638.  https://doi.org/10.1371/journal.pntd.0002638.CrossRefGoogle Scholar
  50. 50.
    Whitt SP, Koch GA, Fender B, Ratnasamy N, Everett ED. Histoplasmosis in pregnancy: case series and report of transplacental transmission. Arch Intern Med. 2004;164(4):454–8.PubMedCrossRefPubMedCentralGoogle Scholar
  51. 51.
    L´opez LF, Valencia Y, Tob´on AM, Vel´asquez O, Santa CD, C´aceres DH. Childhood histoplasmosis in Colombia: clinical and laboratory observations of 45 patients. Med Mycol. 2016;54:677–83.  https://doi.org/10.1093/mmy/myw020.CrossRefGoogle Scholar
  52. 52.
    Pillay T, Pillay DG, Bramdev A. Disseminated histoplasmosis in a human immunodeficiency virus-infected African child. Paediatr Infect Dis J. 1997;16(4):417–8.CrossRefGoogle Scholar
  53. 53.
    Oladele RO, Ayanlowo OO, Richardson MD, Denning DW. Histoplasmosis in Africa: an emerging or a neglected disease? PLoS Negl Trop Dis. 2018;12(1):e0006046.  https://doi.org/10.1371/journal.pntd.0006046.PubMedPubMedCentralCrossRefGoogle Scholar
  54. 54.
    Thanha NT, Vinhb LD, Liemb NT, Shikumad C, Daya JN, Thwaitesa G et. al. Clinical features of three patients with paradoxical immune reconstitution inflammatory syndrome associated with Talaromyces marneffei infection. Medical Mycology Case Reports. 2018;19;33–37PubMedCrossRefGoogle Scholar
  55. 55.
    Thuy Le, Kinh N.V, Ngo T.K, Tung N.L.N., Lam N. T. Thuy P.T.T. et. al. A Trial of Itraconazole or Amphotericin B for HIV-Associated Talaromycosis. New England Journal of Medicine, 2017;376:2329-40.  https://doi.org/10.1056/NEJMoa1613306.PubMedCrossRefGoogle Scholar
  56. 56.
    Sirisanthana V, Sirisanthana T. Disseminated Penicillium marneffei infection in human immunodeficiency virus-infected children. Paediatr Infect Dis J. 1995 Nov 1;14(11):935–9.CrossRefGoogle Scholar
  57. 57.
    Lee PPW, Chan K-W, Lee T, Hok-Kung Ho M, Chen X, Li C-H, et al. Penicilliosis in children without HIV infection—are they immunodeficient? Clin Infect Dis. 2012;54(2):e8–e19.PubMedCrossRefGoogle Scholar
  58. 58.
    Graham SM, Mankhambo L, Phiri A, Kaunda S, Chikaonda T, Mukaka M, et. al. Impact of Human Immunodeficiency Virus Infection on the Etiology and Outcome of Severe Pneumonia in Malawian Children. The Pediatric Infectious Disease Journal. 2011;30(1).PubMedCrossRefGoogle Scholar
  59. 59.
    Hurtado JC, Castillo P, Fernandes F, Navarro M, Lovane L, Casas I, et al. Mortality due to Cryptococcus neoformans and Cryptococcus gattii in low-income settings: an autopsy study. Sci Rep. 2019;9:7493–10.  https://doi.org/10.1038/s41598-019-43941-w.CrossRefPubMedPubMedCentralGoogle Scholar
  60. 60.
    Severo CB, Xavier MO, Gazzoni AF, Severo LC. Cryptococcosis in children. Paediatr Respir Rev. 2009 Dec 1;10(4):166–71.PubMedCrossRefPubMedCentralGoogle Scholar
  61. 61.
    Cherian T, Ramakrishna B, Babu PG, John TJ, Raghupathy P. Pneumocystis carinii pneumonia in pediatric acquired immuno-deficiency syndrome. Indian Paediatr, Vol. 1997:34.Google Scholar
  62. 62.
    Liauw F, Kresnawati W, Kaswandani N. Successful empirical treatment of severe Pneumocystis carinii pneumonia in Immunocompromised Children. American Journal of Medical Case Reports. 2016;4(6):208–11.  https://doi.org/10.12691/ajmcr-4-6-6.CrossRefGoogle Scholar
  63. 63.
    Fattia GL, Zarb HJ, Swinglerb GH. Clinical indicators of Pneumocystis jiroveci pneumonia (PCP) in South African children infected with the human immunodeficiency virus. Int J Infect Dis. 2006;10:282–5.CrossRefGoogle Scholar
  64. 64.
    Abadi J, Nachman S, Kressel A. B. Cryptococcosis in children with AIDS. Clin Infect Dis. 1999;28:309–13.PubMedCrossRefPubMedCentralGoogle Scholar
  65. 65.
    Lizarazo J, Escandón P, Agudelo CI, Castañeda E. Cryptococcosis in Colombian children and literature review. Mem Inst Oswaldo Cruz. 2014 Sep;109(6):797–804.PubMedPubMedCentralCrossRefGoogle Scholar
  66. 66.
    Gonzalez CE, Shetty D, Lewis LL, Mueller BU, Pizzo PA, Walsh TJ. Cryptococcosis in human immunodeficiency virus-infected children. Pediatr Infect Dis J. 1996 Sep;15(9):796–800.PubMedCrossRefPubMedCentralGoogle Scholar
  67. 67.
    Leggiadro RJ, Kline MW, Hughes WT. Extrapulmonary cryptococcosis in children with acquired immunodeficiency syndrome. Pediatr Infect Dis J. 1991;10:658–62.PubMedCrossRefPubMedCentralGoogle Scholar
  68. 68.
    Likasitwattanakul S, Poneprasert SB, Sirisanthana V. Cryptococcosis in HIV-infected children. Southeast Asian J Trop Med Public Health. 2004;35:935–9.PubMedPubMedCentralGoogle Scholar
  69. 69.
    Joshi NS, Fisher BT, Prasad PA, Zaoutis TE. Epidemiology of cryptococcal infection in hospitalized children. Pediatr Infect Dis J. 2010;29:e91–5.PubMedCrossRefPubMedCentralGoogle Scholar
  70. 70.
    Crump JA, Ranadhani HO, Morrissey AB, Saganda W, Mwako MS, Yang LY, et al. Invasive funfal and bacterial infections among hospitalized HIV-infected and HIV-uninfected adults and adolescents in northern Tanzania. Clin Infect Dis. 2011;1:52(3):341–8.  https://doi.org/10.1093/cid/ciq103.CrossRefPubMedGoogle Scholar
  71. 71.
    Mosam A, Moodley V, Ramdial PK, Sathar N, Aboobaker J, Singh S. Persistent pyrexia and plaques: a perplexing puzzle. Lancet (London, England). Elsevier. 2006;368:551.CrossRefGoogle Scholar
  72. 72.
    Pamnani R, Rajab J, Githang’a J, Kasmani R. Disseminated histoplasmosis diagnosed on bone marrow aspirate cytology: report of four cases. East Afr Med J. Kenya Med Assoc. 2010;86:102–5.  https://doi.org/10.4314/eamj.v86i12.62918.CrossRefGoogle Scholar
  73. 73.
    Alverson B, Alexander N, LeGolvan MP, Dunlap W, Levy C. A human immunodeficiency virus-positive infant with probable congenital histoplasmosis in a nonendemic area. Paediatr Infect Dis J. 2010;29(11):1055–7.Google Scholar
  74. 74.
    Connelly MB, Zerella JT. Surgical management of coccidioidomycosis in children. Journal of Paediatric Surgery. 2000 Nov 1;35(11):1633–4.CrossRefGoogle Scholar
  75. 75.
    Ampel NM, Dols CL, Galgiani JN. Coccidioidomycosis during human immunodeficiency virus infection: results of a prospective study in a coccidioidal endemic area. American Journal of Medicine. 1993;94(4):235–40.PubMedCrossRefPubMedCentralGoogle Scholar
  76. 76.
    Bronnimann DA, Adam RD, Galgiani JN, Habib MP, Petersen EA, Porter BEA, et al. Coccidioidomycosis in the acquired immunodeficiency syndrome. Ann Intern Med. 1987;106:372–9.PubMedCrossRefPubMedCentralGoogle Scholar
  77. 77.
    Hyatt HW Sr. Coccidioidomycosis in a 3-week-old infant. American Journal of Diseases of Children. 1963;105:93–8.PubMedPubMedCentralGoogle Scholar
  78. 78.
    Connelly MB, Zerella JT. Surgical management of coccidioidomycosis in children. Journal of Paediatric Surgery. 2000 Nov 1;35(11):1633–4.CrossRefGoogle Scholar
  79. 79.
    Chakrabarti A, Bonifaz A, Gutierrez-Galhardo MC, Mochizuki T, Li S. Global epidemiology of sporotrichosis. Med Mycol. 2015;53(1):3–14.  https://doi.org/10.1093/mmy/myuo62.CrossRefPubMedPubMedCentralGoogle Scholar
  80. 80.
    Bonifaz A, Tirado-Sánchez A. Cutaneous disseminated and extracutaneous sporotrichosis: current status of a complex disease. J Fungi. 2017;3(1):6.CrossRefGoogle Scholar
  81. 81.
    Callens SF, Kitetele F, Lukun P, Lelo P, Van Rie A, Behets F, et al. Pulmonary sporothrix schenckii infection in a HIV positive child. J Trop Pediatr. 2005 Nov 16;52(2):144–6.PubMedCrossRefGoogle Scholar
  82. 82.
    Falci DR, Pasqual;tto AC. Clinical mycology in Latin America and the Caribbean: A snapshot of diagnostic and therapeutic capabilities. Mycoses. 2019: 62(4), 368-373.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Medical Microbiology and ParasitologyUniversity of Calabar Teaching HospitalCalabarNigeria
  2. 2.Department of PaediatricsLagos University Teaching HospitalLagosNigeria
  3. 3.Department of Medical Microbiology & ParasitologyCollege of Medicine University of LagosLagosNigeria

Personalised recommendations