Jacó Ricarte Lima de Mesquita

Hospital de São José

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Marcos Fábio Gadelha Rocha

Universidade Estadual do Ceará

José Júlio Costa Sidrim

Universidade Federal do Ceará

Rossana de Aguiar Cordeiro

Universidade Federal do Ceará

Raimunda Sâmia Nogueira Brilhante

Universidade Federal do Ceará

Terezinha do Menino Jesus Silva Leitão

Universidade Federal do Ceará

Lisandra Serra Damasceno

Universidade Federal do Ceará

Débora de Souza Collares Maia Castelo‐Branco

Universidade Federal do Ceará

Zoilo Pires dè Camargo

Universidade Federal de São Paulo

Hélio Vitoriano Nobre Júnior

Universidade Federal do Ceará

Rita Amanda Chaves de Lima

Universidade Federal do Ceará

Cooperative Institutions

Universidade Federal do Ceará

Universidade Estadual do Ceará

Hospital Geral de Fortaleza

Universidade de Fortaleza

Secretaria da Saúde

Universidade de São Paulo

Unichristus

Instituto Federal de Educação, Ciência e Tecnologia do Ceará

Fundação Oswaldo Cruz

Instituto Evandro Chagas

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Disseminated histoplasmosis in HIV‐infected patients: determinants of relapse and mortality in a north‐eastern area of Brazil

Mycoses (2014)

Lisandra Serra Damasceno Alberto Novaes Ramos Carlos Henrique Alencar Maria Vânia Freitas Gonçalves Jacó Ricarte Lima de Mesquita

Summary Many relapses and deaths resulting from disseminated histoplasmosis ( DH ) in acquired immunodeficiency syndrome ( AIDS ) patients have been observed in an endemic area in north‐eastern Brazil. The objective of this study was to evaluate the risk factors associated with the clinical outcomes of DH / AIDS coinfection in patients from the state of Ceará, Brazil. A retrospective cohort of AIDS patients, after their hospital discharge due to first DH episode in the period 2002–2008, was followed until December 31, 2010, to investigate the factors associated with relapse and mortality. A total of 145 patients were evaluated in the study. Thirty patients (23.3%) relapsed and the overall mortality was 30.2%. The following variables were significantly ( P < 0.05) associated with relapse and overall mortality (univariate analysis): non‐adherence to highly active antiretroviral therapy ( HAART ), irregular use of an antifungal, non‐recovery of the CD 4+ count and having AIDS before DH ; histoplasmosis relapse was also significantly associated with mortality. In the multivariate analysis, non‐adherence to HAART was the independent risk factor that was associated with both relapse (Adj OR = 6.28) and overall mortality (Adj OR = 8.03); efavirenz usage was discovered to be significant only for the overall mortality rate (Adj OR = 4.50). Adherence to HAART was the most important variable that influenced the outcomes in this specific population.

Efavirenz

Univariate analysis

10.1111/myc.12175

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Citations (23)

In vitro study of essential oils encapsulated in chitosan microparticles against Histoplasma capsulatum and their pathogenicity in Caenorhabditis elegans

Biofouling (2025)

Anderson da Cunha Costa Mirele Rodrigues Fernandes Augusto Feynman Dias Nobre Maria Gleiciane Rocha Jacó Ricarte Lima de Mesquita

Histoplasmosis, caused by Histoplasma capsulatum, poses risks for immunocompromised individuals. With limited therapeutic options, this study explores microparticles as antimicrobial delivery systems for Cymbopogon flexuosus and Pelargonium graveolens essential oils against H. capsulatum. The broth microdilution assay showed MICs of 32 to 128 µg/mL in filamentous phase and 8 to 64 µg/mL in yeast phase. Combining microparticles with antifungal drugs demonstrated synergistic effects in both filamentous and yeast-like forms with amphotericin B or itraconazole. Chitosan microparticles reduced H. capsulatum biofilm biomass and metabolic activity by about 60% at 512 µg/mL. In vivo evaluation with Caenorhabditis elegans showed H. capsulatum caused over 90% mortality. These findings highlight the potential use of chitosan microparticles as a delivery system for essential oils against H. capsulatum, especially in combination with other compounds.

Histoplasma

10.1080/08927014.2025.2453184

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AGENTES ETIOLÓGICOS DE MENINGOENCEFALITE CIRCULANTES DURANTE O PERÍODO DE PANDEMIA DA COVID-19

The Brazilian Journal of Infectious Diseases (2022)

Luís Arthur Brasil Gadelha Farias Marcos Maciel Sousa Karene Ferreira Cavalcante Angela Maria Veras Stolp Jacó Ricarte Lima de Mesquita

A pandemia pelo novo coronavírus trouxe mudanças no comportamento da população. O impacto do efeito do uso de máscaras, do distanciamento social e das mudanças de comportamento da população sobre a circulação dos agentes etiológicos das meningites é desconhecido. Descrever os agentes etiológicos em pacientes com meningite da comunidade durante o período de pandemia pelo COVID-19. Estudo de coorte retrospectiva, de janeiro de 2019 a dezembro de 2021, composta por pacientes com suspeita de meningite, em hospital terciário de ensino, conveniado ao SUS, em Fortaleza, Ceará. A identificação do microrganismo foi por cultura para germes piogênicos, micobactérias, fungos, sorologia e RT-PCR para arbovírus, RT-PCR para SARS-CoV-2, FilmArrayR Meningitis/Encephalitis Panel (Biomérieux) e GeneXpert MTB/RIF (Cepheid). Foram atendidos no hospital 721 casos suspeitos de meningite durante o período, e analisados 201 pacientes (28% do total). Em 143 (68%) houve confirmação de meningite. Cultura para germes piogênicos foi realizada em 92 (64%) pacientes, e os microrganismos encontrados foram: Cryptococcus sp. (n = 3; 3%), S. pneumoniae (n = 3; 3%), S. aureus (n = 1; 1%), S. suis sorotipo I (n = 1; 1%), S. agalactiae (n = 1; 1%), N. meningitidis grupo C (n = 1; 1%), K. pneumoniae (n = 1; 1%), L. monocytogenes (n = 1; 1%) e Corynebacterium jeikeium (n = 1; 1%). A cultura para fungos (Cryptococcus) foi positiva em 10 pacientes. A cultura para micobactérias foi realizada em 34 (24%) pacientes, com 2 (6%) positivas. O PCR Multiplex foi realizado em 105 (73%) pacientes, com identificação de S. pneumoniae (n = 16; 15%), N. meningitidis (n = 13; 12%), Vírus Varicela-Zoster (n = 8; 8%), Cryptococcus sp. (n = 7; 7%), Citomegalovírus (n = 6; 6%), Enterovírus (n = -5; 5%), HSV-1 (n = 3; 3%), HSV-2 (n = 2; 2%), S. agalactiae (n = 2; 2%), Haemophilus influenzae (n = 1; 1%), Herpesvírus 6 (n = 1; 1%) e Listeria monocytogenes (n = 1; 1%). Houve coinfecção em 3 pacientes. O RT-PCR para M. tuberculosis (MTB) foi realizado em 51 (36%) pacientes, com detecção em 13 pacientes (25%). No período estudado, houve dois casos de meningite por SARS-CoV-2 (2%). Identificaram-se uma ampla variedade de agentes etiológicos em circulação durante a pandemia. Apesar de S. pneumoniae e N. meningitidis terem sido os agentes mais frequentes, destacou-se a variedade de vírus. Foi relevante o incremento no diagnóstico das meningites pelos métodos moleculares em comparação com as culturas. Casos de meningoencefalite por COVID-19 foram identificados.

10.1016/j.bjid.2022.102553

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Antiretroviral drugs saquinavir and ritonavir reduce inhibitory concentration values of itraconazole against Histoplasma capsulatum strains in vitro

The Brazilian Journal of Infectious Diseases (2015)

Raimunda Sâmia Nogueira Brilhante Érica Pacheco Caetano Giovanna Barbosa Riello Gláucia Morgana de Melo Guedes Débora de Souza Collares Maia Castelo‐Branco

Recent studies have shown that some drugs that are not routinely used to treat fungal infections have antifungal activity, such as protease inhibitor antiretroviral drugs. This study investigated the in vitro susceptibility of Histoplasma capsulatum var. capsulatum to saquinavir and ritonavir, and its combination with the antifungal itraconazole. The susceptibility assay was performed according to Clinical and Laboratory Standards Institute guidelines. All strains were inhibited by the protease inhibitor antiretroviral drugs. Saquinavir showed minimum inhibitory concentrations ranging from 0.125 to 1μgmL(-1) for both phases, and ritonavir presented minimum inhibitory concentrations ranging from 0.0312 to 4μgmL(-1)and from 0.0625 to 1μgmL(-1) for filamentous and yeast phase, respectively. Concerning the antifungal itraconazole, the minimum inhibitory concentration values ranged from 0.0019 to 0.125μgmL(-1) and from 0.0039 to 0.0312μgmL(-1) for the filamentous and yeast phase, respectively. The combination of saquinavir or ritonavir with itraconazole was synergistic against H. capsulatum, with a significant reduction in the minimum inhibitory concentrations of both drugs against the strains (p<0.05). These data show an important in vitro synergy between protease inhibitors and itraconazole against the fungus H. capsulatum.

Saquinavir

Ritonavir

Protease inhibitor (pharmacology)

10.1016/j.bjid.2015.11.003

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Citations (11)

Antifungal Activity of Chitosan against Histoplasma capsulatum in Planktonic and Biofilm Forms: A Therapeutic Strategy in the Future?

Journal of Fungi (2023)

Raimunda Sâmia Nogueira Brilhante Anderson da Cunha Costa Jacó Ricarte Lima de Mesquita Géssica dos Santos Araújo Rosemeyre Souza Freire

Histoplasmosis is a respiratory disease caused by Histoplasma capsulatum, a dimorphic fungus, with high mortality and morbidity rates, especially in immunocompromised patients. Considering the small existing therapeutic arsenal, new treatment approaches are still required. Chitosan, a linear polysaccharide obtained from partial chitin deacetylation, has anti-inflammatory, antimicrobial, biocompatibility, biodegradability, and non-toxicity properties. Chitosan with different deacetylation degrees and molecular weights has been explored as a potential agent against fungal pathogens. In this study, the chitosan antifungal activity against H. capsulatum was evaluated using the broth microdilution assay, obtaining minimum inhibitory concentrations (MIC) ranging from 32 to 128 µg/mL in the filamentous phase and 8 to 64 µg/mL in the yeast phase. Chitosan combined with classical antifungal drugs showed a synergic effect, reducing chitosan’s MICs by 32 times, demonstrating that there were no antagonistic interactions relating to any of the strains tested. A synergism between chitosan and amphotericin B or itraconazole was detected in the yeast-like form for all strains tested. For H. capsulatum biofilms, chitosan reduced biomass and metabolic activity by about 40% at 512 µg/mL. In conclusion, studying chitosan as a therapeutic strategy against Histoplasma capsulatum is promising, mainly considering its numerous possible applications, including its combination with other compounds.

Histoplasma

Broth microdilution

10.3390/jof9121201

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Citations (7)

Accuracy of Buffy Coat in the Diagnosis of Disseminated Histoplasmosis in AIDS-Patients in an Endemic Area of Brazil

Journal of Fungi (2019)

Terezinha do Menino Jesus Silva Leitão António Martins Filho José Evaldo P. Sousa Filho Bruno de Melo Tavares Jacó Ricarte Lima de Mesquita

The buffy coat is obtained routinely for disseminated histoplamosis (DH) diagnosis in Ceará, 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 2012-2013, all results of stained buffy coat smears and culture for fungi performed at São José Hospital were recorded. In total, 489 buffy coats of 361 patients were studied; 19/361 (5.3%; 95%CI = 2.9-7.6%) had positive direct examination stained smears for Histoplasma and 61/361 (16.9%; 95%CI = 13.0-20.8%) had growth in culture. For those with positive Histoplasma cultures, the CD4 count was significantly lower (139.3 vs. 191.7cells/µL; 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.

Buffy coat

Histoplasma

Coat

10.3390/jof5020047

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Citations (10)

MÉTODOS MOLECULARES E MICROBIOLOGIA CONVENCIONAL NA IDENTIFICAÇÃO DE AGENTES ETIOLÓGICOS E NO TRATAMENTO DE MENINGOENCEFALITES AGUDAS

The Brazilian Journal of Infectious Diseases (2023)

Luís Arthur Brasil Gadelha Farias Marcos Maciel Sousa Karene Ferreira Cavalcante Aldenise de Olinda Castro Jacó Ricarte Lima de Mesquita

O diagnóstico precoce das meningites agudas impacta na conduta médica terapêutica, e a identificação da etiologia fornece subsídios para adequação da terapia antimicrobiana. Objetivamos avaliar o impacto dos métodos moleculares e da cultura na identificação etiológica e na modificação da terapia antimicrobiana e antiviral inicial nas meningoencefalites agudas. Este estudo foi aprovado pelo Comitê de Ética em Pesquisa do Hospital São José de Doenças Infecciosas (CAAE: 52811521.7.0000.5044). Estudo retrospectivo de pacientes com meningoencefalite aguda (<14 dias), diagnosticados por métodos moleculares (Genexpert® Cepheid e PCR Filmarray® Biomerieux) e/ou culturas tradicionais (ágar chocolate, ágar sabouraud e MGIT) em hospital de referência em doenças infecciosas, de 2019 a 2021. A análise estatística foi realizada em Excel e o teste utilizado foi o qui-quadrado (significância se p <= 0,05). 152 pacientes foram incluídos no estudo com meningoencefalites agudas. Dos 152 pacientes, 113 realizaram PCR Filmarray®, 46 realizaram Genexpert®, 98 realizaram cultura para germes piogênicos, 26 cultura para micobactérias e 32 culturas para fungos. Um total de 85 (56%) tiveram o diagnóstico etiológico confirmado. Dos 85 pacientes, 43 foram identificados por PCR Filmarray®, 7 por Genexpert® e 14 por cultura convencional, 5 por cultura p/ fungos, 7 por PCR Filmarray® e cultura convencional. Os melhores desempenhos (positividade) foram, respectivamente: PCR Filmarray® (n = 43/113; 38%), Genexpert® (n = 7/46; 15,2%) e cultura (n = 14/98; 14,4%). No grupo do PCR Filmarray® foram identificados vírus (n = 23/43; 53,5%), bactérias (n = 18/43; 41,9%), e fungos (n = 5/43;11,6%). A cultura identificou: C. neoformans (n = 2), S. pneumoniae (n = 3), S. suis I (n = 2), S. agalactiae (n = 1), S. aureus (n = 1), K. pneumoniae (n = 1), Corynebacterium jeikeium (n = 1). Percebeu-se o ganho de diagnóstico com biologia molecular de 23,6% (p = 0,0003). Um total de 22% (25/113) e de 18% (18/98) dos pacientes tiveram antibioticoterapia modificada, pelo PCR Filmarray® e pelas culturas para germes piogênicos. Métodos moleculares trazem informações complementares aos métodos tradicionais. Foram encontrados agentes etiológicos incomuns, como fungos e micobactérias. Uma proporção moderada de pacientes teve terapia modificada pelos resultados. Houve mais frequente solicitação de PCR Filmarray® e genexpert do que as culturas, o que pode significar subutilização das culturas.

GeneXpert MTB/RIF

10.1016/j.bjid.2023.103196

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Histoplasmosis in HIV-positive patients in Ceará, Brazil: clinical-laboratory aspects and in vitro antifungal susceptibility of Histoplasma capsulatum isolates

Transactions of the Royal Society of Tropical Medicine and Hygiene (2012)

Raimunda Sâmia Nogueira Brilhante Maria Auxiliadora Bezerra Fechine Jacó Ricarte Lima de Mesquita Rossana de Aguiar Cordeiro Marcos Fábio Gadelha Rocha

This study contains a descriptive analysis of histoplasmosis in AIDS patients between 2006 and 2010 in the state of Ceará, Brazil. Additionally, the in vitro susceptibility of Histoplasma capsulatum isolates obtained during this period was assessed. We report 208 cases of patients with histoplasmosis and AIDS, describing the epidemiological, clinical, laboratory and therapeutic aspects. The in vitro antifungal susceptibility test was carried out by the microdilution method, according to Clinical and Laboratory Standards Institute, with H. capsulatum in the filamentous and yeast phases, against the antifungals amphotericin B, fluconazole, itraconazole, voriconazole and caspofungin. In 38.9% of the cases, histoplasmosis was the first indicator of AIDS and in 85.8% of the patients the CD4 cell count was lower than 100 cells/mm(3). The lactate dehydrogenase levels were high in all the patients evaluated, with impairment of hepatic and renal function and evolution to death in 42.3% of the cases. The in vitro susceptibility profile demonstrated there was no antifungal resistance among the isolates evaluated. There was a significant increase in the number of histoplasmosis cases in HIV-positive patients during the period surveyed in the state of Ceará, northeastern Brazil, but no antifungal resistance among the recovered isolates of H. capsulatum.

Histoplasma

AIDS-Related Opportunistic Infections

10.1016/j.trstmh.2012.05.003

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Citations (60)

Coccidioidomycosis in armadillo hunters from the state of Ceará, Brazil

Memórias do Instituto Oswaldo Cruz (2012)

Raimunda Sâmia Nogueira Brillhante Renato Evando Moreira Filho Marcos Fábio Gadelha Rocha Débora de Souza Collares Maia Castelo‐Branco Maria Auxiliadora Bezerra Fechine

Coccidioidomycosis is a systemic mycosis with a variable clinical presentation. Misdiagnosis of coccidioidomycosis as bacterial pneumopathy leads to inappropriate prescription of antibiotics and delayed diagnosis. This report describes an outbreak among armadillo hunters in northeastern Brazil in which an initial diagnosis of bacterial pneumonia was later confirmed as coccidioidomycosis caused by Coccidioides posadasii. Thus, this mycosis should be considered as an alternative diagnosis in patients reporting symptoms of pneumonia, even if these symptoms are only presented for a short period, who are from areas considered endemic for this disease.

Coccidioides immitis

Coccidioides

10.1590/s0074-02762012000600017

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Citations (18)

Synergistic Effects of Ketamine and Azole Derivatives on Candida Spp. Resistance to Fluconazole

Future Microbiology (2020)

João Batista de Andrade Neto Cecília Rocha da Silva Fátima Daiana Dias Barroso Lívia Gurgel do Amaral Valente Sá Rosana de Sousa Campos

The emergence of Candida spp. with resistance to antifungal molecules, mainly the azole class, is an increasing complication in hospitals around the globe. Aim: In the present research, we evaluated the synergistic effects of ketamine with two azole derivatives, itraconazole and fluconazole, on strains of Candida spp. to fluconazole. Materials & methods: The drug synergy was evaluated by quantifying the fractional inhibitory concentration index and by fluorescence microscopy and flow cytometry techniques. Results: Our achievements showed a synergistic effect between ketamine in addition to the two antifungal agents (fluconazole and itraconazole) against planktonic cells and biofilms of Candida spp. Conclusion: This combination promoted alteration of membrane integrity, generation of reactive oxygen species, damage to and DNA and externalization of phosphatidylserine.

Azole

10.2217/fmb-2019-0082

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Citations (17)