• International Journal of Technology (IJTech)
  • Vol 12, No 2 (2021)

Touch Biopsy: A Simple and Rapid Method for the Diagnosis of Systemic Mycoses with Skin Dissemination in HIV-Infected Patients

Touch Biopsy: A Simple and Rapid Method for the Diagnosis of Systemic Mycoses with Skin Dissemination in HIV-Infected Patients

Title: Touch Biopsy: A Simple and Rapid Method for the Diagnosis of Systemic Mycoses with Skin Dissemination in HIV-Infected Patients
Retno Wahyuningsih, Robiatul Adawiyah, Aida SD Hoemardani, Ridhawati Sjam, Evy Yunihastuti, Darma Imran, Eliza Miranda, Samsuridjal Djauzi, Mulyati Tugiran, Ariananda Hariadi, Sem Samuel Surja

Corresponding email:


Cite this article as:
Wahyuningsih, R., Adawiyah, R., Hoemardani, A.S., Sjam, R., Yunihastuti, E., Imran, D., Miranda, E., Djauzi, S., Tugiran, M., Hariadi, A., Surja, S.S., 2021. Touch Biopsy: A Simple and Rapid Method for the Diagnosis of Systemic Mycoses with Skin Dissemination in HIV-Infected Patients. International Journal of Technology. Volume 12(2), pp. 243-251

1,054
Downloads
Retno Wahyuningsih 1. Department of Parasitology, Faculty of Medicine Universitas Indonesia, Salemba Raya Street No.6, Jakarta 10430, Indonesia 2. Department of Parasitology, School of Medicine, Indonesian Christian Un
Robiatul Adawiyah Department of Parasitology, Faculty of Medicine Universitas Indonesia, Salemba Raya Street No.6, Jakarta 10430, Indonesia
Aida SD Hoemardani Indonesia Dharmais Cancer Hospital, S. Parman Street Kav. 84-86, Jakarta 11420, Indonesia
Ridhawati Sjam Department of Parasitology, Faculty of Medicine Universitas Indonesia, Salemba Raya Street No.6, Jakarta 10430, Indonesia
Evy Yunihastuti Department of Internal Medicine Faculty of Medicine, Universitas Indonesia/ Cipto Mangunkusumo Hospital, Salemba raya street No.6, Jakarta 10430, Indonesia
Darma Imran Department of Neurology, Faculty of Medicine, Universitas Indonesia/ Cipto Mangunkusumo Hospital, Salemba Raya Street No.6, Jakarta 10430, Indonesia
Eliza Miranda Department of Dermato-Venereology, Faculty of Medicine, Universitas Indonesia/ Cipto Mangunkusumo Hospital, Salemba Raya Street No.6, Jakarta 10430, Indonesia
Samsuridjal Djauzi Department of Internal Medicine Faculty of Medicine, Universitas Indonesia/ Cipto Mangunkusumo Hospital, Salemba raya street No.6, Jakarta 10430, Indonesia
Mulyati Tugiran Department of Parasitology, Faculty of Medicine Universitas Indonesia, Salemba Raya Street No.6, Jakarta 10430, Indonesia
Ariananda Hariadi Department of Parasitology, Faculty of Medicine Universitas Indonesia, Salemba Raya Street No.6, Jakarta 10430, Indonesia
Sem Samuel Surja Department of Parasitology, School of Medicine and Health Sciences, Universitas Katolik Indonesia Atma Jaya, Jl. Pluit Raya No. 2, Jakarta Utara 14440, Indonesia
Email to Corresponding Author

Abstract
Touch Biopsy: A Simple and Rapid Method for the Diagnosis of Systemic Mycoses with Skin Dissemination in HIV-Infected Patients

Systemic fungal infection can disseminate to the skin and require prompt treatment, making early diagnosis very important. This study describes the use of a simple, quick touch biopsy method for the diagnosis of invasive mycoses in patients with AIDS with cutaneous manifestations. We identified fungal infections in 24 of the 29 investigated patients. Histoplasma capsulatum, Cryptococcus neoformans, Talaromyces artroroseus, Aspergillus flavus, Candida tropicalis, and Malassezia sp. were visualized directly in samples obtained from cutaneous lesions and confirmed by culture and molecular examination. The results suggested that touch biopsy is a simple, rapid method for the diagnosis of systemic mycoses with skin dissemination. It can be performed using simple tools and provides quick results, allowing for early intervention with appropriate antifungal therapy.

Cutaneous dissemination; Rapid diagnosis; Systemic fungal infection

Introduction

Fungi are known to be one of the types of microorganisms responsible for fatal opportunistic infections in HIV-infected patients (Lortholary et al., 1999; Vanittanakom et al., 2006; Bicanic et al., 2008). The dissemination of systemic fungal infections to the skin is common in HIV-infected patients, and laboratory investigations are required to establish timely diagnosis (Lortholary et al., 1999; Dhar et al., 2006; Dinato et al., 2006).

Systemic fungal infection is very difficult to diagnose because the fungus infects internal organs and  thus biopsy is required to obtain clinical materials for laboratoryinvestigations (Azar and Hage, 2017; Sanguinetti et al., 2019). Dissemination to the skin is a blessing in disguise because the collection of clinical materials becomes much easier.

In our laboratory, sample collection for cutaneous mycoses is generally completed using skin scraping for microscopic wet slide analysis and culture. However, this approach has several limitations. For example, fungi such as Histoplasma do not occur in superficial skin scales but in leucocytes, which may not be observable in KOH preservation (Kauffman, 2007), although KOH is very good in plasma electrolysis (Saksono et al., 2012). Culturing is a diagnostic effort that is always carried out in mycological investigations. Culturing can be used to isolate the causative fungi, but unfortunately, this method is time-consuming. Meanwhile, patients with systemic mycoses require immediate diagnosis so that the right drug can be given promptly.

      Infections with HIV are currently distributed throughout Indonesia (Ministry of Health Republic Indonesia, 2018). Left untreated, this infection will develop into AIDS, which is susceptible to various opportunistic infections, including fungal infections. Indonesia is an archipelago with a wide variety of health facilities. Fully equipped laboratories are available only in big cities; therefore, a simple method is needed for use in areas with limited laboratory settings. Technological innovation is very important for the next generation (Berawi, 2015). In this paper, we describe a method that we call touch biopsy to obtain samples for the diagnosis of systemic mycoses with cutaneous dissemination in individuals with HIV infections. This method is relatively simple in that it can be used even in remote areas with limited laboratory equipment. The touch biopsy method was used to take samples from the skin, which were then examined using conventional methods (e.g., KOH slide testing and culturing). The fungi that grew on the cultures were morphologically identified and then confirmed on a molecular level using the PCR method.

Conclusion

    Touch biopsy is a simple, rapid method of diagnosing systemic mycosis with cutaneous dissemination. This method provides fast results, allowing for immediate anti-fungal treatment.

Acknowledgement

    RW received a research grant from Dana Ilmu Pengetahuan Indonesia/ Lembaga Pengelolaan Dana Pendidikan (DIPI/LPDP) with contract number MR/P017622/1, year 2017–2020.

References

Azar, M.M., Hage, C.A., 2017. Laboratory Diagnostics for Histoplasmosis. Journal of Clinical Microbiology, Volume 55(6), pp. 1612–1620

Baumgarten, K.L., Valentine, V.G., Garcia-Diaz, J.B., 2004. Primary Cutaneous Cryptococcosis in a Lung Transplant Recipient. Southern Medical Journal, Volume 97(7), pp. 692–695

Berawi, M.A., 2015. Creating Sustainable Design and Technology Development: A Call for Innovation. International Journal of Technology, Volume 6(1), pp. 12

Bicanic, T., Wood, R., Meintjes, G., Rebe, K., Brouwer, A., Loise, A., Bekker, L., Jaffar, S., Harrison, T., 2008. High-Dose Amphotericin B with Flucytosine for the Treatment of Cryptococcal Meningitis in HIV-Infected Patients: A Randomized Trial. Clinical Infectious Disease, Volume 47(1), pp. 123–130

Desai, M., Rudge, J.W., Adisasmito, W., Mounier-Jack, S., Coker, R., 2010. Critical Interactions Between Global Fund-Supported Programmes and Health Systems: A Case Study in Indonesia. Health Policy Planning, Volume 25(suppl 1), pp. 4347

Dhar, S., Roy, S.K.D., Todi, S.K., Roy, S., Dhar, S., 2006. Seven Cases of Histoplasmosis: Cutaneous and Extra Cutaneous Involvement. Indian Journal of Dermatology, Volume 51(2), pp. 137–139

Dinato, S.L., Dinato, M.M., Nakanishi, C.P., Almeida, J.R., Romiti, N., 2006. Disseminated Cutaneous Cryptococcosis in a Patient with AIDS. Revista do Instituto de Medicina Tropical de Sao Paulo, Volume 48(6), pp. 353–358

Dinika, I., Nurhadi, B., Masruchin, N., Balia, R.L., Utama, G.L., 2019. The Roles of Candida tropicalis Toward Peptide and Amino Acid Changes in Cheese Whey Fermentation. International Journal of Technology, Volume 10(8), pp. 15331540

Karimi, K., Wheat, J., Connolly, P., Cloud, G., Hajjeh, R., Wheat, E., Alves, K., Lacaz, Cd.S., Keath, E., 2002. Differences in Histoplasmosis in Patients with Acquired Immunodeficiency Syndrome in the United States and Brazil. Journal of Infectious Disease, Volume 186, pp. 1655–1660

Kauffman, C.A., 2007. Histoplasmosis: A Clinical and Laboratory Update. Clinical Microbiology Review, Volume 20(1), pp. 115–132

Khayhan, K., Hagen, F., Pan, W., Simwani, S., Fisher, M.C., Wahyuningsih, R., Chakrabarti, A., Chowdary, A., Ikeda, R., 2013. Geographically Structured Populations of Cryptococcus neoformans variety grubii in Asia Correlate with HIV Status and Show a Clonal Population Structure. PLoS ONE, Volume 8(9): e72222. https://doi.org/10.1371/journal.pone.0072222

Kwon-Chung, K.J., Polacheck, I., Bennet, J.E., 1982. Improved Diagnostic Medium for Separation of Cryptococcus neoformans var. neoformans (Serotypes A and D) and Cryptococcus neoformans var. gattii (Serotypes B and C). Journal Clinical Microbiology, Volume 15(3), pp. 535–537

Lortholary, O., Denning, D.W., Dupont, B., 1999. Endemic Mycoses: A Treatment Update. Journal Antimicrobial Chemotheraphy, Volume 43(3), pp. 321–331

Ministry of Health Republic of Indonesia, 2018. Situation and Analysis HIV AIDS. Data Centre and Information Ministry of Health Republic of Indonesia. Reporting period September 2018.

Montero, D.C.V., Maqueda, M.G., Piñero, M.C.B., Kowalczuk, A., Galimberti, R., 2010. Cutaneous Expression of Systemic Candidiasis in Immunosuppressed Patients. Dermatology Argentine, Volume 16(5), pp. 337–343

Pan, W., Khayhan, K., Hagen, F., Wahyuningsih, R., Chakrabarti, A., Chowdhary, A., Ikeda, R., Taj-Aldeen, S.J., Khan, Z., Imran, D., Sjam, R., Sriburee, P., Liao, W., Chaicumpar, K., Ingviya, N., Mouton, J.W., Curfs-Breuker, I., Boekhout, T., Meis, J.F., Klaassen, C.H.W., 2012. Resistance of Asian Cryptococcus neoformans Serotype A is Confined to Few Microsatellite Genotypes. PLoS ONE, Volume 7(3): e32868. https://doi.org/10.1371/journal.pone.0032868

Pasqualotto, A.C., Bittar, A.E., de Quadros, M., Severo, L.C., 2005. Cryptococcal Cellulitis in a Renal Transplant Patient. Nephrology Dialysis Transplantation, Volume 20(9), pp. 2007–2008

Saksono, N., Ariawan, B., Bismo, S., 2012. Hydrogen Production System using Non-Thermal Plasma Electrolysis in Glycerol-KOH Solution. International Journal of Technology, Volume 3(1), pp. 815

Sanguinetti, M., Posteraro, B., Beigelman-Aubry, C., Lamoth, F., Dunet, F., Slavin, M., Richardson, M.D., 2019. Diagnosis and Treatment of Invasive Fungal Infections: Looking Ahead. Journal of Antimicrobial Chemotherapy, Volume 74(suppl 2), pp. 27–37

Surja, S.S., Adawiyah, R., Houbraken, J., Rozaliyani, A., Sjam, R., Yunihastuti, E., Wahyuningsih, R., 2020. Talaromyces atroroseus in HIV and Non-HIV Patient: A First Report from Indonesia. Medical Mycology, Volume 58(4), pp. 560563

Tjitra, E., Anstey, N.M., Sugiarto, P., Warikar, N., Kenangalem, E., Karyana, M., Lampah, D.A., Price, R.C., 2008. Multidrug-Resistant Plasmodium vivax Associated with Severe and Fatal Malaria: A Prospective Study in Papua, Indonesia. PLoS Medicine, Volume 5(6), pp. 890–899

Tobón, A.M., Agudelo, C.A., Rosero, D.S., Ochoa, J.E., De Bedout, C., Zuluaga, A., Arango, M., Cano, L.E., Sampedro, J., Restrepo, A., 2005. Disseminated Histoplasmosis: A Comparative Study Between Patients with Acquired Immunodeficiency Syndrome and Non-Human Immunodeficiency Virus Infected Individual. American Journal Tropical Medicine Hygiene, Volume 73(3), pp. 576–582

Vanittanakom, N., Cooper, Jr., C.R., Fisher, M.C., Sirisanthana, T., 2006. Penicillium marneffei Infection and Recent Advances in the Epidemiology and Molecular Biology Aspects. Clinical Microbiology Review, Volume 19(1), pp. 95–110

Vasudevan, B., Ashish, B., Amitabh, S., Mohanty, A.P., 2010. Primary Cutaneous Histoplamsosis in a HIV-Positive Individual. Journal of Global Infectious Disease, Volume 2(2), pp. 112–115

Walsh, T.J., 1998. Editorial Response: Primary Cutaneous Aspergillosis an Emerging Infection Among Immunocompromised Patients. Clinical Infectious Disease, Volume 27(3), pp. 453–457