Burden of HIV-associated histoplasmosis compared with tuberculosis in Latin America: a modelling study

Abstract

None.

The Broad Clinical Spectrum of Disseminated Histoplasmosis in HIV-Infected Patients: A 30 Years’ Experience in French Guiana

“…In 10-60% of HAH cases, severe forms have been described, which can rapidly progress to death by septic shock-like presentation, intravascular disseminated coagulation, hemophagocytosis syndrome, concurrent or isolated massive neurological, renal or pulmonary involvement [2]. These situations require the urgent initiation of the lipid formulation of intravenous amphotericin B (when available) given its fungicidal activity on Histoplasma capsulatum [5,6,8].…”

“…These factors might help physicians initiate early presumptive antifungal therapy before the results of microbiological cultures are available. A switch from the systematic presumptive anti-tuberculosis therapy in suspected tuberculosis-like cases to a presumptive antifungal therapy for suspected histoplasmosis-like cases could be associated with an important decrease in AIDS-related deaths in endemic areas for Histoplasma capsulatum, notably across Latin America [2].…”

“…Fungal infections are a major cause of opportunistic infections at the advanced stage of HIV infection [1]. Histoplasma capsulatum is a thermally dimorphic fungus described worldwide with the Americas being the world hotspot according to current available data [2]. Infection with Histoplasma capsulatum is responsible for histoplasmosis, a disease with a broad spectrum of clinical features included in a well described classification of syndromes that can vary from sub-clinical, acute to chronic disease evolutions [3].…”

What is AIDS in the Amazon and the Guianas in the 90-90-90 era?

“…For other countries, where awareness and mycological expertise is not present, where liposomal amphotericin is absent, the added value would be even greater. [13][14][15] This is in total alignment with the Manaus declaration in 2019 recommending access to diagnostic tests and effective treatment for all hospitals in Latin America by 2025, further emphasized by the imminent WHO/PAHO guidelines for the diagnosis and treatment of disseminated histoplasmosis in HIV patients. [16]…”

HIV patients dying on anti-tuberculosis treatment: are undiagnosed infections still a problem in French Guiana?

“…Moreover, histoplasmosis is frequently associated with tuberculosis (ranging from 2 to 38% and in most countries over 10%) [2]. This diagnostic difficulty is estimated to cause large numbers of deaths often attributed to tuberculosis [3][4][5]. The interpretation of this finding was that perhaps patients with culture negative "tuberculosis" in fact had something else than tuberculosis.…”