Clinical and Laboratory Profile of Persons Living with Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome and Histoplasmosis from a Colombian Hospital

Abstract

Abstract. Histoplasmosis is common among persons living with human immunodeficiency virus/acquired immune deficiency syndrome (PLWHA) in Latin America, but its diagnosis is difficult and often nonspecific. We conducted prospective screening for histoplasmosis among PLWHA with signs or symptoms suggesting progressive disseminated histoplasmosis (PDH) and hospitalized in Hospital La María in Medellín, Colombia. The study's aim was to obtain a clinical and laboratory profile of PLWHA with PDH. During 3 years (May 2008 to August 2011), we identified 89 PLWHA hospitalized with symptoms suggestive of PDH, of whom 45 (51%) had histoplasmosis. We observed tuberculosis (TB) coinfection in a large proportion of patients with PDH (35%), so all analyses were performed adjusting for this coinfection and, alternatively, excluding histoplasmosis patients with TB. Results showed that the patients with PDH were more likely to have Karnofsky score ≤ 30 (prevalence ratio [PR] = 1.98, 95% confidence interval [CI] = 0.97-4.06), liver compromised with hepatomegaly and/or splenomegaly (PR = 1.77, CI = 1.03-3.06) and elevation in serum of alanine aminotransferase and aspartate aminotransferase to values > 40 mU/mL (PR = 2.06, CI = 1.09-3.88 and PR = 1.53, CI = 0.99-2.35, respectively). Using multiple correspondence analyses, we identified in patients with PDH a profile characterized by the presence of constitutional symptoms, namely weight loss and Karnofsky classification ≤ 30, gastrointestinal manifestations with alteration of liver enzymes and hepatosplenomegaly and/or splenomegaly, skin lesions, and hematological alterations. Study of the profiles is no substitute for laboratory diagnostics, but identifying clinical and laboratory indicators of PLWHA with PDH should allow development of strategies for reducing the time to diagnosis and thus mortality caused by Histoplasma capsulatum.

Fungal Infections Complicating Lung Transplantation

“…Histoplasma capsulatum, the etiologic agent of histoplasmosis, is a dimorphic fungus endemic in the Mississippi and Ohio River Valleys of the United States, [432][433][434] in many areas of Latin America, [435][436][437] Africa, 438 and more recently in China 439 and Southeast Asia. 432,440 Histoplasmosis is rare in Europe, 441 except when acquired in other endemic areas.…”

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

“…[ 5 ] In French Guiana, among consecutive HIV patients hospitalized for infectious symptoms (fever, isolated or with other symptoms), 42% of those with CD4<200 had culture-confirmed histoplasmosis, and 85% of those with CD4<50 had histoplasmosis[ 6 ]; In Fortaleza, of 378 consecutively admitted HIV patients, 164 (43%) had microscopically confirmed histoplasmosis[ 7 ]; In Panama, 7.65% of patients with an HIV infection had culture-positive H . capsulatum [ 8 ], in Guatemala, and in Colombia histoplamosis and TB are the main opportunistic infections;[ 9 , 10 ] In Venezuela, in patients with AIDS, histoplasmosis was documented in 29 of 66 (44%) autopsies performed[ 11 , 12 ]. Most histoplasmin prevalence studies took place before the AIDS epidemic was identified, because histoplasmin testing is no longer performed.…”

The important role of co-infections in patients with AIDS and progressive disseminated histoplasmosis (PDH): A cohort from Colombia

“…In persons living with HIV/AIDS (PLWHA), the mycosis often produces a severe clinical form of disease called progressive disseminated histoplasmosis (PDH), which has a high mortality if treatment is not initiated promptly [4] , [5] . As has been previously reported, PDH symptoms are nonspecific, and among PLWHA, symptoms may be similar to those observed in other infectious diseases, thus complicating diagnosis and treatment [4] , [6] , [7] , [8] . In Colombia and other endemic countries in the Americas, where access to antiretroviral therapy (ART) can be limited, histoplasmosis is a cause of high morbidity and mortality (up to 30%) in PLWHA [9].…”