Diagnosing disseminated histoplasmosis in advanced HIV/AIDS disease in Cameroon using a point of care lateral flow assay – a case series

Abstract

Background Histoplasmosis is an AIDS-defining opportunistic infection. Disseminated histoplasmosis (DH) can be fatal without early diagnosis and treatment initiation. We present four cases of disseminated histoplasmosis in advanced HIV/AIDS disease patients diagnosed using Histoplasma lateral flow assay (LFA) in Yaoundé, Cameroon. Cases presentation : Four women with HIV but unknown CD4 + T cell count were received at the Hospital presenting with asthenia, weight loss, productive cough and fever (39°C) as common symptoms for at least three weeks. Two of the patients had skin lesions. These included facial papules, macules and umbilicated vesicles scattered over the trunk and limbs. These were diffuse lesions which were purulent, itching and papillomatous lesions with a necrotic center, and one patient had a right forearm ulcer. We performed the Histoplasma antigen tests using the Histoplasma antigen lateral flow assay (LFA) and they were strongly positive in all four patients. Histopathology in skin biopsy allowed identification of the species as Histoplasma capsulatum var capsulatum in one patient. In this same patient, Pseudomonas aeruginosa and Proteus mirabilis were cultured from the forearm ulcer. This patient later commenced antibiotics (Levofloxacin 500 mg) and oral itraconazole (800mg/day) with immediate improvement. Unfortunately, the other three patients could not afford itraconazole, were discharged and lost to follow up. Conclusion Early diagnosis and treatment are essential for the management of DH. LFA is a test that can be set up in any setting with limited resource. Access to this can be a major advance in the diagnosis of histoplasmosis in resource limited settings.