Disseminated Histoplasmosis as Aids Presentation. Case Report and Comprehensive Review of Current Literature

Zanotti, Paola; Chirico, Claudia; Gulletta, Maurizio; Ardighieri, Laura; Casari, Salvatore; Roldán, Eugenia Quirós; Izzo, Ilaria; Pinsi, G.; Lorenzin, Giovanni; Facchetti, Fabio; Castelli, Francesco; Focà, Emanuele

doi:10.4084/mjhid.2018.040

Cited by 20 publications

(16 citation statements)

References 70 publications

(66 reference statements)

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“…Cuban epidemiology follows the rule, and papules are the most frequent features [17]. In our patient, clinical findings, including skin eruption and laboratory abnormalities, are similar to those reported in the literature [1, 4, 12]. …”

Section: Discussionsupporting

confidence: 84%

An Italian Case of Disseminated Histoplasmosis Associated with HIV

Papalini

Belfiori

Martino

et al. 2019

Case Reports in Infectious Diseases

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Histoplasma capsulatum is a dimorphic fungus, endemic in the Americas, Africa (var. duboisii), India, and Southeast Asia. H. capsulatum infection is rarely diagnosed in Italy, while in Latin America, progressive disseminated histoplasmosis (PDH) is one of the most frequent AIDS-defining illnesses and causes of AIDS-related deaths. We report a case of PDH and new HIV infection diagnosis in a Cuban patient, who has been living in Italy for the past 10 years. Bone marrow aspirate and peripheral blood smear microscopy suggested H. capsulatum infection. The diagnosis was confirmed with the culture method identifying its thermal dimorphism. Liposomal amphotericin B was administered alone for 10 days and then for another 2 days, accompanied with voriconazole; the former was stopped for probable side effects (persistent fever and worsening thrombocytopenia), and voriconazole was continued to complete 4 weeks. PDH maintenance treatment consisted of itraconazole for one year. Antiretroviral therapy (ART) was started on the third week of antifungal treatment. At the 3-year follow-up, the patient is adherent on ART, the virus was suppressed, and she has an optimal immune recovery. This case highlights the need to suspect histoplasmosis in the differential diagnosis of opportunistic infections in immunocompromised persons, native to or who have traveled to endemic countries.

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Section: Discussionsupporting

confidence: 84%

An Italian Case of Disseminated Histoplasmosis Associated with HIV

Papalini

Belfiori

Martino

et al. 2019

Case Reports in Infectious Diseases

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“… 4 Infections may occur by inhalation of microconidia following human activities that disrupt the soil which tend to aerosolize the hyphae and conidia of the organism or orally, causing infection in the intestines. 1 , 5 Perinatal and congenital infections have also been reported in children living with HIV. 6 , 7 Histoplasmosis in African children is not uncommon.…”

Section: Introductionmentioning

confidence: 99%

Histoplasmosis in African children: clinical features, diagnosis and treatment

Ekeng

Edem

Akintan

et al. 2022

Therapeutic Advances in Infection

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Most of the reviews on histoplasmosis documented in literature have been in the adult population. Very few studies highlight the peculiarities associated with histoplasmosis in Africa especially in the pediatric population. This review addresses the above concerns with clinical summaries and diagnosis of some case reports of histoplasmosis in African children. We highlighted 44 case reports of histoplasmosis in African children (1950–2021) distributed across Western Africa (38.6%, n = 17), Eastern Africa (9.1%, n = 4), Southern Africa (9.1%, n = 4), and Central Africa (43.2%, n = 19). No case report was found from Northern Africa. The age range was 1–17 years, with a mean of 9.2. Of the 44 case reports, 8 cases (18.2%, 8/44) were caused by Histoplasma capsulatum var capsulatum, 33 cases (75%, 33/44) were caused by Histoplasma capsulatum var duboisii, and specie identification was not found in 3 cases. Only three (6.8%) cases were HIV positive; 56.8% (25/44) were disseminated histoplasmosis, pulmonary histoplasmosis accounted for just one case (2.3%, 1/44). Extrapulmonary presentation included skin lesions (ulcers, fistulas, nodules, patches, pigmentations, papules, and abscesses), bone lesions, osteoarthritis, and fractures. The commonest sites affected were skin ( n = 29, 65.9%), bones ( n = 20, 45.5%), and lymph nodes ( n = 15, 34.1%). Histopathology was the commonest diagnostic method ( n = 33, 75%). Amphotericin B was first-line therapy in 45.5% of the cases ( n = 20) followed by ketoconazole (20.5%, n = 9); 27 cases (61.4%) had favorable outcomes, 8 cases (18.2%) had fatal outcomes, while in 9 cases, the outcome was not revealed. This review revealed several cases of histoplasmosis misdiagnosed as other conditions including tuberculosis ( n = 3, 6.8%), pneumonia ( n = 1, 2.3%), cancers ( n = 4, 9.1%), nephritic syndrome ( n = 1, 2.3%), leishmaniasis ( n = 1, 2.3%), and hyperreactive malarial splenomegaly syndrome ( n = 1, 2.3%). In addition, histoplasmosis was not considered in some case reports even when symptoms were suggestive. Diagnosis of histoplasmosis was made at autopsy with postmortem findings suggestive of histoplasmosis ( n = 3, 6.8%). This report highlights the need for a paradigm shift on the part of pediatricians in Africa. They need to look beyond clinical conditions considered common in our environment for this age group and evaluate for other diseases including histoplasmosis.

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“…infection. As with many fungal infections, the most prevalent risk factor for life-threatening histoplasmosis is HIV/ AIDS [99,100]. In hyper-endemic regions, up to 25% of HIV+ patients develop clinical histoplasmosis [101], with highly active antiretroviral therapy decreasing this rate [102].…”

Section: Histoplasmamentioning

confidence: 99%

How Environmental Fungi Cause a Range of Clinical Outcomes in Susceptible Hosts

Denham

Wambaugh

Brown

2019

Journal of Molecular Biology

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Life-threatening infections in immunocompetent individuals have been documented for all the fungi we discuss. However, the majority of life-threatening infections typically present in individuals with particular immunocompromising risk factors [4]. Thus, the outcome of infection is determined by a constellation of fungal traits and host susceptibilities (Table 1). In this review, we discuss host and fungal factors that contribute to infectivity, persistence within the host, and progression to life-threatening infections for five groups of fungi: Cryptococcus, Aspergillus, Histoplasma, Blastomyces, and Coccidioides spp. These common environmental fungi do not require an infectious life cycle for their survival. They are not transmissible between humans, nor are humans considered a particularly suitable niche for commensalism, such as it is for certain Candida spp. [10]. We do not discuss Candida spp., which are addressed elsewhere in this issue. Aspergillus spp. and Cryptococcus spp. are considered some of the more cosmopolitan fungal species. Due to their large geographical range, respiratory exposure to these fungi is commonplace [11]. Aspergillus spp. commonly cause both asymptomatic and symptomatic 2

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Disseminated Histoplasmosis as Aids Presentation. Case Report and Comprehensive Review of Current Literature

Cited by 20 publications

References 70 publications

An Italian Case of Disseminated Histoplasmosis Associated with HIV

An Italian Case of Disseminated Histoplasmosis Associated with HIV

Histoplasmosis in African children: clinical features, diagnosis and treatment

How Environmental Fungi Cause a Range of Clinical Outcomes in Susceptible Hosts

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