Fatal disseminated histoplasmosis

Salfelder, K.; Brass, K.; Doehnert, G.; Doehnert, R.; Sauerteig, E.

doi:10.1007/bf00578541

Cited by 16 publications

(1 citation statement)

References 24 publications

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“…Clinically, histoplasmosis is frequently missed, partly due to the overlap of its symptoms with those of tuberculosis [ 1 ]. However, autopsy studies of fatal histoplasmosis focusing on the clinicopathological correlation are very scarce [ 17 – 19 , 21 , 22 ].…”

Section: Introductionmentioning

confidence: 99%

High prevalence and mortality due to Histoplasma capsulatum in the Brazilian Amazon: An autopsy study

et al. 2021

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Background Histoplasmosis is acquired by inhalation of spores of the dimorphic fungus Histoplasma spp. Although this pathogen is distributed worldwide, it is more prevalent in the Americas. However, the real burden of histoplasmosis remains undefined in many endemic regions. Methodology We conducted a series of 61 autopsies to individuals who died in a hospital in the Brazilian Amazon focused on infectious diseases. We performed a detailed histological and microbiological evaluation with genetic characterization of Histoplasma strains with the aim to evaluate the contribution of histoplasmosis to morbidity and mortality. Additionally, we assessed the clinicopathological correlation. Principal findings Evidence of Histoplasma infection was detected in 21 patients (34%). Eight cases were disseminated infections, all of them occurred in HIV-positive patients. Six cases were localized histoplasmosis, limited to the lungs. In seven patients Histoplasma DNA was detected by PCR in patients with no histological lesions. Histoplasma infection was detected in 38% of HIV-positive patients and was a major contributor to death in 22% of them. Lungs, liver and spleen were affected in all cases of disseminated histoplasmosis. Phylogenetic analysis of the strains suggested a high diversity of Histoplasma species circulating in the Brazilian Amazon. Histoplasmosis was clinically missed in 75% of the disseminated infections. In conclusion, substantial mortality is associated with disseminated histoplasmosis among HIV-positive patients in the Brazilian Amazon. Conclusions The high incidence of histoplasmosis, the low index of clinical suspicion, and the severity of the disseminated disease highlight the need of proactively implementing sensitive routine screening methods for this pathogen in endemic areas. Antifungal prophylaxis against Histoplasma should be encouraged in the severely immunocompromised HIV patients in these areas.

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