Histoplasmosis Diagnosed in Europe and Israel: A Case Report and Systematic Review of the Literature from 2005 to 2020

Abstract

Human histoplasmosis is a mycosis caused by two distinct varieties of a dimorphic fungus: Histoplasma capsulatum var. capsulatum and H. capsulatum var. duboisii. In Europe, it is usually imported by migrants and travellers, although there have been some autochthonous cases, especially in Italy; however, most European physicians are unfamiliar with its clinical and pathological picture, particularly among immunocompromised patients without HIV infection. This systematic review of all the cases of histoplasmosis reported in Europe and Israel between 2005 and 2020 identified 728 cases diagnosed in 17 European countries and Israel described in 133 articles. The vast majority were imported (mainly from Central and South America), but there were also seven autochthonous cases (six in Europe and one in Israel). The patients were prevalently males (60.4%), and their ages ranged from 2 to 86 years. The time between leaving an endemic region and the diagnosis of histoplasmosis varied from a few weeks to more than 40 years. Progressive disseminated histoplasmosis was the most frequent clinical picture among people living with HIV infection (89.5%) or a different immunocompromising condition (57.1%), but it was also recorded in 6.2% of immunocompetent patients. Twenty-eight cases were caused by Histoplasma duboisii. Immunocompromised patients without HIV infection had the worst outcomes, with a mortality rate of 32%.

Histoplasma capsulatum var duboisii Infection: A Global Review, 1950–2021

“…Although the occurrence of Hcd infection is largely attributed to Africa, several cases have been reported outside Africa including indigenous case reports [69,74,75]. This is corroborated in an earlier review by Antinori et al and Develoux et al which also confirmed significant number of Hcd infection cases reported outside Africa [74,75]. Our review demonstrates the occurrence of Hcd infection as a worldwide disease entity contrary to the previous opinion that all cases are contracted from Africa.…”

Let's talk about sex characteristics—As a risk factor for invasive fungal diseases

“…Out of 25 meta-analyses/systematic reviews on histoplasmosis, four met inclusion criteria and showed a male predominance ranging from 68% to 100%. [101][102][103][104] Details on selection process as well as results can be found in the online supplement.…”

Methods of laboratory diagnosis of histoplasmosis – problems and prospects

“…В недавней работе Antinori с соавторами было отмечено, что при обследовании лиц с иммунодефицитными состояниями культуральный метод использовали в 46,4-57,5% случаев, гистологические исследования -в 58,4-78,6%. При обследовании иммунокомпетентных лиц на долю диагностических мероприятий, связанных с культуральным или гистологическим методами приходилось 12,3% случаев, а наибольшее внимание уделялось иммунологическим тестам -44,4% [5].…”

“…Не исключено, что из-за фенотипических различий штаммов Histoplasma spp. могут варьировать аналитические характери-чего возрастает вероятность регистрации завозных случаев гистоплазмоза на неэндемичные территории [3,4,5]. Во внешней среде H. capsulatum обитает в загрязненной пометом птиц и/или летучих мышей почве в мицелиальной форме.…”