Histoplasmosis in the Republic of Congo dominated by African histoplasmosis, Histoplasma capsulatum var. duboisii

Amona, Fructueux Modeste; Denning, David W.; Moukassa, Donatien; Develoux, M.; Hennequin, Christophe

doi:10.1371/journal.pntd.0009318

Cited by 15 publications

(10 citation statements)

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“…The true burden of histoplasmosis is currently unknown, and adequate mapping is lacking. There is a need to probably institute active localized surveillance programs in endemic areas, particularly in previously suggested epicenters in Transvaal and Cape Province, South Africa [ 35 ], Kimpese, Democratic Republic of the Congo [ 18 ], Ogbunike, Nigeria [ 35 ], and Brazzaville, Republic of Congo [ 99 ], and rural areas with potentially high risks. Nearly all cases of histoplasmosis reported in the literature are diagnosed in tertiary medical centers in urban cities, and patients sometimes need to travel long distances.…”

Section: Resultsmentioning

confidence: 99%

Histoplasmosis in Africa: Current perspectives, knowledge gaps, and research priorities

et al. 2022

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Background Histoplasmosis is a chronic granulomatous disease caused by the thermally dimorphic fungus Histoplasma capsulatum. The 2 variants Histoplasma capsulatum var. capsulatum (Hcc) and Histoplasma capsulatum var. duboisii (Hcd) causes infection in humans and commonly termed classical or American histoplasmosis and African histoplasmosis, respectively. Histoplasma capsulatum var. farciminosum (Hcf) affects equines. In recent times, there have been heightened sensitization on fungal infections such as histoplasmosis in Africa, aimed at improving awareness among relevant stakeholders, particularly healthcare workers. This effort is expected to be paralleled with increased detection of both classical and African histoplasmosis, which has remained underdiagnosed over the years. In this narrative review, we describe the current perspectives of histoplasmosis in Africa, identify knowledge gaps, and suggest research priorities. Methods A PubMed, Google Scholar, and Africa Journal Online (AJOL) literature search was conducted for studies on histoplasmosis in Africa between 2000 and 2020. Histoplasmosis essays in medical mycology textbooks were also consulted. This narrative review was prepared from the data gathered. Findings In the past 2 decades, histoplasmosis in general has seen a relative increase in case detection in some Africa countries, probably attributable to the gradually increasing medical mycology advocacy efforts in Africa. Histoplasmosis cases are dominated by African histoplasmosis mostly in Western and Central Africa, while classical histoplasmosis is more common in Southern and Northern Africa. Although both classical and African histoplasmosis are common in Africa, the latter is more restricted to Africa, and cases outside the continent usually have a travel history to the continent. Despite the clinical and laboratory difference between African histoplasmosis and classical histoplasmosis, it is not straightforward to distinguish them. The typical manifestation of African histoplasmosis is the appearance of lesions affecting the skin, bones, and lymph nodes and unusually linked to human immunodeficiency virus (HIV)/AIDS. By contrast, classical histoplasmosis mostly affects the lungs and is often associated with immunosuppression, mainly HIV/AIDS. The present perspectives of histoplasmosis in Africa highlight unclear details on the true burden, strain diversity, infection route and genetic basis of African histoplasmosis, availability of specie-specific diagnostic tools, and compliance with recommended antifungal therapy. These knowledge gaps represent research questions that require scientific exploration. Conclusions Despite a subtle increase in identifying histoplasmosis cases in Africa, it remains underdiagnosed and neglected in some parts of the continent. Increasing awareness and training among healthcare workers, bridging diagnostic and therapeutic gaps, and encouraging more research in Africa are crucial to improve the current perspectives of histoplasmosis in Africa.

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Section: Resultsmentioning

confidence: 99%

Histoplasmosis in Africa: Current perspectives, knowledge gaps, and research priorities

et al. 2022

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“…Our review seems to indicate that there is an underreporting of paediatric histoplasmosis from Africa (only 6% of the cases). Two recent reviews focusing on African histoplasmosis reported that 25% and 30% of the 57 and 94 cases, respectively, were children [95,96]. Lack of awareness and clinical recognition, as well as a lack of management resources, might well explain this observation.…”

Section: Discussionmentioning

confidence: 99%

Paediatric Histoplasmosis 2000–2019: A Review of 83 Cases

MacInnes

Warris

2021

JoF

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Histoplasmosis is an endemic fungal infection that is confined to specific geographical regions. Histoplasma spp. are primary pathogens that cause disease in both immunocompetent and immunocompromised patients, ranging from a single-organ (mostly affecting the lungs) infection to life-threatening disseminated disease. Knowledge about the clinical epidemiology relies on data from adult populations; little is known about the patient and disease characteristics in the paediatric population. Therefore, a structured review of published cases of paediatric histoplasmosis between 2000 and 2019 was performed. A literature search of PubMed was conducted and the epidemiological and clinical data from 83 cases were analysed. The mean age at presentation was 9.5 ± 5.5 years, and 51% were girls. Two-thirds of the children were immunocompromised. The majority of children presented with disseminated disease. The most frequently observed clinical symptoms were respiratory symptoms, alongside non-specific systemic features, including fever, myalgia, fatigue and weight loss. The mortality rate was 11%. Histoplasmosis affects children of any age. Being immunocompromised is a risk factor for severe and disseminated disease. The lack of specific presenting features leads to underreporting and delay in diagnosis. To improve the recognition and outcome of histoplasmosis in childhood, increased awareness and surveillance systems are warranted.

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“…In addition, a case series study by Pakasa et al 9 revealed a high incidence (44.4%, 16/36) of histoplasmosis in young children, within the age range of 3–7 years. In a more recent review by Amona et al , 10 of the 54 cases reported in Congo, 17 (31.5%) were from the pediatric age group. However, there still exist occurrences of histoplasmosis being misdiagnosed as other clinical conditions like tuberculosis (TB), pneumonia, cancers, nephrotic syndrome and hyperreactive malarial splenomegaly syndrome.…”

Section: Introductionmentioning

confidence: 93%

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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Histoplasmosis in the Republic of Congo dominated by African histoplasmosis, Histoplasma capsulatum var. duboisii

Cited by 15 publications

References 25 publications

Histoplasmosis in Africa: Current perspectives, knowledge gaps, and research priorities

Histoplasmosis in Africa: Current perspectives, knowledge gaps, and research priorities

Paediatric Histoplasmosis 2000–2019: A Review of 83 Cases

Histoplasmosis in African children: clinical features, diagnosis and treatment

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