Incidence and Trends in Immune Reconstitution Inflammatory Syndrome Associated With Histoplasma capsulatum Among People Living With Human Immunodeficiency Virus: A 20-Year Case Series and Literature Review

Melzani, Alessia; Michel, Regis de Reynal de Saint; Ntab, Balthazar; Djossou, Félix; Epelboin, Loïc; Blanchet, Denis; Demar, Magalie; Couppié, Pierre; Adenis, Antoine

doi:10.1093/cid/ciz247

Cited by 26 publications

(38 citation statements)

References 30 publications

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“…In studies done among HIV patients, histoplasmosis-associated -IRIS was associated with histoplasmosis; IRIS was reported to be uncommon with incidence rates of 0.74 cases per 1000 HIV-infected person-years 0.5% [37][38][39]. However according to another study among 271 patients, the emergence of IRIS tended to be quite common in people with HIV and disseminated histoplasmosis; whether the IRIS is triggered by the Histoplasma or other co-infections, is still unclear [40].…”

Section: Histoplasmosis-associated Immune Reconstitution Inflammatorymentioning

confidence: 99%

“…The clinical manifestations vary from case to case, and they commonly include fever, lymphadenopathy, mucocutaneous lesions, and disseminated disease. The timeline of occurrence from initiation of ART is also varied from a few days to months, and symptoms can set in when the patient is already on the ART course or when the ART is just introduced [39,44,45]. Histoplasmosis-associated IRIS in HIV patients may have a predilection for females over males, with one study showing that it was four times more frequent in females than males [39].…”

Section: Histoplasmosis-associated Immune Reconstitution Inflammatorymentioning

confidence: 99%

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Treatment of Histoplasmosis

Bongomin¹,

Kwizera²,

Baluku³

et al. 2020

Histoplasma and Histoplasmosis

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Histoplasmosis, caused by the thermally dimorphic fungus Histoplasma capsulatum, is an uncommon multisystem disease with a global distribution. The spectrum of clinical manifestations ranges from an asymptomatic or minimally symptomatic acute pulmonary disease following inhalation of a large inoculum of Histoplasma microconidia to chronic pulmonary disease in patients with underlying structural lung disease. It also extends to acute progressive disseminated disease in patients with severe immunodeficiency. Generally, antifungal therapy is indicated for patients with progressive acute pulmonary histoplasmosis, chronic pulmonary histoplasmosis and acute progressive disseminated histoplasmosis. In immunocompetent patients, acute pulmonary histoplasmosis may be a self-limiting disease without the need for systemic antifungal therapy. Oral triazole antifungal drugs alone are recommended for less severe disease. However, moderate-to-severe acute pulmonary histoplasmosis requires intravenous amphotericin B therapy for at least 1-2 weeks followed by oral itraconazole for at least 12 weeks. For acute progressive disseminated histoplasmosis, intravenous amphotericin B therapy is given for at least 2 weeks (4-6 weeks if meningeal involvement) or until a patient can tolerate oral therapy, followed by oral itraconazole (or an alternative triazole) for at least 12 months. Chronic cavitary pulmonary histoplasmosis is treated with oral itraconazole for 1-2 years. There is insufficient evidence to support the use of isavuconazole or the echinocandins for the treatment of histoplasmosis.

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Section: Histoplasmosis-associated Immune Reconstitution Inflammatorymentioning

confidence: 99%

Section: Histoplasmosis-associated Immune Reconstitution Inflammatorymentioning

confidence: 99%

Treatment of Histoplasmosis

Bongomin¹,

Kwizera²,

Baluku³

et al. 2020

Histoplasma and Histoplasmosis

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“…In these cases, if lymph node biopsy is not possible, colonoscopy facilitates the diagnosis. Furthermore, immune reconstitution inflammatory syndromes (IRIS) following recent initiation of antiretroviral therapy are frequently associated with histoplasmosis lymphadenitis [26].…”

Section: Clinical Findingsmentioning

confidence: 99%

“…An immune reconstitution inflammatory syndrome (IRIS) is sometimes a complication of antiretroviral therapy in HAH patients in the weeks following the initiation of treatment as reported in French Guiana, with a relatively low incidence among patients living with HIV (0.74 cases per 1000 HIV-infected person-years) [26]. Fever may be accompanied by various signs and symptoms: digestive manifestations, lymph node enlargement, hematologic manifestations, and respiratory manifestations.…”

Section: Atypical Findingsmentioning

confidence: 99%

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The Broad Clinical Spectrum of Disseminated Histoplasmosis in HIV-Infected Patients: A 30 Years’ Experience in French Guiana

Couppié¹,

Herceg²,

Bourne-Watrin³

et al. 2019

JoF

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Histoplasmosis is a common but neglected AIDS-defining condition in endemic areas for Histoplasma capsulatum. At the advanced stage of HIV infection, the broad spectrum of clinical features may mimic other frequent opportunistic infections such as tuberculosis and makes it difficult for clinicians to diagnose histoplasmosis in a timely manner. Diagnosis of histoplasmosis is difficult and relies on a high index of clinical suspicion along with access to medical mycology facilities with the capacity to implement conventional diagnostic methods (direct examination and culture) in a biosafety level 3 laboratory as well as indirect diagnostic methods (molecular biology, antibody, and antigen detection tools in tissue and body fluids). Time to initiation of effective antifungals has an impact on the patient’s prognosis. The initiation of empirical antifungal treatment should be considered in endemic areas for Histoplasma capsulatum and HIV. Here, we report on 30 years of experience in managing HIV-associated histoplasmosis based on a synthesis of clinical findings in French Guiana with considerations regarding the difficulties in determining its differential diagnosis with other opportunistic infections.

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