Multiple skeletal lesions and pleural effusion owing to Histoplasma capsulatum infection in an immunocompetent patient from a non-endemic region

Suleman, Farhana Ebrahim; Scheepers, Pieter A.

doi:10.4102/sajr.v15i3.372

Cited by 2 publications

(3 citation statements)

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“…Unlike classical histoplasmosis which involves the lungs, African histoplasmosis commonly involves the skin and may progress to cause bone damage. 12 , 19 , 25 , 31 Localized lesions are commonly seen in immunocompetent population and may present as boils, swellings, ulcers, papules, subcutaneous abscesses, cutaneous fistulas, limb deformity, tumors, or enlarged lymph nodes. 37 , 38 , 40 , 43 , 45 Lesions may be painful or painless.…”

Section: Resultsmentioning

confidence: 99%

“…37 , 38 , 40 , 43 , 45 Common radiological findings include osteolytic lesions, periosteal reaction, cortical erosion, and cauterization. 15 , 16 , 25 , 26 , 29 The presence of lymphadenopathy on clinical examination in the pediatric age group is most often associated with TB, malignancies, and sepsis. 12 , 13 , 32 , 44 Garcia-Guiñon et al 44 report a case of DH misdiagnosed as TB in a 10-year-old girl who presented with painless suppurative lesions on the head, face, the upper body, and the armpit.…”

Section: Resultsmentioning

confidence: 99%

“…Diagnostic modalities for histoplasmosis used in the cases reviewed were mostly histopathology ( n = 33, 75%). Others included microscopy ( n = 3,6.8%), bone marrow aspirate and cytology ( n = 3,6.8%), culture ( n = 1,2.3%), and serology ( n = 1,2.3%) 11 – 16 , 22 – 35 , 37 , 41 – 44 , 46 Molecular diagnosis was not used in any of the cases. The diagnosis of histoplasmosis in children can be challenging.…”

Section: Resultsmentioning

confidence: 99%

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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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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Histoplasmosis in African children: clinical features, diagnosis and treatment

Ekeng

Edem

Akintan

et al. 2022

Therapeutic Advances in Infection

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Histoplasmosis in Children; HIV/AIDS Not a Major Driver

Ekeng

Edem

Amamilo³

et al. 2021

JoF

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The classification of histoplasmosis as an AIDS-defining illness has largely attributed its occurrence in people to the presence of HIV/AIDS especially in Africa. Prior to the advent of the HIV/AIDS epidemic, several cases of histoplasmosis were documented both in the pediatric and adult populations. Our review revealed 1461 reported cases of pediatric histoplasmosis globally in the last eight decades (1939–2021). North America (n = 1231) had the highest number of cases, followed by South America (n = 135), Africa (n = 65), Asia (n = 26) and Europe (n = 4). Histoplasmosis was much more common in the non-HIV pediatric population (n = 1418, 97.1%) compared to the HIV population. The non-HIV factors implicated were, childhood malignancies (n = 207), such as leukemias and lymphomas as well as their treatment, lung diseases (n = 7), environmental exposures and toxins (n = 224), autoimmune diseases (n = 12), organ transplants (n = 12), long-term steroid therapy (n = 3), the use of immunosuppressive drugs such as TNF-alpha inhibitors (n = 7) malnutrition (n = 12), histiocytosis (n = 3), Hyper immunoglobulin M and E syndromes (n = 15, 1.2%), pancytopenia (n = 26), diabetes mellitus (n = 1) and T-cell deficiency (n = 21). Paediatricians should always consider or rule out a diagnosis of histoplasmosis in children presenting with symptoms suggestive of the above clinical conditions.

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Multiple skeletal lesions and pleural effusion owing to Histoplasma capsulatum infection in an immunocompetent patient from a non-endemic region

Cited by 2 publications

References 5 publications

Histoplasmosis in African children: clinical features, diagnosis and treatment

Histoplasmosis in African children: clinical features, diagnosis and treatment

Histoplasmosis in Children; HIV/AIDS Not a Major Driver

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