Progressive disseminated histoplasmosis in HIV-positive patients

Abstract

Background: Histoplasmosis is the most common endemic mycosis among people living with advanced HIV infection. Purpose: Describe general aspects and challenges of this disease and its association with HIV. Research Design: Review of literature. Study Sample: Articles found using different combinations of terms including “disseminated histoplasmosis” and AIDS/HIV or immunosuppression in PubMed, Scopus, WHO Global health library, and Scielo database. Analysis: We look for information on epidemiology, pathogenesis, diagnosis, and treatment of histoplasmosis in AIDS patients. Results: Histoplasmosis is caused by Histoplasma capsulatum, a dimorphic fungus encountered throughout the world, mainly in soil enriched with bat and bird excreta. Progressive disseminated histoplasmosis is the main presentation of this mycosis in people living with advanced HIV and is fatal if left untreated. Symptoms include a systemic disease characterized by fever, weight loss, night sweats, skin manifestations, hepatomegaly, splenomegaly, and septic shock. Diagnostic tests include culture, visualization of H. capsulatum by direct and histopathological examination, serology, antigen, molecular, and skin testing. Patients with disseminated disease require aggressive and prolonged treatment to eradicate the pathogen and include amphotericin B and itraconazole. In many low income countries of endemic regions, histoplasmosis in HIV-positive patients is often undiagnosed or misdiagnosed as another opportunistic infection, due to the similarity in clinical manifestations and to the paucity of better diagnostic tests. Conclusion: Histoplasmosis remains a neglected disease. Few studies about the disease and expensive treatments make it difficult to reduce the morbidity and mortality of this condition. Public health services and physicians must be aware of histoplasmosis' burden among the HIV-positive population.

Disseminated histoplasmosis diagnosed through blood smear

“…Claudio José dos Santos Júnior [1], [2]  , Thiago José Matos Rocha [3]  and Aryanna Kelly Pinheiro Souza [2] …”

“…Histoplasmosis develops in immunodeficient individuals, such as those affected by acquired immunodeficiency syndrome (AIDS), with a high rate of morbidity and mortality 1 , 2 . The disseminated subtype addressed in this work is a strain with poor prognosis, and its diagnosis is still challenging to determine 3 .…”

Septic shock, hyperferritinemic syndrome, and multiple organ dysfunction without respiratory failure in a patient with disseminated histoplasmosis and advanced HIV disease

“…Histoplasmosis is endemic or highly endemic in Latin America, the Caribbean, and North America, where disseminated histoplasmosis (DH) represents the most frequent clinical presentation in individuals with advanced HIV disease 1 . DH is a frequent cause of death among individuals with advanced HIV disease from endemic regions, where the best diagnostic and therapeutic resources are usually limited and/or unavailable 2 . Therefore, DH remains neglected, undiagnosed, or misdiagnosed mainly as tuberculosis 3 , 4 .…”

Atypical Presentations of Progressive Disseminated Histoplasmosis in an Immunocompetent Adult: Ectopic Calcification (Aneurysm of Sinus of Valsalva) and Large Vessel (Left Subclavian Artery) Stenosis in the Background of Adrenal Insufficiency

“…The Immunocompromised individuals especially the HIV-infected peoples are easy to infect with H capsulatum [3]. Occasionally, Immunocompetent patients are also infected with H capsulatum, which is usually presented with nonspecific clinical manifestations such as prolonged fever, weight loss, oropharyngeal ulcers, hepatosplenomegaly, and lymphadenopathy [4].…”