Histoplasma capsulatum var. duboisii: A KwaZulu‐Natal, South Africa public sector perspective

Abstract

Background: Histoplasma capsulatum var. duboisii (H. duboisii) causes potentially fatal disease in the immunocompromised patient, and the literature on these cases is limited. The study was undertaken to describe the cases of H. duboisii seen in a resource-limited setting.Methods: A 5-year retrospective, laboratory-based histopathologic review of all H. duboisii cases.Results: A total of 24 patients were diagnosed with cutaneous H. duboisii infection.The male-to-female ratio was 1.4. All the patients were human immunodeficiency virus (HIV) positive, and 70.83% (17 of 24 patients) were on antiretroviral therapy.The clinically identified lesions were as follows: plaques, nodular plaques, papules, papulo-pustules, and umbilicated papules. Histopathological appraisal revealed organisms typical of H. duboisii. The commonest epidermal alterations were interface change, parakeratosis, spongiosis, ulceration, acanthosis, hyperkeratosis, transepidermal elimination, and exocytosis in decreasing order. The dermal changes included histiocytic pattern (n = 14), neutrophil-rich (n = 13), non-necrotizing granulomatous inflammation (n = 9), and karyorrhexis (n = 6). Histoplasma was confirmed in 53% (8 of 15 samples) of the tissue samples submitted for routine fungal culture. Conclusion:This study showed the demographics, clinical and histopathology features of H. duboisii infection in a resource-limited setting. Further research on histopathological features of this rare infection is essential to expand on the knowledge base and support findings in this study.

Asymptomatic Leg Ulcer in a HIV-2+ Veteran: Answer

“…In profound immunosuppressed individuals, there may even be a negligible host response to the organisms. 6…”

“…Identification of the organism is key to diagnosis. 6 Fungal culture is the gold standard for the diagnosis of H. capsulatum infections but is hampered by the slow growth of this microorganism (up to 4 weeks). H. capsulatum antigens can be detected in the urine and serum of patients, but this technique is not widely available.…”

“…Fungal infections remain a substantial disease burden in those living with HIV/AIDS. 6 In mild-to-moderate histoplasmosis, recommended treatment includes a loading dose of 200 mg of itraconazole thrice daily for 3 days, followed by itraconazole 200 mg twice daily for 12 months. 7 Dermal reaction patterns specifically described for Hcd skin involvement includes granulomatous inflammation, histiocytic and neutrophil-rich reaction patterns, necrosis, and fibrosis.…”

“…7 Dermal reaction patterns specifically described for Hcd skin involvement includes granulomatous inflammation, histiocytic and neutrophil-rich reaction patterns, necrosis, and fibrosis. 6 Necrosis is most commonly seen in immunocompromised patients (as in HIV/AIDS-associated cases). In profound immunosuppressed individuals, there may even be a negligible host response to the organisms.…”

“…In profound immunosuppressed individuals, there may even be a negligible host response to the organisms. 6 Histological features of Hcd include the narrow-necked budding and variable organism size, usually ranging from 7 to 15 mm 6 , as opposed to Hcc, which typically presents with smaller yeasts, ranging from 2 to 4 mm, and with thinner walls. Bud scars are common.…”