The Current and Future States of Diagnostic Tests for Histoplasmosis with a Focus on People with HIV and Disseminated Histoplasmosis

Villareal, Kenneth; Price, Ann; Pasqualotto, Alessandro C.; Bahr, Nathan C

doi:10.3390/jof9080793

Cited by 7 publications

(2 citation statements)

References 70 publications

(136 reference statements)

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“…Similarly, when it manifests as a gastric presentation, it may mimic the appearance of a tumor ( Doleschal et al, 2016 ). In addition, misidentification is possible in the microbiology laboratory with other organisms such as Candida glabrata , Pneumocystis jiroveci, Toxoplasma gondii , Leishmania donovani , Cryptococcus neoformans ( Villareal et al, 2023 ).…”

Section: Discussionmentioning

confidence: 99%

Histoplasmosis in patients living with HIV in Europe: review of literature

Kontogiannis,

Di Lorenzo,

Zaçe

et al. 2024

Front. Microbiol.

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Histoplasma capsulatum (var. capsulatum Hcc and duboisii Hcd), is a dimorphic fungus that causes histoplasmosis. It usually affects people coming from endemic areas, causing a variety of clinical manifestations up to progressive disseminated histoplasmosis (PDH), especially among people living with HIV (PLWH). We conducted a systematic review to assess histoplasmosis burden of PLWH in Europe. The review follows PRISMA guidelines, with protocol registered in PROSPERO (CRD42023429779). Seventy-eight articles were selected, including 109 patients (32 women). On overall, median age was 37 years. Forty-six patients were Americans, 39 Africans, 17 Europeans, 5 Asians, in 2 cases nationality was not specified. Cases were mainly diagnosed in Italy (28.4%), France (17.3%) and Spain (17.4%), with a north–south gradient. Six cases lacked epidemiologic links with endemic areas. Concerning CDC HIV staging at diagnosis, the information was available for 60 PLWH (55%) and all subjects were at stage C3 except for two subjects at stage B3. PDH was the AIDS-presenting illness in 39 patients. Most patients had a PDH (80.7%); other common extrapulmonary forms were isolated cutaneous histoplasmosis (7.3%), or lymphatic localization (2.7%). In 30 cases, the diagnosis was made by analyzing only one sample. For the remaining 79 cases, multiple samples were collected from each patient. Regarding the biological sample more frequently used for the diagnosis of histoplasmosis, bronchoalveolar lavage sample was taken from 39 patients, and tested positive in 51.3% of cases; 36 patients underwent a skin biopsy which was positive in 86.1% of cases and 28 patients performed bone-marrow biopsy, which led to the diagnosis of histoplasmosis in 92.9% of cases. The identification of Histoplasma capsulatum was available in 97 PLWH through examination of different samples: Hcc and Hcd were identified in 89 and 8 PLWH, respectively. Concerning therapies, 67.9% were treated with liposomal amphotericin B, 18.3% with itraconazole, 10 died pre-treatment. The overall mortality rate was 23.6%. Non-survivors exhibited more frequently gastrointestinal symptoms (p = 0.017), while cutaneous signs correlated with better survival (p = 0.05). Untreated patients faced higher mortality (p < 0.001). Histoplasmosis should be considered amongst opportunistic infection in PLWH, even in Europe, especially if patients originate from or have travelled to endemic areas.Systematic review registration: The registration number is CRD42023429779.

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Section: Discussionmentioning

confidence: 99%

Histoplasmosis in patients living with HIV in Europe: review of literature

Kontogiannis,

Di Lorenzo,

Zaçe

et al. 2024

Front. Microbiol.

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“…Enzyme immunoassays (EIAs), where available, have bridged this diagnostic gap by enabling detection of Histoplasma antigen in both urine and serum samples ( 6 ). The first EIA test, developed by MiraVista Diagnostics ( https://miravistalabs.com ), is 95% sensitive in urine samples ( 7 ), but this test is not a viable option for low- and middle-income countries because samples can be processed only at 1 reference laboratory in Indianapolis, Indiana, USA.…”

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confidence: 99%

Systematic Review of Prevalence of Histoplasma Antigenuria in Persons with HIV in Latin America and Africa

Sekar,

Hale,

Gakuru

et al. 2024

Emerg. Infect. Dis.

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Histoplasmosis is a fungal disease associated with substantial mortality rates among persons with advanced HIV disease. Our systematic review synthesized data on the global prevalence of Histoplasma -caused antigenuria in persons with HIV. We searched PubMed/Medline, Embase, and Scopus databases on January 3, 2023, to identify cross-sectional and cohort studies evaluating Histoplasma antigenuria prevalence among adults with HIV infection. We calculated point estimates and 95% CIs to summarize prevalence. Of 1,294 studies screened, we included 15. We found Histoplasma antigenuria among 581/5,096 (11%; 95% CI 11%–12%) persons with HIV and 483/3,789 persons with advanced HIV disease (13%; 95% CI 12%–14%). Among persons with HIV and symptoms consistent with histoplasmosis, Histoplasma antigenuria prevalence was 14% (95% CI 13%–15%; 502/3,631 participants). We determined that persons with advanced HIV disease, inpatients, and symptomatic persons might benefit from a systematic approach to early detection of histoplasmosis using urine antigen testing.

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