The important role of co-infections in patients with AIDS and progressive disseminated histoplasmosis (PDH): A cohort from Colombia

Abstract

A total of 23/45 (51%) patients with AIDS and histoplasmosis from Medellín, Colombia had other infections. Tuberculosis was the most common (n = 16/23, 70%). Pneumocystosis and cryptococcosis were found in three patients each (13%), bacterial infection and cytomegalovirus occurred each in two patients (9%) while toxoplasmosis, herpes virus and esophageal candidiasis were recorded in one patient each (4%). Of all co-infected patients, 18/23 (78%) had one, four (17%) had two and one (4%) had three additional opportunistic infections.

Screening for invasive fungal disease using non‐culture‐based assays among inpatients with advanced HIV disease at a large academic hospital in South Africa

“…In Colombia, 51% of people living with HIV with progressive disseminated histoplasmosis had at least one other OI at the time of presentation. TB was the main co‐infection (70% of patients), followed by pneumocystosis and cryptococcosis 30 . In our setting, TB was also the main co‐infection.…”

“…Our study highlights that some invasive fungal disease could have been misdiagnosed as TB. Clinicians should therefore maintain a higher index of suspicion of invasive fungal disease in this inpatient group and look for other OIs, even if a diagnosis of TB has been made 30 …”

Evaluation of a Histoplasma antigen lateral flow assay for the rapid diagnosis of progressive disseminated histoplasmosis in Colombian patients with AIDS

“…Early diagnosis is critical for providing proper treatment; however, diagnosis of PDH can be challenging. Symptoms in PLHIV may lack specificity and be similar to opportunistic infections, especially infections caused by Mycobacterium species, complicating diagnosis and treatment of PDH, especially in geographic regions where tuberculosis and other opportunistic infections are frequent …”

“…Symptoms in PLHIV may lack specificity and be similar to opportunistic infections, especially infections caused by Mycobacterium species, complicating diagnosis and treatment of PDH, especially in geographic regions where tuberculosis and other opportunistic infections are frequent. [2][3][4][5] Laboratory diagnosis by culture can take weeks and serology may be falsely negative early in infection or as a result of immunosuppression in these patients. 6,7 Recently, an in-house Western blot assay has reported high sensitivity to diagnose PDH in HIV (90% sensitivity), but this assay is not commercially available.…”

Histoplasmosis: diagnostic challenges

“…The symptoms of progressive histoplasmosis are nonspecific, so its differentiation with other infections, especially tuberculosis, is a challenge, even to determine the presence of coinfections that occur frequently in patients with HIV/AIDS. (1,2,4) The laboratory tests available for the conventional diagnosis of this fungal infection have several limitations: 1) Collecting blood, respiratory tract or tissue samples for cultures is the golden standard, but sensitivity is variable based on the immunity of the patient, so the culture sometimes yields false-negative results. In addition, Histoplasma isolation may require up to six weeks for optimal growth.…”