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Ekeng BE, Davies AA, Osaigbovo II, Emanghe UE, Udoh UA, Alex-Wele MA, Adereti OC, Oladele RO. Current epidemiology of histoplasmosis in Nigeria: A systematic review and meta-analysis. Niger Postgrad Med J 2023; 30:12-17. [PMID: 36814158 DOI: 10.4103/npmj.npmj_311_22] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
Introduction Histoplasmosis commonly occurs in the advanced HIV disease population and also in immunocompetent individuals. Previous reviews and recent studies highlight several cases of histoplasmosis reported in Nigeria. We aimed to describe the current epidemiology of histoplasmosis in Nigeria and the need for active surveillance in the at-risk populations. Methods Literature searches for all publications on histoplasmosis in Nigeria were performed using online databases including Google scholar, PubMed and African Journal online. The following search terms: 'histoplasmosis' and 'Nigeria', AND/OR 'Histoplasma and Nigeria' were used. No limitations on the date or other search criteria were applied, to avoid the exclusion of articles on histoplasmosis in Nigeria. All publications on histoplasmosis outside Nigeria were excluded. Results Our review identified a total of 231 cases of histoplasmosis reported from Nigeria: 128 were from individual case reports and case series while 103 were cases from two observational studies. Of the 231 cases, 97 (42.0%) were from South West Nigeria, 66 (28.6%) were from South-South Nigeria, 24 (10.4%) were from North West, 22 (9.5%) from North Central Nigeria, 17 (7.4%) from South East Nigeria and 5 (2.2%) from the North East. Based on Nigeria's current population size of 216,953,585 the burden of histoplasmosis per 100,000 inhabitants was estimated to be 0.1%. The sheer number of cases detected in recent observational studies compared with individual case reports and series reported over a longer duration of 6 decades suggests gross under-reporting of histoplasmosis in Nigeria. Conclusion Histoplasmosis is not an uncommon clinical entity in Nigeria. Histoplasmosis case finding should be improved by training and retraining healthcare professionals and providing much-needed diagnostic capacity and infrastructure across health facilities in Nigeria.
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Affiliation(s)
- Bassey Ewa Ekeng
- Department of Medical Microbiology and Parasitology, University of Calabar Teaching Hospital, Calabar; Medical Mycology Society of Nigeria, Lagos, Nigeria
| | - Adeyinka Afolake Davies
- Medical Mycology Society of Nigeria, Lagos; Department of Medical Microbiology and Parasitology, Olabisi Onabanjo University Teaching Hospital, Sagamu, Nigeria
| | - Iriagbonse Iyabo Osaigbovo
- Medical Mycology Society of Nigeria, Lagos; Department of Medical Microbiology, School of Medicine, College of Medical Sciences, University of Benin, Benin City, Nigeria
| | - Ubleni Ettah Emanghe
- Department of Medical Microbiology and Parasitology, University of Calabar Teaching Hospital; Department of Medical Microbiology and Parasitology, Faculty of Basic Clinical Sciences, College of Medical Sciences, University of Calabar, Calabar, Nigeria
| | - Ubong Aniefiok Udoh
- Department of Medical Microbiology and Parasitology, University of Calabar Teaching Hospital, Calabar; Medical Mycology Society of Nigeria, Lagos; Department of Medical Microbiology and Parasitology, Faculty of Basic Clinical Sciences, College of Medical Sciences, University of Calabar, Calabar, Nigeria
| | - Mary Adanma Alex-Wele
- Medical Mycology Society of Nigeria, Lagos; Department of Medical Microbiology and Parasitology, University of Port-Harcourt Teaching Hospital, Port-Harcourt, Nigeria
| | - Oluwaseun Chinaza Adereti
- Department of Medical Microbiology and Parasitology, Faculty of Basic Medical Sciences, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Rita Okeoghene Oladele
- Medical Mycology Society of Nigeria; Department of Medical Microbiology and Parasitology, Faculty of Basic Medical Sciences, College of Medicine, University of Lagos, Lagos, Nigeria
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Ekeng BE, Edem K, Akintan P, Oladele RO. Histoplasmosis in African children: clinical features, diagnosis and treatment. Ther Adv Infect Dis 2022; 9:20499361211068592. [PMID: 35083042 PMCID: PMC8785273 DOI: 10.1177/20499361211068592] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 11/28/2021] [Indexed: 11/17/2022] Open
Abstract
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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Affiliation(s)
- Bassey Ewa Ekeng
- Department of Medical Microbiology and Parasitology, University of Calabar Teaching Hospital, Calabar 540271, Nigeria
- Medical Mycology Society of Nigeria, Lagos, Nigeria
| | - Kevin Edem
- Department of Paediatrics, University of Uyo Teaching Hospital, Uyo, Nigeria
| | - Patricia Akintan
- Department of Paediatrics, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Rita O. Oladele
- Department of Medical Microbiology and Parasitology, Faculty of Basic Medical Sciences, College of Medicine, University of Lagos, Lagos, NigeriaMedical Mycology Society of Nigeria, Nigeria
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Histoplasmosis in Children; HIV/AIDS Not a Major Driver. J Fungi (Basel) 2021; 7:jof7070530. [PMID: 34209280 PMCID: PMC8305925 DOI: 10.3390/jof7070530] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Revised: 06/24/2021] [Accepted: 06/25/2021] [Indexed: 12/31/2022] Open
Abstract
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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Ferrisse TM, Rocha AFL, Miotto LN, de Almeida Lança ML, Massucato EMS, Bufalino A. Disseminated Histoplasmosis Infection in HIV-Negative Patients: Series Case and Literature Review. CURRENT FUNGAL INFECTION REPORTS 2021. [DOI: 10.1007/s12281-021-00414-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Johannigman TA, Gonzalez O, Dutton JW, Kumar S, Dick EJ. Gingival histoplasmosis: An atypical presentation of African histoplasmosis in three baboons (Papio spp). J Med Primatol 2019; 49:47-51. [PMID: 31595520 DOI: 10.1111/jmp.12443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 08/08/2019] [Accepted: 09/04/2019] [Indexed: 11/29/2022]
Abstract
Gingival lesions as the sole manifestation of African histoplasmosis (Histoplasma capsulatum var. duboisii) have never been reported in baboons. Grossly, lesions can be indistinguishable from bacterial ulcerative gingivitis or gingival hyperplasia. Clinical outcomes of primary gingival histoplasmosis in baboons are unknown and may complicate colony management decisions.
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Affiliation(s)
- Taylor A Johannigman
- Southwest National Primate Research Center, Texas Biomedical Research Institute, San Antonio, Texas.,The Ohio State University College of Veterinary Medicine, Columbus, Ohio
| | - Olga Gonzalez
- Southwest National Primate Research Center, Texas Biomedical Research Institute, San Antonio, Texas
| | - John W Dutton
- Southwest National Primate Research Center, Texas Biomedical Research Institute, San Antonio, Texas
| | - Shyamesh Kumar
- Southwest National Primate Research Center, Texas Biomedical Research Institute, San Antonio, Texas
| | - Edward J Dick
- Southwest National Primate Research Center, Texas Biomedical Research Institute, San Antonio, Texas
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Vanbreuseghem R. Reflexions sur L'Histoplasmose Africaine et L'Histoplasmose Americaine: Reflections on African and American Histoplasmosis. Mycoses 2012. [DOI: 10.1111/j.1439-0507.1982.tb02735.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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N'Golet A, N'Gouoni BG, Moukassa D, Nkoua-Mbon JB. Maxillary African histoplasmosis: unusual diagnostic problems of an unusual presentation. Pathol Res Pract 2005; 200:841-4. [PMID: 15792130 DOI: 10.1016/j.prp.2004.07.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Among bone lesions of African histoplasmosis, those affecting the jaw are relatively rare and concern, with other facial involvements, particularly infants and adolescent patients with an usual uncompromised immunologic status. As clinical and radiologic features are not specific, the differential diagnosis to other mandibular diseases is difficult. We report on a case of African histoplasmosis that involved the right mandibula of a 17-year-old Congolese boy with a persistent and fungiform cutaneous ulceration. As mycologic tests had not been carried out initially, the disease was histologically diagnosed on the basis of the presence of numerous intra-cytoplasmic large yeasts in a granulomatous lesion containing giant cells. As it is impossible to confront the histologic diagnosis with mycologic tests in such a situation, the problems of the differential diagnosis to other deep fungus infections and to some yeast-like foreign body-granulomas encountered at the microscopical level underline the importance of culturing organisms from lesions to confirm the histologic diagnosis. It is worth considering this pathology at least for three reasons: it usually mimicks a malignant jaw tumor; it may constitute a migrant pathology; and prognosis is commonly favorable with amphotericin B treatment.
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Affiliation(s)
- Arthur N'Golet
- Anatomical Pathology Department, Centre Hospitalier Universitaire de Brazzaville, Brazzaville, Congo.
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Ferreira OG, Cardoso SV, Borges AS, Ferreira MS, Loyola AM. Oral histoplasmosis in Brazil. ORAL SURGERY, ORAL MEDICINE, ORAL PATHOLOGY, ORAL RADIOLOGY, AND ENDODONTICS 2002; 93:654-9. [PMID: 12142871 DOI: 10.1067/moe.2002.122588] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE We report 10 cases of histoplasmosis with oral manifestations seen in a teaching hospital in Brazil. STUDY DESIGN This is a retrospective study of the sociodemographic, clinicopathologic, and treatment data of these cases. RESULTS Overall, 8 of 10 cases were seropositive for human immunodeficiency virus (HIV), whereas 2 were negative. The predominant oral manifestations found in HIV-seropositive patients were ulcers, oral pain, and odynophagia; both of the HIV-seronegative patients were symptom-free. HIV infection was suspected in 7 cases because of the presence of oral lesions of histoplasmosis. Asthenia, fever, weight loss, lymphadenopathy, and hepatosplenomegaly were found only in HIV-seropositive patients. Radiographs in 3 out of 10 patients suggested pulmonary involvement. Amphotericin B was the antifungal therapy chosen, and clinical remission of oral lesions occurred in an average of 30 days (accumulated doses: 500-1500 mg). Itraconazole was very effective as a follow-up treatment in terms of prevention of recurrence. CONCLUSION Histoplasmosis only rarely affects HIV-seronegative patients; however, the possibility of hidden immunodepression should be considered when oral manifestations of histoplasmosis are present.
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Abstract
We present a case of an 82-year-old man with a 1-year history of a slowly enlarging, nontender, exophytic oral mucosal lesion with focal ulceration of the right alveolar ridge of the mandible associated with cortical bone resorption. Two consecutive biopsies revealed histoplasma capsulatum. A review of the literature confirms that this is an uncommon manifestation of this fungal disease, but must be considered in the differential diagnosis of an oral ulcerative lesion.
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Affiliation(s)
- T J Dobleman
- Department of Otolaryngology-Head and Neck Surgery, University of Chicago Medical Center, Illinois
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Adekeye EO, Edwards MB, Williams HK. Mandibular African histoplasmosis: imitation of neoplasia or giant-cell granuloma? ORAL SURGERY, ORAL MEDICINE, AND ORAL PATHOLOGY 1988; 65:81-4. [PMID: 3422400 DOI: 10.1016/0030-4220(88)90197-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
The lesion reported in this article destroyed much of the right side of the mandible in a 14-year-old boy. Clinically, it resembled Burkitt's lymphoma and was initially treated as such. After correct microscopic diagnosis, the mass regressed with the use of intravenous amphotericin B and surgical reduction. The histologic comparison with giant-cell granuloma is considered.
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Affiliation(s)
- E O Adekeye
- Department of Dental Surgery, Abu Hospital, Kaduna, Nigeria
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Toth BB, Frame RR. Oral histoplasmosis: diagnostic complication and treatment. ORAL SURGERY, ORAL MEDICINE, AND ORAL PATHOLOGY 1983; 55:597-600. [PMID: 6308534 DOI: 10.1016/0030-4220(83)90376-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Intraoral histoplasmosis is difficult to diagnose, both because the clinician fails to be aware of it and because the lesion has clinical similarities to other disease entities, creating a misleading clinical impression. Effective communication between clinician and pathologist is essential, if one is to arrive at an accurate diagnosis and provide the best treatment. A new antimycotic agent, ketoconazole, is now available for oral administration. Studies indicate that it has major therapeutic advantages and significantly lower toxicity than comparable antimycotic agents.
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Young SK, Rohrer MD, Twesme AT. Spontaneous regression of oral histoplasmosis. ORAL SURGERY, ORAL MEDICINE, AND ORAL PATHOLOGY 1981; 52:267-70. [PMID: 6945537 DOI: 10.1016/0030-4220(81)90264-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
A case of histoplasmosis with an unusual clinical presentation and subsequent disease course was diagnosed when a tooth extraction site failed to heal. Culture, biopsy, and serologic study confirmed the presence of Histoplasma capsulatum. Radiographs and sputum culture established pulmonary involvement. Oral and pulmonary lesions regressed without treatment. This case is presented to raise the question of whether all cases of histoplasmosis with oral involvement should be assumed to be disseminated disease requiring treatment with amphotercin B.
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Abstract
Histoplasmosis is a generalized fungal infection that is caused by the organism H capsulatum. In the most common disease-producing mechanism, the organism is inhaled and lodges in the lung, where it initiates an inflammatory focus. The peribronchial lymph nodes are subsequently involved, forming a primary complex that may ultimately calcify and become radiographically evident. From the primary complex, dissemination by the bloodstream may lead to colonization elsewhere. In the less frequent disease-producing complex, the organism is introduced directly into the tissue through a break in its continuity. A primary complex is then formed by involvement of the lymph nodes. Dissemination from such a focus is rare. It is generally believed that oral and pharyngeal lesions of the histoplasmosis represent symptoms of a systemic disease and are not a localized form of the disease. Histoplasmosis can occur at all ages; however, it is more often found in infancy and old age, especially in white males. Any area in the oral cavity may be affected; the most common sites are: larynx, tongue, palate, buccal mucosa. gingiva, and pharynx. The most frequently reported symptoms are pain, hoarseness, loss of weight, ulcer, and sore throat. The appearance of the oral and pharyngeal lesions may vary and may manifest as ulcers, nodules, or verrucous plaques. Deep, indurated ulcers are common, accounting for the predominant clinical impression of squamous carcinoma.
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