[Histoplasmosis, caused by Histoplasma capsulatum, and AIDS]

Unusual otolaryngological manifestations of certain systemic bacterial and fungal infections in children

OBJECTIVE

Systemic bacterial and fungal infections may sometimes present local manifestations within otolaryngological district whose early detection may be useful in establishing a correct diagnosis and more appropriate treatment. This paper reviews certain systemic bacterial and fungal diseases presenting ENT manifestations in the pediatric population from an otolaryngological perspective.

METHODS

A medline searching for specific issues was performed in order to achieve more information as possible with regards to ENT manifestation of systemic bacterial and fungal infections. Limits for pediatric age were used. Two separate sections for bacterial and fungal disease are included. The section on systemic bacterial infections considers cat-scratch disease, Lyme borreliosis, actinomycosis, Lemierre's syndrome and congenital syphilis, and the section on systemic fungal infections includes candidiasis, aspergillosis and histoplasmosis.

CONCLUSIONS

Pediatricians and ear, nose and throat (ENT) specialists, approaching head and neck disorders in children, should therefore consider them among the possible differential diagnoses. This means that physicians need to recognize the first head and neck manifestations of systemic infections promptly in order to be able to treat them efficaciously and avoid the dangerous systemic spreading of the infective process.

[Oral histoplasmosis 34 years after return of Africa]

INTRODUCTION

Histoplasmosis is a tropical fungal infection sharing many similarities with tuberculosis: the transmission by air dropplets, the usually asymptomatic primary-infection, the disseminated infection encountered among immunosuppressed patients and the granulomatous pathological lesions. In France, histoplasmosis is uncommon and may be misdiagnosed as tuberculosis.

OBSERVATION

A 78 years old male patient presents with a raspberry-like lesion of the mouth causing difficulties to eat and weight loss of 14 kg. The diagnosis of tuberculosis is evoked because of the presence of a giant-cell granuloma in one of the biopsies. The histoplasmosis serology, requested because the patient stayed in Africa, is positive. Revisions of the pathology put into evidence the presence of spores in histiocytes confirming diagnosis of histoplasmosis. The treatment with itraconazole is effective.

CONCLUSION

Histoplasmosis is a differential diagnosis of tuberculosis, especially in endemic regions. The histoplasmosis serology can be useful. The reference in diagnosis examinations keeps being the microscopic observation of spores and their mycological growth.

Acquired immunodeficiency syndrome-related oral and/or cutaneous histoplasmosis: a descriptive and comparative study of 21 cases in French Guiana

BACKGROUND

Oral or cutaneous acquired immunodeficiency syndrome (AIDS)-related histoplasmosis is a rare presentation of disseminated histoplasmosis.

OBJECTIVE

To describe this clinical presentation and to compare it with other forms of AIDS-related disseminated histoplasmosis.

METHODS

A cross-sectional study of patients with AIDS-related disseminated histoplasmosis was performed. CD4 counts and survival were compared between patients with oral or cutaneous histoplasmosis and patients with nonmucocutaneous disseminated histoplasmosis.

RESULTS

The mean CD4 lymphocyte count was lower in patients with mucocutaneous lesions than in patients with nonmucocutaneous disseminated histoplasmosis (29 vs. 72/mm3, P = 0.002). The proportion of survivors 1 month after diagnosis did not differ significantly between the two groups (13/21 vs. 32/45, P = 0.4). At 6 months, the proportion of survivors was significantly lower for patients with mucocutaneous lesions (6/21 vs. 22/39, P = 0.03).

CONCLUSIONS

These results suggest that mucocutaneous lesions occur at a later stage of human immunodeficiency virus infection, but are not, in themselves, associated with a higher level of mortality. The excess mortality at 6 months reflects deaths from other complications of severe immunodepression. This study confirms the polymorphism of mucocutaneous lesions, emphasizing the need for systematic testing for Histoplasma in all cases of mucocutaneous lesions in AIDS patients.

Pharyngo-laryngeal histoplasmosis: one case in an immunocompetent child

We report a very rare case of disseminated pharyngo-laryngeal histoplasmosis with systemic spread in a 10-year-old, immunocompetent child from Guyana. The main signs were a marked deterioration in his general condition, hepato-splenomegaly, multiple lymphadenopathy and ulcerated pharyngo-laryngeal lesions. The diagnosis was made from brushings of the ulcerative lesions, a lymph node biopsy and serological tests performed in the national reference center for histoplasmosis. The initial treatment was with amphotericin B, which was then replaced by oral itraconazole. We report here the main epidemiological, clinical and therapeutic characteristics.