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Velut G, de Laval F, Berry M, Dufour Gaume F, André N, Epelboin L, Lavergne A, Enfissi A, Djossou F, Rousset D, Briolant S. Etiology of Acute Febrile Illnesses in Adults in the Defense Community in French Guiana. Am J Trop Med Hyg 2024; 110:819-825. [PMID: 38377600 PMCID: PMC10993844 DOI: 10.4269/ajtmh.22-0638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 06/13/2023] [Indexed: 02/22/2024] Open
Abstract
In tropical countries, acute febrile illnesses represent a complex clinical problem for general practitioners. We describe the prevalence of different etiologies of acute febrile illnesses occurring among French service members and their families, excluding children, in general practice in French Guiana. From June 2017 to March 2020, patients with a fever ≥37.8°C with a duration of less than 15 days who sought medical care at the army medical centers in Cayenne and Kourou were prospectively enrolled. Based on clinical presentation, blood, urine, nasopharyngeal, and stool samples were collected for diagnostic testing for viruses, bacteria, and parasites (by direct examination, microscopic examination of blood smears, culture, serology, or polymerase chain reaction), and standardized biological tests were systematically performed. Among 175 patients retained for analysis, fever with nonspecific symptoms was predominant (46.9%), with 10 Plasmodium vivax malaria cases, 8 dengue infections, and 6 cases of Q fever. The second most frequent cause of acute febrile illness was upper respiratory tract infections (32.0%) due to influenza virus (n = 18) or human rhinovirus (n = 10). Among the causes of acute febrile illness in French Guiana, clinicians should first consider arboviruses and malaria, as well as Q fever in cases of elevated C-reactive protein with nonspecific symptoms and influenza in cases of signs and symptoms associated with upper respiratory tract infections. Despite an expanded microbiological search, the etiology of 51.4% of acute febrile illnesses remain unknown. Further investigations will be necessary to identify the etiology of acute febrile illnesses, including new pathogens, in French Guiana.
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Affiliation(s)
- Guillaume Velut
- Centre d’Epidémiologie et de Santé Publique des Armées, Marseille, France
| | - Franck de Laval
- Centre d’Epidémiologie et de Santé Publique des Armées, Marseille, France
- Aix-Marseille Université, INSERM, Institut de Recherche pour le Développement, Economic and Social Sciences, Health Systems, and Medical Informatics, Marseille, France
| | - Morgane Berry
- Centre Médical Interarmées de Cayenne, Cayenne, French Guiana
| | | | - Nathalie André
- Direction Interarmées du Service de Santé des Forces Armées en Guyane, Cayenne, French Guiana
| | - Loïc Epelboin
- Service des Maladies Infectieuses et Tropicales, et Centre d’investigation Clinique (CIC INSERM 1424), Centre Hospitalier de Cayenne, Cayenne, French Guiana
| | - Anne Lavergne
- Laboratoire des Interactions Virus-Hôtes, Institut Pasteur de la Guyane, Cayenne Cedex, French Guiana
| | - Antoine Enfissi
- Laboratoire de Virologie, Institut Pasteur de la Guyane, Cayenne Cedex, French Guiana
| | - Felix Djossou
- Service des Maladies Infectieuses et Tropicales, et Centre d’investigation Clinique (CIC INSERM 1424), Centre Hospitalier de Cayenne, Cayenne, French Guiana
| | - Dominique Rousset
- Laboratoire de Virologie, Institut Pasteur de la Guyane, Cayenne Cedex, French Guiana
| | - Sébastien Briolant
- Aix Marseille Université, Institut de Recherche pour le Développement, Assistance Publique-Hôpitaux de Marseille, Service de Santé des Armées, Vecteurs – Infections Tropicales et Méditerranéennes, Marseille, France
- Institut Hospitalo-Universitaire – Méditerranée Infection, Marseille, France
- Unité de Parasitologie Entomologie, Département de Microbiologie et Maladies Infectieuses, Institut de Recherche Biomédicale des Armées, Marseille, France
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Castellanos Reynosa ME, Caal ME, Mercado D, Medina N, Pérez JC, Emeto TI, Arathoon E. Clinical characteristics, diagnosis, treatment and outcomes of patients living with HIV and co-infected with tuberculosis and histoplasmosis: a 5-y retrospective case series. Trans R Soc Trop Med Hyg 2024:trad104. [PMID: 38279781 DOI: 10.1093/trstmh/trad104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 12/18/2023] [Accepted: 01/01/2024] [Indexed: 01/28/2024] Open
Abstract
BACKGROUND In Latin America, tuberculosis (TB) and histoplasmosis are two of the most frequent opportunistic infections affecting people living with human immunodeficiency virus (HIV). However, there are limited data on the clinical characteristics and outcomes of patients with concurrent TB and histoplasmosis infections. METHODS This was a retrospective observational study to describe the clinical, epidemiological and laboratory characteristics and outcomes of 21 patients living with HIV (PLHIV) who were diagnosed with concurrent histoplasmosis and TB between 2017 and 2021 in Guatemala City, Guatemala. RESULTS Most patients were male and were newly diagnosed with HIV. All patients had advanced HIV disease (AHD). They presented with a median CD4 count of 20 cells/µl. The most common symptoms reported by the patients were fever, weight loss, cough and diarrhoea. Twelve patients died within 6 months of baseline evaluation, for a mortality rate of 57.1%. CONCLUSIONS PLHIV with concurrent TB and histoplasmosis infections are characterised by AHD, predominantly presenting with disseminated forms of these infections and with unspecific symptoms and signs. This evidence calls for early HIV and opportunistic infection screening and insights into the challenges and opportunities for the efficient diagnostic and therapeutic management of patients with AHD with concurrent histoplasmosis and TB infections.
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Affiliation(s)
- María Eugenia Castellanos Reynosa
- Public Health and Tropical Medicine, College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia
| | | | - Danicela Mercado
- Clínica Familiar Luis Ángel García, Hospital General San Juan de Dios, Guatemala City, Guatemala
| | - Narda Medina
- Asociación de Salud Integral, Guatemala City, Guatemala
| | | | - Theophilus I Emeto
- Public Health and Tropical Medicine, College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia
| | - Eduardo Arathoon
- Asociación de Salud Integral, Guatemala City, Guatemala
- Clínica Familiar Luis Ángel García, Hospital General San Juan de Dios, Guatemala City, Guatemala
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Cipolat MM, Rodrigues DR, Brenol CV, Pasqualotto AC, Falci DR. Incidence of histoplasmosis in patients receiving TNF-alpha inhibitors: A systematic review and meta-analysis. Medicine (Baltimore) 2023; 102:e36450. [PMID: 38065857 PMCID: PMC10713183 DOI: 10.1097/md.0000000000036450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 11/13/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Immunobiological drugs such as TNF-α inhibitors are valuable in rescue therapy for autoimmune diseases such as rheumatoid arthritis and inflammatory bowel disease (IBD), but they increase the risk of infectious complications. Histoplasmosis is a significant concern in patients living in endemic regions, however, few studies have assessed the incidence of Histoplasma infection during therapy, and classic estimates may underestimate the risk. This study aimed to produce an updated risk estimate of histoplasmosis in patients on TNF-α blocking therapy. METHODS This is a systematic review and meta-analysis of studies that contain parameters for calculating the risk of histoplasmosis in people who use TNF-α inhibitors, to produce a risk estimate. RESULTS We identified 11 studies with the necessary parameters for inclusion in the meta-analysis, most of which were from North America. The incidence rate of histoplasmosis found was 33.52 cases per 100,000 patients treated with TNF-ɑ inhibitors (95% CI 12.28-91.46). Considering only studies evaluating monoclonal antibodies, the calculated incidence was 54.88/100,000 patients treated (95%CI 23.45-128.34). In subgroup analysis, the incidence was much higher in patients with IBD compared to rheumatic diseases. There was significant heterogeneity among the studies. CONCLUSION The risk of histoplasmosis during TNF-α inhibitory therapy may be considerably higher than that found in classical estimates, especially in patients with IBD. There is a lack of studies evaluating histoplasmosis in large endemic areas, such as Central and South America.
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Affiliation(s)
- Murillo M. Cipolat
- Graduate Program in Medical Sciences (PPGCM), Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Débora R.R. Rodrigues
- Graduate Program in Medical Sciences (PPGCM), Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Claiton V. Brenol
- Graduate Program in Medical Sciences (PPGCM), Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Alessandro C. Pasqualotto
- Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, Brazil
- Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil
| | - Diego R. Falci
- Graduate Program in Medical Sciences (PPGCM), Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
- Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil
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Rajasingham R, Medina N, Mousquer GT, Caceres DH, Jordan A, Nacher M, Falci DR, Sebro A, Pasqualotto AC, Sued O, Chiller T, Perez F. Cost-effectiveness evaluation of routine histoplasmosis screening among people living with advanced HIV disease in Latin America and the Caribbean. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001861. [PMID: 37582115 PMCID: PMC10427011 DOI: 10.1371/journal.pgph.0001861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 07/03/2023] [Indexed: 08/17/2023]
Abstract
Histoplasma antigen can be detected in people with advanced HIV disease (AHD), allowing for early and accurate diagnosis of histoplasmosis. The aim of this analysis was to assess the cost-effectiveness of routine histoplasmosis screening using antigen detection, among people with AHD. We developed a decision analytic model to evaluate Histoplasma antigen screening among people with AHD. The model estimated the costs, effectiveness, and cost-effectiveness of routine screening for Histoplasma antigen compared to the current practice of no routine Histoplasma antigen screening. The model includes stratification by symptoms of histoplasmosis, severity of presentation, and estimates of 30-day mortality. Data sources were taken from the Pan American Health Organization (PAHO) Strategic Fund databases on public purchases of medicines, and published literature on treatment outcomes. Outcome measures are life years saved (LYS), costs (US dollars), and incremental cost-effectiveness ratios (ICERs). Routine Histoplasma antigen screening avoids an estimated 17% of deaths in persons with advanced HIV disease, and is cost-effective compared to no histoplasmosis screening, with an ICER of $26/LYS. In sensitivity analysis assuming treatment for histoplasmosis with liposomal amphotericin, Histoplasma antigen screening remains cost-effective with an ICER of $607/LYS. Histoplasma antigen screening among people with AHD is a cost-effective strategy and could potentially avert 17% of AIDS-related deaths. Prospective evaluation of histoplasmosis screening is warranted to determine effectiveness and treatment outcomes with this strategy.
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Affiliation(s)
- Radha Rajasingham
- Division of Infectious Diseases & International Medicine, Department of Medicine, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Narda Medina
- ASRT, Inc., Mycotic Diseases Branch, Division of Foodborne, Waterborne, and Environmental Diseases (DFWED), Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Gabriel T. Mousquer
- Graduate Program in Biosciences, Federal University of Health Sciences of Porto Alegre (UFCSPA), Porto Alegre, Brazil
| | - Diego H. Caceres
- Center of Expertise in Mycology Radboudumc/CWZ, Nijmegen, The Netherlands
- Studies in Translational Microbiology and Emerging Diseases (MICROS) Research Group, School of Medicine and Health Sciences, Universidad del Rosario, Bogota, Colombia
| | - Alexander Jordan
- Mycotic Diseases Branch -Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Mathieu Nacher
- Center for Clinical Investigation Antilles-Guyane, Inserm 1424, Cayenne Hospital, Cayenne, French Guiana, France
| | - Diego R. Falci
- Infectious Diseases Unit, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
- School of Medicine, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Ayanna Sebro
- National AIDS Coordinating Committee Secretariat, Port of Spain, Trinidad & Tobago
| | - Alessandro C. Pasqualotto
- Federal University of Health Sciences of Porto Alegre, Porto Alegre, Brazil
- Molecular Biology Laboratory, Santa Casa de Misericordia de Porto Alegre, Porto Alegre, Brazil
| | - Omar Sued
- Communicable Diseases Prevention, Control, and Elimination Department, Pan American Health Organization, District of Colombia, United States of America
| | - Tom Chiller
- Mycotic Diseases Branch -Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Freddy Perez
- Federal University of Health Sciences of Porto Alegre, Porto Alegre, Brazil
- Communicable Diseases Prevention, Control, and Elimination Department, Pan American Health Organization, District of Colombia, United States of America
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Fretz A, Penner JC, Bainbridge ED, Babik JM. A silver lining. J Hosp Med 2023; 18:82-86. [PMID: 36178229 DOI: 10.1002/jhm.12966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Revised: 07/12/2022] [Accepted: 09/06/2022] [Indexed: 01/05/2023]
Affiliation(s)
- Anna Fretz
- Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - John C Penner
- Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Emma D Bainbridge
- Division of Infectious Diseases, University of California, San Francisco, San Francisco, California, USA
| | - Jennifer M Babik
- Division of Infectious Diseases, University of California, San Francisco, San Francisco, California, USA
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An DTV, Tung NT, Ha BTV, Tam VM, Cuong DD. A Case of Histoplasmosis Detected Through Bone Marrow Analysis. CLINICAL PATHOLOGY (THOUSAND OAKS, VENTURA COUNTY, CALIF.) 2023; 16:2632010X231180798. [PMID: 37360517 PMCID: PMC10285582 DOI: 10.1177/2632010x231180798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 05/22/2023] [Indexed: 06/28/2023]
Abstract
Histoplasmosis is an endemic infection caused by Histoplasma capsulatum, leading to a broad spectrum of disease from asymptomatic to severe disseminated disease. To diagnose Histoplasmosis, culture remains the gold standard for the laboratory diagnosis; however, this fungus grows slowly, taking a long time 2 to 3 weeks or may take up to 8 weeks. Therefore, some other methods such as bone marrow examination play an essential role in rapid identification and early diagnosis, especially in cases of severe disseminated disease. In this case, we report a 55-year-old man with a 1-year history of gout, self-medicating (including Medrol) who was admitted to the hospital because of persistent fever and swelling of his left arm. About laboratory investigation, there was a bicytopenia (RBC and PLT), blood and pus cultures many times were negative. On the slide of the bone marrow specimen, images of yeast suspected of Histoplasma capsulatum were observed. Therefore, the patient was treated with antifungal medication, and the culture was repeated with prolonged follow-up time and positive results with H. capsulatum after 16 days. In conclusion, bone marrow test plays a significant role in the diagnosis of some fungal infections, which can contribute to an early diagnosis, especially in cases of culture and serological tests are not available or cannot be performed. Patients who present with fever and bicytopenia or pancytopenia should be performed early bone marrow test, which can support the earlier diagnosis to have appropriate treatment.
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Affiliation(s)
- Do Thi Vinh An
- The Center of Hematology and Blood Transfusion, Bach Mai Hospital, Hanoi, Vietnam
| | - Nguyen Tuan Tung
- The Center of Hematology and Blood Transfusion, Bach Mai Hospital, Hanoi, Vietnam
| | - Bui Thi Viet Ha
- Department of Microbiology, Faculty of Biology, VNU University of Science, Vietnam National University, Hanoi, Vietnam
| | - Vu Minh Tam
- The Center of Hematology and Blood Transfusion, Bach Mai Hospital, Hanoi, Vietnam
| | - Do Duy Cuong
- The Center of Tropical diseases, Bach Mai Hospital, Hanoi, Vietnam
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7
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Adamian CMC, de Lima Mota MA, Martins AAF, Aragão MC, Carvalho MS, Meneses GC, Silva Júnior GBD, Leitão TDMJS, De Francesco Daher E. Progressive disseminated histoplasmosis in HIV-positive patients. Int J STD AIDS 2022; 33:544-553. [PMID: 35343333 DOI: 10.1177/09564624221076605] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Histoplasmosis is the most common endemic mycosis among people living with advanced HIV infection. PURPOSE Describe general aspects and challenges of this disease and its association with HIV. RESEARCH DESIGN Review of literature. STUDY SAMPLE Articles found using different combinations of terms including "disseminated histoplasmosis" and AIDS/HIV or immunosuppression in PubMed, Scopus, WHO Global health library, and Scielo database. ANALYSIS We look for information on epidemiology, pathogenesis, diagnosis, and treatment of histoplasmosis in AIDS patients. RESULTS Histoplasmosis is caused by Histoplasma capsulatum, a dimorphic fungus encountered throughout the world, mainly in soil enriched with bat and bird excreta. Progressive disseminated histoplasmosis is the main presentation of this mycosis in people living with advanced HIV and is fatal if left untreated. Symptoms include a systemic disease characterized by fever, weight loss, night sweats, skin manifestations, hepatomegaly, splenomegaly, and septic shock. Diagnostic tests include culture, visualization of H. capsulatum by direct and histopathological examination, serology, antigen, molecular, and skin testing. Patients with disseminated disease require aggressive and prolonged treatment to eradicate the pathogen and include amphotericin B and itraconazole. In many low income countries of endemic regions, histoplasmosis in HIV-positive patients is often undiagnosed or misdiagnosed as another opportunistic infection, due to the similarity in clinical manifestations and to the paucity of better diagnostic tests. CONCLUSION Histoplasmosis remains a neglected disease. Few studies about the disease and expensive treatments make it difficult to reduce the morbidity and mortality of this condition. Public health services and physicians must be aware of histoplasmosis' burden among the HIV-positive population.
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Affiliation(s)
- Caio Manuel Caetano Adamian
- Medical Sciences Post-Graduate Program, Department of Internal Medicine, 28121Federal University of Ceará, Fortaleza, Brazil
| | - Matheus Alves de Lima Mota
- Medical Sciences Post-Graduate Program, Department of Internal Medicine, 28121Federal University of Ceará, Fortaleza, Brazil.,School of Medicine, 28128University of Fortaleza, Fortaleza, Brazil
| | - Augusto Adler Freire Martins
- Medical Sciences Post-Graduate Program, Department of Internal Medicine, 28121Federal University of Ceará, Fortaleza, Brazil
| | - Matheus Cardoso Aragão
- Medical Sciences Post-Graduate Program, Department of Internal Medicine, 28121Federal University of Ceará, Fortaleza, Brazil
| | - Marina Santos Carvalho
- Medical Sciences Post-Graduate Program, Department of Internal Medicine, 28121Federal University of Ceará, Fortaleza, Brazil
| | | | | | | | - Elizabeth De Francesco Daher
- Medical Sciences Post-Graduate Program, Department of Internal Medicine, 28121Federal University of Ceará, Fortaleza, Brazil
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Hoyos Pulgarin JA, Alzate Piedrahita JA, Moreno Gómez GA, Sierra Palacio JF, Ordoñez KM, Arias Ramos D. Closing gaps in histoplasmosis: clinical characteristics and factors associated with probable/histoplasmosis in HIV/AIDS hospitalized patients, a retrospective cross-sectional study in two tertiary centers in Pereira, Colombia. AIDS Res Ther 2021; 18:51. [PMID: 34384448 PMCID: PMC8358261 DOI: 10.1186/s12981-021-00377-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 08/03/2021] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND The HIV pandemic continues to cause a high burden of morbidity and mortality due to delayed diagnosis. Histoplasmosis is prevalent in Latin America and Colombia, is difficult to diagnose and has a high mortality. Here we determined the clinical characteristics and risk factors of histoplasmosis in people living with HIV (PLWH) in Pereira, Colombia. MATERIALS AND METHODS This was a retrospective cross-sectional study (2014-2019) involving two tertiary medical centers in Pereira, Colombia. People hospitalized with HIV were included. Histoplasma antigen detection was performed in urine samples. Probable histoplasmosis was defined according to European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group/National Institute of Allergy and Infectious Diseases Mycoses Study Group criteria. RESULTS 172 HIV-infected patients were analyzed. Histoplasmosis was confirmed in 29% (n = 50/172) of patients. The logistic regression analysis showed that the risk factors for histoplasmosis were pancytopenia (OR 4.1, 95% CI 1.6-10.3, P = 0.002), < 50 CD4 + cells/μL (OR 3.1, 95% CI 1.3-7.3, P = 0.006) and Aspartate transaminase (AST) levels > 46 IU/L (OR 3.2, 95% CI 1.3-8, P = 0.010). CONCLUSIONS Histoplasmosis is highly prevalent in hospitalized patients with HIV in Pereira, Colombia. The clinical findings are nonspecific, but there are some clinical abnormalities that can lead to suspicion of the disease, early diagnosis and prompt treatment. Urine antigen detection is useful for diagnosis, but is not widely available. An algorithmic approach is proposed for low-resource clinical settings.
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Affiliation(s)
- Julián Andrés Hoyos Pulgarin
- Infectious Diseases, Pereira, Colombia.
- Internal Medicine Physician, Pereira, Colombia.
- Universidad Tecnológica de Pereira, Pereira, Colombia.
- Grupo de Investigación en Medicina Interna, Universidad Tecnológica de Pereira, Pereira, Colombia.
| | - John Alexander Alzate Piedrahita
- Internal Medicine Physician, Pereira, Colombia
- Universidad Tecnológica de Pereira, Pereira, Colombia
- San Jorge University Hospital, Pereira, Colombia
- Grupo de Investigación en Medicina Interna, Universidad Tecnológica de Pereira, Pereira, Colombia
| | - German Alberto Moreno Gómez
- Public Health Doctor, Pereira, Colombia
- Universidad Tecnológica de Pereira, Pereira, Colombia
- San Jorge University Hospital, Pereira, Colombia
- Grupo de Investigación en Medicina Interna, Universidad Tecnológica de Pereira, Pereira, Colombia
| | - Juan Felipe Sierra Palacio
- General Physician, Pereira, Colombia
- San Jorge University Hospital, Pereira, Colombia
- Grupo de Investigación en Medicina Interna, Universidad Tecnológica de Pereira, Pereira, Colombia
| | - Karen Melissa Ordoñez
- Infectious Diseases, Pereira, Colombia
- Universidad Tecnológica de Pereira, Pereira, Colombia
- San Jorge University Hospital, Pereira, Colombia
| | - Deving Arias Ramos
- Internal Medicine Physician, Pereira, Colombia
- Grupo de Investigación en Medicina Interna, Universidad Tecnológica de Pereira, Pereira, Colombia
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Nacher M, Valdes A, Adenis A, Blaizot R, Ugo F, Abboud P, Demar M, Djossou F, Epelboin L, Misslin C, Blanchet D, Couppié P, Alsibai KD. Review of diagnostic methods and results for HIV-associated disseminated histoplasmosis: Pathologists are not sufficiently involved. Trop Med Int Health 2021; 26:1462-1469. [PMID: 34310800 DOI: 10.1111/tmi.13663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Disseminated histoplasmosis is a major killer of HIV-infected persons in Latin America. Antigen detection, fungal culture and Polymerase Chain Reaction are often not available, but cytology and histology are present in most hospitals and may offer a diagnostic alternative. In this study, we review 34 years of clinical experience to describe the roles of cytology and histology in diagnosing disseminated histoplasmosis. METHODS Retrospective multicentric study of 349 patients between 1 January 1981 and 1 October 2014 with confirmed disseminated histoplasmosis. RESULTS Around 32/214 (14.9%) of samples were screened using cytopathology, as were 10/101 (9.9%) bronchoalveolar lavage samples and 5/61 (8.2%) of spinal fluid samples. The samples most commonly sent to pathology were liver biopsies, lower digestive tract and lymphnode biopsies; the greatest proportion of positive results were found in lower digestive tract (43/59 (72.9%) positives), lymph node (39/63 (66.1%)), and liver (38/75 (50.7%)) samples. Overall, 97.2% of bone marrow and 97% of bronchoalveolar lavage samples were directly examined by a mycologist. Positive direct examination was independently associated with death (aHR = 1.5 (95%CI = 1-2.2)). CONCLUSIONS Opportunities for a rapid diagnosis were regularly missed, notably for bone marrow samples, which could have been examined using staining methods complementary to those of the mycologist.
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Affiliation(s)
- Mathieu Nacher
- CIC INSERM 1424, Centre Hospitalier Andree Rosemon Cayenne, Cayenne, French Guiana.,DFR Santé, Université de Guyane, Cayenne, French Guiana
| | - Audrey Valdes
- Equipe Opérationnelle d'hygiène hospitalière, Centre hospitalier Andree Rosemon Cayenne, Cayenne, French Guiana
| | - Antoine Adenis
- CIC INSERM 1424, Centre Hospitalier Andree Rosemon Cayenne, Cayenne, French Guiana.,DFR Santé, Université de Guyane, Cayenne, French Guiana
| | - Romain Blaizot
- DFR Santé, Université de Guyane, Cayenne, French Guiana.,Department of Dermatology, Centre Hospitalier Andree Rosemon Cayenne, Cayenne, French Guiana
| | - Françoise Ugo
- Service des Maladies Infectieuses et Tropicales, Centre Hospitalier Andree Rosemon Cayenne, Cayenne, French Guiana
| | - Philippe Abboud
- Service des Maladies Infectieuses et Tropicales, Centre Hospitalier Andree Rosemon Cayenne, Cayenne, French Guiana
| | - Magalie Demar
- Laboratory, Centre Hospitalier Andree Rosemon Cayenne, Cayenne, French Guiana.,UMR Tropical Biome and Immunopathology, Université de Guyane, Cayenne, French Guiana
| | - Félix Djossou
- Service des Maladies Infectieuses et Tropicales, Centre Hospitalier Andree Rosemon Cayenne, Cayenne, French Guiana
| | - Loïc Epelboin
- Service des Maladies Infectieuses et Tropicales, Centre Hospitalier Andree Rosemon Cayenne, Cayenne, French Guiana
| | - Caroline Misslin
- Service de Médecine, Centre Hospitalier de l'Ouest Guyanais, Saint Laurent du Maroni, French Guiana
| | - Denis Blanchet
- Laboratory, Centre Hospitalier Andree Rosemon Cayenne, Cayenne, French Guiana.,UMR Tropical Biome and Immunopathology, Université de Guyane, Cayenne, French Guiana
| | - Pierre Couppié
- DFR Santé, Université de Guyane, Cayenne, French Guiana.,Department of Dermatology, Centre Hospitalier Andree Rosemon Cayenne, Cayenne, French Guiana
| | - Kinan Drak Alsibai
- Department of Pathology, Centre Hospitalier Andrée Rosemon Cayenne, Cayenne, French Guiana
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Antinori S, Giacomelli A, Corbellino M, Torre A, Schiuma M, Casalini G, Parravicini C, Milazzo L, Gervasoni C, Ridolfo AL. Histoplasmosis Diagnosed in Europe and Israel: A Case Report and Systematic Review of the Literature from 2005 to 2020. J Fungi (Basel) 2021; 7:jof7060481. [PMID: 34198597 PMCID: PMC8231918 DOI: 10.3390/jof7060481] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 06/07/2021] [Accepted: 06/10/2021] [Indexed: 12/22/2022] Open
Abstract
Human histoplasmosis is a mycosis caused by two distinct varieties of a dimorphic fungus: Histoplasma capsulatum var. capsulatum and H. capsulatum var. duboisii. In Europe, it is usually imported by migrants and travellers, although there have been some autochthonous cases, especially in Italy; however, most European physicians are unfamiliar with its clinical and pathological picture, particularly among immunocompromised patients without HIV infection. This systematic review of all the cases of histoplasmosis reported in Europe and Israel between 2005 and 2020 identified 728 cases diagnosed in 17 European countries and Israel described in 133 articles. The vast majority were imported (mainly from Central and South America), but there were also seven autochthonous cases (six in Europe and one in Israel). The patients were prevalently males (60.4%), and their ages ranged from 2 to 86 years. The time between leaving an endemic region and the diagnosis of histoplasmosis varied from a few weeks to more than 40 years. Progressive disseminated histoplasmosis was the most frequent clinical picture among people living with HIV infection (89.5%) or a different immunocompromising condition (57.1%), but it was also recorded in 6.2% of immunocompetent patients. Twenty-eight cases were caused by Histoplasma duboisii. Immunocompromised patients without HIV infection had the worst outcomes, with a mortality rate of 32%.
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Affiliation(s)
- Spinello Antinori
- Luigi Sacco Department of Biomedical and Clinical Sciences, Università di Milano, 20157 Milan, Italy; (A.G.); (M.S.); (G.C.)
- III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, 20157 Milan, Italy; (M.C.); (A.T.); (L.M.); (C.G.); (A.L.R.)
- Correspondence: ; Tel.: +39-0250319765; Fax: +39-0250319758
| | - Andrea Giacomelli
- Luigi Sacco Department of Biomedical and Clinical Sciences, Università di Milano, 20157 Milan, Italy; (A.G.); (M.S.); (G.C.)
- III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, 20157 Milan, Italy; (M.C.); (A.T.); (L.M.); (C.G.); (A.L.R.)
| | - Mario Corbellino
- III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, 20157 Milan, Italy; (M.C.); (A.T.); (L.M.); (C.G.); (A.L.R.)
| | - Alessandro Torre
- III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, 20157 Milan, Italy; (M.C.); (A.T.); (L.M.); (C.G.); (A.L.R.)
| | - Marco Schiuma
- Luigi Sacco Department of Biomedical and Clinical Sciences, Università di Milano, 20157 Milan, Italy; (A.G.); (M.S.); (G.C.)
- III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, 20157 Milan, Italy; (M.C.); (A.T.); (L.M.); (C.G.); (A.L.R.)
| | - Giacomo Casalini
- Luigi Sacco Department of Biomedical and Clinical Sciences, Università di Milano, 20157 Milan, Italy; (A.G.); (M.S.); (G.C.)
- III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, 20157 Milan, Italy; (M.C.); (A.T.); (L.M.); (C.G.); (A.L.R.)
| | | | - Laura Milazzo
- III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, 20157 Milan, Italy; (M.C.); (A.T.); (L.M.); (C.G.); (A.L.R.)
| | - Cristina Gervasoni
- III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, 20157 Milan, Italy; (M.C.); (A.T.); (L.M.); (C.G.); (A.L.R.)
| | - Anna Lisa Ridolfo
- III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, 20157 Milan, Italy; (M.C.); (A.T.); (L.M.); (C.G.); (A.L.R.)
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11
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McKinsey DS. Treatment and Prevention of Histoplasmosis in Adults Living with HIV. J Fungi (Basel) 2021; 7:jof7060429. [PMID: 34071599 PMCID: PMC8229061 DOI: 10.3390/jof7060429] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 05/22/2021] [Accepted: 05/25/2021] [Indexed: 11/16/2022] Open
Abstract
Histoplasmosis causes life-threatening disseminated infection in adult patients living with untreated HIV. Although disease incidence has declined dramatically in countries with access to antiretroviral therapy, histoplasmosis remains prevalent in many resource-limited regions. A high index of suspicion for histoplasmosis should be maintained in the setting of a febrile multisystem illness in severely immunosuppressed patients, particularly in persons with hemophagocytic lymphohistiocytosis. Preferred treatment regimens for initial therapy include liposomal amphotericin B for severe disease, or itraconazole for mild to moderate disease. Subsequently, itraconazole maintenance therapy should be administered for at least one year and then discontinued if CD4 count increases to ≥150 cells/µL. Antiretroviral therapy, which improves outcome when administered together with an antifungal agent, should be instituted immediately, as the risk of triggering Immune Reconstitution Syndrome is low. The major risk factor for relapsed infection is nonadherence. Itraconazole prophylaxis reduces risk for histoplasmosis in patients with CD4 counts <100/µL but is not associated with survival benefit and is primarily reserved for use in outbreaks. Although most patients with histoplasmosis have not had recognized high-risk exposures, avoidance of contact with bird or bat guano or inhalation of aerosolized soil in endemic regions may reduce risk. Adherence to effective antiretroviral therapy is the most important strategy for reducing the incidence of life-threatening histoplasmosis.
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Affiliation(s)
- David S McKinsey
- Metro Infectious Disease Consultants, Kansas City, MO 64132, USA
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12
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Nacher M, Alsibai KD, Adenis A, Blaizot R, Abboud P, Demar M, Djossou F, Epelboin L, Misslin C, Ntab B, Valdes A, Couppié P. Reduced Severity in Patients With HIV-Associated Disseminated Histoplasmosis With Deep Lymphadenopathies: A Trench War Remains Within the Lymph Nodes? Front Cell Infect Microbiol 2021; 10:598701. [PMID: 33628743 PMCID: PMC7897652 DOI: 10.3389/fcimb.2020.598701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 12/09/2020] [Indexed: 11/13/2022] Open
Abstract
Background Disseminated histoplasmosis is a major killer of patients with advanced HIV. It is proteiform and often hard to diagnose in the absence of diagnostic tests. We aimed to describe disseminated histoplasmosis with lymphadenopathies in French Guiana and to compare survival and severity of those patients to patients without lymphadenopathies. Methods A retrospective cohort study was performed on data records collected between January 1, 1981 and October 1, 2014. Results Among 349 cases of disseminated histoplasmosis 168 (48.3%) had superficial lymphadenopathies and 133(38.1%) had deep lymphadenopathies. The median LDH concentration, ferritin concentration, TGO concentration, and WHO performance status were lower among patients with deep lymphadenopathies than those without deep lymphadenopathies. There was a significant decrease in the risk of early death (<1 month) among those with deep lymphadenopathies relative to those without (OR=0.26 (95%CI=0.10-0.60), P=0.0006) and in the overall risk of death (OR=0.33 (95%CI=0.20-0.55), P<0.0001). These associations remained strongly significant after adjusting for time period, CD4 counts, age, delay between beginning of symptoms and hospital admission, antifungal and antiretroviral treatment. Conclusions The present data show that in patients with advanced HIV and disseminated histoplasmosis, the presence of deep lymphadenopathies is associated with fewer markers of severity and a lower risk of death. To our knowledge it is the first study to show this. The presence of deep lymphadenopathies is hypothesized to reflect the patient's partially effective defense against H. capsulatum.
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Affiliation(s)
- Mathieu Nacher
- CIC INSERM 1424, Centre hospitalier Andree Rosemon Cayenne, Cayenne, French Guiana.,DFR Santé, Université de Guyane, Cayenne, French Guiana
| | - Kinan Drak Alsibai
- Department of Pathology, Centre hospitalier Andrée Rosemon, Cayenne, French Guiana
| | - Antoine Adenis
- CIC INSERM 1424, Centre hospitalier Andree Rosemon Cayenne, Cayenne, French Guiana.,DFR Santé, Université de Guyane, Cayenne, French Guiana
| | - Romain Blaizot
- DFR Santé, Université de Guyane, Cayenne, French Guiana.,Department of Dermatology, Centre hospitalier Andrée Rosemon, Cayenne, French Guiana
| | - Philippe Abboud
- Service des Maladies Infectieuses et Tropicales, Centre hospitalier Andrée Rosemon Cayenne, Cayenne, French Guiana
| | - Magalie Demar
- Laboratory, Centre hospitalier Andrée Rosemon Cayenne, Cayenne, French Guiana.,UMR Tropical Biome and Immunopathology, Université de Guyane, Cayenne, French Guiana
| | - Félix Djossou
- Service des Maladies Infectieuses et Tropicales, Centre hospitalier Andrée Rosemon Cayenne, Cayenne, French Guiana
| | - Loïc Epelboin
- Service des Maladies Infectieuses et Tropicales, Centre hospitalier Andrée Rosemon Cayenne, Cayenne, French Guiana
| | - Caroline Misslin
- Service de Médecine, Centre hospitalier de l'Ouest Guyanais, Saint Laurent du Maroni, French Guiana
| | - Balthazar Ntab
- Département d'Information Médicale, Centre hospitalier de l'Ouest Guyanais, Saint Laurent du Maroni, French Guiana
| | - Audrey Valdes
- Equipe Opérationnelle d'hygiène hospitalière, Centre hospitalier Andrée Rosemon Cayenne, Cayenne, French Guiana
| | - Pierre Couppié
- DFR Santé, Université de Guyane, Cayenne, French Guiana.,Department of Dermatology, Centre hospitalier Andrée Rosemon, Cayenne, French Guiana
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13
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Nacher M, Valdes A, Adenis A, Blaizot R, Abboud P, Demar M, Djossou F, Epelboin L, Misslin C, Ntab B, Louvel D, Drak Alsibai K, Couppié P. Gastrointestinal disseminated histoplasmosis in HIV-infected patients: A descriptive and comparative study. PLoS Negl Trop Dis 2021; 15:e0009050. [PMID: 33481806 PMCID: PMC7857560 DOI: 10.1371/journal.pntd.0009050] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 02/03/2021] [Accepted: 12/08/2020] [Indexed: 12/13/2022] Open
Abstract
Disseminated histoplasmosis is one the main AIDS-defining opportunistic infections in HIV-infected patients, notably in Latin America. The non-specific and proteiform clinical presentation leads to diagnostic delays that may lead to fatal outcomes. This retrospective multicentric study aimed to describe the frequency and manifestations of gastrointestinal histoplasmosis in French Guiana, and to compare patients with disseminated histoplasmosis with or without gastrointestinal involvement. Between January 1, 1981 and October 1, 2014 co-infections with HIV and histoplasmosis were enrolled. Inclusion criteria were: age >18 years, confirmed HIV infection; first proven episode of histoplasmosis. Among 349 cases of disseminated histoplasmosis, 245 (70%) had a gastrointestinal presentation. Half of patients with gastrointestinal signs had abdominal pain or diarrhea, mostly watery. Half of patients with abdominal pain had diarrhea (63/124) and half of those with diarrhea (63/123) had abdominal pain. A significant proportion of patients also had hepatomegaly and, to a lesser degree, splenomegaly. After adjusting for potential confounding, the presence of lymphadenopathies >2cm (AOR = 0.2, IC95 = 0.04–0.7, P = 0.01), Haitian origin (AOR = 0.04, IC95 = 0.004–0.4, P = 0.006) were associated with a lower prevalence of gastrointestinal signs and positive gastrointestinal presence of H. capsulatum. Persons with a gastrointestinal H. capsulatum were more likely to have a decreased prothrombin time, lower ferritin, lower liver enzymes, and lower concentrations of LDH than those without gastrointestinal signs and symptoms. They also had a shorter interval between symptoms onset and diagnosis. Patients with a positive gastrointestinal identification of H. capsulatum were less likely to die at 1 month than those without a gastrointestinal presentation (respectively, 4.6% vs 18.5%, P = 0.01). Subacute or chronic gastrointestinal presentations are very frequent during disseminated histoplasmosis, they seem less severe, and should lead to suspect the diagnosis in endemic areas. There were populational or geographic differences in the frequency of gastrointestinal manifestations that could not be explained. This retrospective multicentric study aimed to describe the frequency and manifestations of gastrointestinal histoplasmosis in French Guiana, and to compare patients with disseminated histoplasmosis with or without gastrointestinal involvement. Between January 1, 1981 and October 1, 2014 co-infections with HIV and histoplasmosis were enrolled. Inclusion criteria were: age >18 years, confirmed HIV infection; first proven episode of histoplasmosis. Among 349 cases of disseminated histoplasmosis, 245 (70%) had a gastrointestinal presentation. Half of patients with gastrointestinal signs had abdominal pain or diarrhea, mostly watery. Half of patients with abdominal pain had diarrhea (63/124) and half of those with diarrhea (63/123) had abdominal pain. A significant proportion of patients also had hepatomegaly and, to a lesser degree, splenomegaly. After adjusting for potential confounding, the presence of lymphadenopathies >2cm, Haitian origin were associated with a lower prevalence of gastrointestinal signs and presence of H. capsulatum. Persons with a gastrointestinal presentation were more likely to have a decreased prothrombin time, lower liver enzyme concentration, ferritin, and lower concentrations of LDH than those without gastrointestinal signs and symptoms. The delay between symptom’s onset and diagnosis was also shorter and the proportion of deaths at 1 month was significantly lower among those with gastrointestinal presence of H. capsulatum. Subacute or chronic gastrointestinal presentations are very frequent during disseminated histoplasmosis, they seem less severe, and should lead to suspect the diagnosis in endemic areas.
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Affiliation(s)
- Mathieu Nacher
- CIC INSERM 1424, Centre hospitalier Andree Rosemon Cayenne, Cayenne, French Guiana
- DFR Santé, Université de Guyane, Cayenne, Cayenne, French Guiana
- * E-mail:
| | - Audrey Valdes
- Equipe Opérationnelle d’hygiène hospitalière, Centre hospitalier Andree Rosemon Cayenne, Cayenne, French Guiana
| | - Antoine Adenis
- CIC INSERM 1424, Centre hospitalier Andree Rosemon Cayenne, Cayenne, French Guiana
- DFR Santé, Université de Guyane, Cayenne, Cayenne, French Guiana
| | - Romain Blaizot
- DFR Santé, Université de Guyane, Cayenne, Cayenne, French Guiana
- Department of dermatology, Centre hospitalier Andree Rosemon Cayenne, Cayenne, French Guiana
| | - Philippe Abboud
- Service des Maladies Infectieuses et Tropicales, Centre hospitalier Andree Rosemon Cayenne, Cayenne, French Guiana
| | - Magalie Demar
- Laboratory, Centre hospitalier Andree Rosemon Cayenne, Cayenne, French Guiana
- UMR Tropical Biome and Immunopathology, Université de Guyane, Cayenne, French Guiana
| | - Félix Djossou
- Service des Maladies Infectieuses et Tropicales, Centre hospitalier Andree Rosemon Cayenne, Cayenne, French Guiana
| | - Loïc Epelboin
- Service des Maladies Infectieuses et Tropicales, Centre hospitalier Andree Rosemon Cayenne, Cayenne, French Guiana
| | - Caroline Misslin
- Service de Médecine, Centre hospitalier de l’Ouest Guyanais, Saint Laurent du Maroni, French Guiana
| | - Balthazar Ntab
- Département d’Information Médicale, Centre hospitalier de l’Ouest Guyanais, Saint Laurent du Maroni, French Guiana
| | - Dominique Louvel
- Service de Médecine B, Gastroentérologie, Centre Hospitalier Andrée Rosemon, Cayenne, French Guiana
| | - Kinan Drak Alsibai
- Service d’Anatomopathologie, Centre Hospitalier Andrée Rosemon, Cayenne, French Guiana
| | - Pierre Couppié
- DFR Santé, Université de Guyane, Cayenne, Cayenne, French Guiana
- Department of dermatology, Centre hospitalier Andree Rosemon Cayenne, Cayenne, French Guiana
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14
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Drak Alsibai K, Couppié P, Blanchet D, Adenis A, Epelboin L, Blaizot R, Louvel D, Djossou F, Demar M, Nacher M. Cytological and Histopathological Spectrum of Histoplasmosis: 15 Years of Experience in French Guiana. Front Cell Infect Microbiol 2020; 10:591974. [PMID: 33194840 PMCID: PMC7658294 DOI: 10.3389/fcimb.2020.591974] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 10/07/2020] [Indexed: 12/29/2022] Open
Abstract
Background Disseminated histoplasmosis remains a major killer of immunocompromised patients in Latin America. Cytological and histological methods are usually present in most hospitals and may represent a precious diagnostic method. We report 15 years of experience of the department of pathology of the Centre Hospitalier de Cayenne Andrée Rosemon in French Guiana. Methods Specimens from live patients from January 2005 to June 2020 with the presence of H. capsulatum on cytological and/or histological analysis were analyzed. All specimens were examined by an experienced pathologist. The analysis was descriptive. Results Two hundred two cytological and histological samples were diagnosed with histoplasmosis between January 2005 and June 2020. The 202 samples included 153 (75.7%) histopathological formalin-fixed and paraffin-embedded tissues (biopsy or surgical specimens) and 49 (24.3%) cytological analysis from all organs. One hundred thirty-four patients (82.7%) were HIV-positive, 15 patients (9.3%) had immunosuppressant treatment, and 13 patients (8%) were immunocompetent. Seventy-eight of 202 (38.5%) were samples from the digestive tract, mostly the colon (53/78 cases, 70%) and small intestine (14/78 cases, 18%). Microorganisms were more numerous in digestive samples (notably the colon) than in other organs. Lymphocyte and histiocyte inflammation of moderate to marked intensity were observed in all positive specimens. Tuberculoid epithelioid granuloma were present in 16/78 (20,5%) specimens including 14 colon and 2 small intestine specimens. There were 11/202 cases of liver histoplasmosis, 26/202 (12,8%) cases of pulmonary histoplasmosis. Bone marrow involvement was diagnosed in 14 (2%) specimens (8 aspiration and 6 biopsies). Lymph nodes were positive in 42 specimens (31 histology and 11 cytology). Histopathological analysis of the 31 lymph nodes showed a variable histological appearance. Tuberculoid forms were most frequent (24/31, 77,4%). Conclusions From the pathologist perspective, this is the largest series to date showing that digestive involvement was the most frequent, usually with a tuberculoid form and a greater load of Histoplasma. With awareness and expertise, cytology and pathology are widely available methods that can give life-saving results in a short time to help orient clinicians facing a potentially fatal infection requiring prompt treatment.
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Affiliation(s)
- Kinan Drak Alsibai
- Department of Pathology, Centre Hospitalier de Cayenne Andrée Rosemon, Cayenne, French Guiana
- Centre of Biological Resource (CRB Amazonie), Centre Hospitalier de Cayenne Andrée Rosemon, Cayenne, French Guiana
| | - Pierre Couppié
- Department of Dermatology, Centre Hospitalier de Cayenne Andrée Rosemon, Cayenne, French Guiana
- DFR Santé, Université de Guyane, Cayenne, French Guiana
| | - Denis Blanchet
- Laboratory, Centre Hospitalier de Cayenne Andrée Rosemon, Cayenne, French Guiana
| | - Antoine Adenis
- CIC INSERM 1424, Centre Hospitalier de Cayenne Andrée Rosemon, Cayenne, French Guiana
| | - Loïc Epelboin
- 1 Service des Maladies Infectieuses et Tropicales, Centre Hospitalier de Cayenne Andrée Rosemon, Cayenne, French Guiana
| | - Romain Blaizot
- Department of Dermatology, Centre Hospitalier de Cayenne Andrée Rosemon, Cayenne, French Guiana
| | - Dominique Louvel
- Service de Médecine B, Centre Hospitalier de Cayenne Andrée Rosemon, Cayenne, French Guiana
| | - Félix Djossou
- 1 Service des Maladies Infectieuses et Tropicales, Centre Hospitalier de Cayenne Andrée Rosemon, Cayenne, French Guiana
| | - Magalie Demar
- Laboratory, Centre Hospitalier de Cayenne Andrée Rosemon, Cayenne, French Guiana
- UMR Tropical Biome and Immunopathology, Université de Guyane, Cayenne, French Guiana
| | - Mathieu Nacher
- DFR Santé, Université de Guyane, Cayenne, French Guiana
- CIC INSERM 1424, Centre Hospitalier de Cayenne Andrée Rosemon, Cayenne, French Guiana
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15
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Nacher M. Histoplasmosis in Persons Living with HIV. J Fungi (Basel) 2019; 6:jof6010003. [PMID: 31861334 PMCID: PMC7151178 DOI: 10.3390/jof6010003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 10/08/2019] [Indexed: 12/16/2022] Open
Affiliation(s)
- Mathieu Nacher
- Centre d’Investigation Clinique Antilles Guyane, Inserm CIC1424, Centre Hospitalier de Cayenne, 97300 Cayenne, French Guiana;
- EA3593 Ecosystèmes Amazoniens et Pathologie Tropicale (EPaT), Université de Guyane, DFR Santé, 97300 Cayenne, French Guiana
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