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Jaugey T, Schneider M, Bellini C, Yerly S, Sotiriadis C, Pezzetta E. Histoplasmosis peritonitis in an immunocompetent patient: case report. BMC Infect Dis 2024; 24:201. [PMID: 38355443 PMCID: PMC10865641 DOI: 10.1186/s12879-024-09083-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 02/01/2024] [Indexed: 02/16/2024] Open
Abstract
Histoplasmosis is a fungal infection most frequently seen in immunocompromised patients. It is endemic in Central and South America and in Africa. The infection is usually asymptomatic in a healthy individual. Extrapulmonary dissemination can be seen in immunocompromised hosts. Gastrointestinal manifestations frequently involve the terminal ileum and cecum, mimicking Crohn's disease or malignancy. We describe the case of a 36-year-old healthy man from Cameroon, living in Switzerland for 13 years and without any medical nor surgical history, who presented peritonitis not responding to antibiotics. CT-scan showed bowel obstruction and signs of peritonitis. We opted for an explorative laparoscopy, which was converted to laparotomy with extensive adhesiolysis. Diagnostic of histoplasmosis was confirmed by histology and PCR analysis on biopsy. To our knowledge, this is the first described case of peritonitis as main outcome of a disseminated histoplasmosis involving the peritoneum in an immunocompetent patient.
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Affiliation(s)
- Thomas Jaugey
- Department of Surgery, Riviera-Chablais Hospital, Rennaz, Vaud, Switzerland
| | - Michael Schneider
- Department of Surgery, Riviera-Chablais Hospital, Rennaz, Vaud, Switzerland.
- Department of Visceral Surgery, Lausanne University Hospital CHUV, Rue du Bugnon 46, Lausanne, Lausanne, 1011, Switzerland.
| | - Cristina Bellini
- Service of Infectious Diseases, Central Institute, Valais Hospitals, Sion, Switzerland
| | - Stephane Yerly
- Histocytopathology, Service of Histocytopathology, Central Institute, Valais Romand Hospitals, Sion, Valais, Switzerland
| | | | - Edgardo Pezzetta
- Department of Surgery, Riviera-Chablais Hospital, Rennaz, Vaud, Switzerland
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Yee AC, Huang S, Singh R, Rizzi D, Shama N, Khoury N, Weisberg IS. Disseminated histoplasmosis in an HIV/AIDS transgender male-to-female with atypical and persistent GI manifestations. JGH Open 2024; 8:e13011. [PMID: 38268953 PMCID: PMC10805500 DOI: 10.1002/jgh3.13011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Revised: 11/09/2023] [Accepted: 11/12/2023] [Indexed: 01/26/2024]
Abstract
Disseminated histoplasmosis is a rare complication of infection due to Histoplasma capsulatum. Typically, histoplasmosis is self-limiting and asymptomatic in infected individuals with immunocompetence. Disseminated disease, however, can arise in high-risk populations with primary or acquired cellular immunodeficiency including HIV/AIDS, transplant recipients, and those undergoing immunosuppressive therapy. Here we describe a unique case of extrapulmonary gastrointestinal histoplasmosis by infiltrative Peyer's patch disease with bone marrow involvement in a transgender HIV-infected woman.
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Affiliation(s)
- Aaron C Yee
- Department of Internal MedicineNew York‐Presbyterian Brooklyn Methodist HospitalBrooklynNew YorkUSA
| | - Sarah Huang
- Department of Internal MedicineNew York‐Presbyterian Brooklyn Methodist HospitalBrooklynNew YorkUSA
| | - Ranbir Singh
- Department of Internal MedicineNew York‐Presbyterian Brooklyn Methodist HospitalBrooklynNew YorkUSA
| | - Dean Rizzi
- Department of Internal MedicineNew York‐Presbyterian Brooklyn Methodist HospitalBrooklynNew YorkUSA
| | | | - Neil Khoury
- University of Connecticut Health CenterFarmingtonConnecticutUSA
| | - Ilan S Weisberg
- Department of GastroenterologyNew York‐Presbyterian Brooklyn Methodist HospitalBrooklynNew YorkUSA
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Ekeng BE, Itam-Eyo AE, Osaigbovo II, Warris A, Oladele RO, Bongomin F, Denning DW. Gastrointestinal Histoplasmosis: A Descriptive Review, 2001-2021. Life (Basel) 2023; 13:689. [PMID: 36983844 PMCID: PMC10051669 DOI: 10.3390/life13030689] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 02/15/2023] [Accepted: 02/27/2023] [Indexed: 03/08/2023] Open
Abstract
Gastrointestinal histoplasmosis (GIH) is infrequently described in people without underlying HIV infection. We aimed to compare the clinical presentation of GIH in people with and without HIV infection. We conducted a literature search of published cases of GIH from 2001-2021 and found 212 cases. Of these, 142 (67.0%) were male, and 124 (58.5%) had HIV infection. Most cases were from North America (n = 88, 41.5%) and South America (n = 79, 37.3%). Of the 212 cases, 123 (58.0%) were included in both clinical and pathological analyses. The remainder were excluded as details about clinical and pathological findings were not available. Of the 123 cases, 41 had HIV infection while 82 were without HIV infection. The diagnosis was predominantly by histopathology (n = 109, 88.6%). A significant proportion of people with HIV infection had abdominal pain as the most predominant symptom of GIH compared to those without HIV infection (65.9% versus 41.9%, p < 0.05). The colon was the most affected site with a slightly higher proportion in those with HIV infection compared with cases without HIV infection (46.3% versus 42.7%). The commonest pathologic findings were caecal and ileal ulcers. Caecal ulcers were significantly more frequent in cases with HIV infection compared to those without HIV (32.1% versus 7.1%, p < 0.05). Despite being more common in people with HIV infection, GIH also affects people without HIV infection with similar clinical presentations.
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Affiliation(s)
- Bassey E. Ekeng
- Medical Mycology Society of Nigeria, Lagos 101017, Nigeria
- Department of Medical Microbiology and Parasitology, University of Calabar Teaching Hospital, Calabar 540271, Nigeria
| | - Asa E. Itam-Eyo
- Department of Internal Medicine, University of Calabar Teaching Hospital, Calabar 540271, Nigeria
| | - Iriagbonse I. Osaigbovo
- Medical Mycology Society of Nigeria, Lagos 101017, Nigeria
- Department of Medical Microbiology, School of Medicine, College of Medical Sciences, University of Benin, Benin City 300213, Nigeria
| | - Adilia Warris
- Medical Research Council Centre for Medical Mycology, University of Exeter, Exeter EX4 4QD, UK
| | - Rita O. Oladele
- Medical Mycology Society of Nigeria, Lagos 101017, Nigeria
- Department of Medical Microbiology and Parasitology, Faculty of Basic Medical Sciences, College of Medicine, University of Lagos, Lagos 101017, Nigeria
| | - Felix Bongomin
- Department of Medical Microbiology & Immunology, Faculty of Medicine, Gulu University, Gulu P.O. Box 166, Uganda
| | - David W. Denning
- Manchester Fungal Infection Group, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester M13 9WL, UK
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Canakis A, Kolachana S, Holden VK, Cross RK. Opportunistic Knocks: A Gardener with Ulcerative Colitis and New Pulmonary Nodules. Dig Dis Sci 2023; 68:380-384. [PMID: 36670323 PMCID: PMC9859740 DOI: 10.1007/s10620-022-07785-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/05/2022] [Indexed: 01/22/2023]
Affiliation(s)
- Andrew Canakis
- Division of Gastroenterology and Hepatology, University of Maryland School of Medicine, 685 West Baltimore Street, Suite 8-00, Baltimore, MD, 21201, USA
| | - Sindhura Kolachana
- Department of Medicine, University of Maryland Medical Center, Baltimore, MD, USA
| | - Van K Holden
- Division of Pulmonary and Critical Care Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Raymond K Cross
- Division of Gastroenterology and Hepatology, University of Maryland School of Medicine, 685 West Baltimore Street, Suite 8-00, Baltimore, MD, 21201, USA.
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Inayat F, Nawaz G, Afzal A, Ajmal M, Haider M, Sarfraz M, Haq ZU, Taj S, Ishtiaq R. Isolated Colonic Histoplasmosis in Patients Undergoing Immunomodulator Therapy: A Systematic Review. J Investig Med High Impact Case Rep 2023; 11:23247096231179448. [PMID: 37293945 PMCID: PMC10262664 DOI: 10.1177/23247096231179448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 05/04/2023] [Accepted: 05/14/2023] [Indexed: 06/10/2023] Open
Abstract
Gastrointestinal histoplasmosis remains an inconspicuous clinicopathologic entity. It is predominantly considered a protean manifestation of disseminated disease. We hereby delineate a unique case of biopsy-proven isolated colonic histoplasmosis in a patient undergoing methotrexate therapy. Furthermore, we present the first systematic review of the MEDLINE, Google Scholar, Embase, and Scopus databases regarding isolated colonic histoplasmosis in adult patients receiving immunomodulator therapy (IMT). A total of 13 case reports (level of clinical evidence: IV) were identified. The mean age was 55.6 ± 11.1 years, with 9 (69.2%) cases reported in women. Patients with subclinical disease (5, 38.5%) were often incidentally diagnosed by screening colonoscopy. Symptomatic individuals predominantly presented with diarrhea (4, 30.8%), weight loss (3, 23.1%), and/or abdominal pain (3, 23.1%). IMT was mainly administered for liver transplant (4, 30.8%), renal transplant (4, 30.8%), and ulcerative colitis (2, 15.4%). Common colonoscopy features included colonic ulcerations (7, 53.8%), polyps or pseudopolyps (3, 23.1%), and/or mass-like lesions (3, 23.1%). Diagnosis was made by histology of colonic biopsy in 11 (84.6%) and resected specimens in 2 (15.4%) patients. Treatment consisted of a combination of amphotericin B with oral itraconazole in 6 (46.2%), oral itraconazole alone in 5 (38.5%), and amphotericin B alone in 2 (15.4%) patients. Complete clinical recovery was achieved in all patients. This article illustrates that isolated colonic involvement can be the only clinical presentation of histoplasmosis. It may masquerade as other bowel disorders, presenting diagnostic and therapeutic conundrums. Gastroenterologists should rule out colonic histoplasmosis in IMT recipients who develop unexplained colitis symptoms.
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Affiliation(s)
| | - Gul Nawaz
- Marshfield Clinic Health System, Marshfield, WI, USA
| | | | - Maleeha Ajmal
- Marshfield Clinic Health System, Marshfield, WI, USA
| | - Marjan Haider
- Marshfield Clinic Health System, Marshfield, WI, USA
| | | | | | - Sobaan Taj
- Hackensack Meridian Health, Edison, NJ, USA
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Xi L, Qin X, Song Y, Han J, Li Z, Zhang J. Gut Microbial Alterations in Diarrheal Baer's Pochards ( Aythya baeri). Front Vet Sci 2021; 8:756486. [PMID: 34722711 PMCID: PMC8551490 DOI: 10.3389/fvets.2021.756486] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 09/03/2021] [Indexed: 01/07/2023] Open
Abstract
The structure and composition of gut microbiota correlate with the occurrence and development of host health and disease. Diarrhea can cause alterations in gut microbiota in animals, and the changes in the gut microbial structure and composition may affect the development of diarrhea. However, there is a scarcity of information on the effects of diarrhea on gut fungal composition and structure, particularly in Baer's pochard (Aythya baeri). The current study was performed for high-throughput sequencing of the fungal-specific internal transcribed spacer 1 (ITS-1) to detect the differences of gut mycobiota in healthy and diarrheal Baer's pochard. Results showed that the gut mycobiota not only decreased significantly in diversity but also in structure and composition. Statistical analysis between two groups revealed a significant decrease in the abundance of phylum Rozellomycota, Zoopagomycota, Mortierellomycota, and Kickxellomycota in diarrheal Baer's pochard. At the genus levels, fungal relative abundance changed significantly in 95 genera, with 56 fungal genera, such as Wickerhamomyces, Alternaria, Penicillium, Cystofilobasidium, and Filobasidium, increasing significantly in the gut of the diarrheal Baer's pochard. In conclusion, the current study revealed the discrepancy in the gut fungal diversity and community composition between the healthy and diarrheal Baer's pochard, laying the basis for elucidating the relationship between diarrhea and the gut mycobiota in Baer's pochard.
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Affiliation(s)
- Li Xi
- Department of Animal Science, College of Biology and Food, Shangqiu Normal University, Shangqiu, China.,Henan Engineering Research Center of Development and Application of Green Feed Additives, College of Biology and Food, Shangqiu Normal University, Shangqiu, China
| | - Xinxi Qin
- Department of Animal Science, College of Biology and Food, Shangqiu Normal University, Shangqiu, China
| | - Yumin Song
- Linyi Agricultural Science and Technology Career Academy, Linyi, China
| | - Jincheng Han
- Department of Animal Science, College of Biology and Food, Shangqiu Normal University, Shangqiu, China.,Henan Engineering Research Center of Development and Application of Green Feed Additives, College of Biology and Food, Shangqiu Normal University, Shangqiu, China
| | - Zhiqiang Li
- Department of Animal Science, College of Biology and Food, Shangqiu Normal University, Shangqiu, China.,Henan Engineering Research Center of Development and Application of Green Feed Additives, College of Biology and Food, Shangqiu Normal University, Shangqiu, China
| | - Jinliang Zhang
- Department of Animal Science, College of Biology and Food, Shangqiu Normal University, Shangqiu, China.,Henan Engineering Research Center of Development and Application of Green Feed Additives, College of Biology and Food, Shangqiu Normal University, Shangqiu, China
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