Acute histoplasmosis in immunocompetent travelers: a systematic review of literature

Abstract

BackgroundHistoplasmosis is a fungal infection highly endemic in the American continent. The disease can be severe in immunocompromised subjects. In immunocompetent subjects the clinical manifestations are variable. Aim of this work was to review the cases of acute histoplasmosis in immunocompetent travelers reported in literature.MethodsA systematic review of literature was conducted. Electronic search was performed in Pubmed and LILACS. Two reviewers independently extracted data on demographic, clinical and radiological features, and treatment. Cases were classified according to Wheat’s definitions.ResultsSeventy-one studies were included in the analysis, comprising a total of 814 patients. Twenty-one patients diagnosed at the Centre of Tropical Diseases, Negrar (VR), Italy were also included. The most common travel destination was Central America (168 people, 29.8%); the most common way of exposure to histoplasma was the exploration of caves and/or contact with bat guano (349 people, 60.9%). The multivariate logistic regression model showed association between the development of disseminated histoplasmosis (DH) and activities that involved the exploration of caves and/or the contact with bats’ guano (adjusted OR: 34.20 95% CI: 5.29 to 220.93) or other outdoor activities (adjusted OR: 4.61 95% CI: 1.09 to 19.56). No significant difference in the attack rate between countries of destination was observed (p-value: 0.8906, Kruskal-Wallis test).ConclusionsHistoplasmosis often causes no or mild symptoms in immunocompetent individuals, although a severe syndrome may occur. The infection can mimic other diseases, and the epidemiological risk of exposure is an important clue to raise the index of suspicion.Electronic supplementary materialThe online version of this article (10.1186/s12879-018-3476-z) contains supplementary material, which is available to authorized users.

Timely Diagnosis of Histoplasmosis in Non-endemic Countries: A Laboratory Challenge

“…Similar studies are lacking in other non-endemic regions. Available figures indicate that histoplasmosis is the most frequent imported mycosis (Salzer et al, 2018): cases correspond to immigrants, expatriates, transient workers or tourists having had Histoplasma exposure in endemic areas (Molina-Morant et al, 2018;Salzer et al, 2018;Staffolani et al, 2018). Transmission related to solid organ donation has been sporadically described (Kamei et al, 2003;Ashbee et al, 2008;Berger, 2018).…”

“…Activities related to cave exploration, or exposure to soils enriched in nitrogen from bats and birds droppings are the common denominator of up to 29.4% cases of imported histoplasmosis (Kamei et al, 2003;Ashbee et al, 2008). Clusters of cases are associated to groups undergoing leisure or professional activities in high risk locations (Alonso et al, 2007;Cottle et al, 2013), and sum up to 56.2% of well-documented published cases in European travelers (Staffolani et al, 2018).…”

“…Spain along with France and Italy have reported the largest numbers of sporadic cases involving travelers and immigrants (Loulergue et al, 2007;Peigne et al, 2011;Buitrago and Cuenca-Estrella, 2012;Nacher et al, 2018;Staffolani et al, 2018). They accumulate up to 64.1% of the cases diagnosed in immunocompetent European travelers (Staffolani et al, 2018), and concentrate 66.4% of travel-related cases belonging to a cluster.…”

“…Spain along with France and Italy have reported the largest numbers of sporadic cases involving travelers and immigrants (Loulergue et al, 2007;Peigne et al, 2011;Buitrago and Cuenca-Estrella, 2012;Nacher et al, 2018;Staffolani et al, 2018). They accumulate up to 64.1% of the cases diagnosed in immunocompetent European travelers (Staffolani et al, 2018), and concentrate 66.4% of travel-related cases belonging to a cluster. Isolated cases have been communicated in several other European countries (Ashbee et al, 2008;Doleschal et al, 2016;Lindner et al, 2018) as well as in Asia (Cho et al, 2018) and the MiddleEast (Segel et al, 2015).…”

“…This is presumedly the most frequent form of imported histoplasmosis (Norman et al, 2009). After return to their country of origin, these cases usually remain unnoticed unless patients are investigated in the setting of an outbreak (Staffolani et al, 2018). Some patients fail to clear the infection and evolve inadvertently to a chronic form with pulmonary nodules.…”