Clinical features and endemic trend of histoplasmosis in China: A retrospective analysis and literature review

Abstract

Introduction Histoplasmosis is a rare mycosis with nonspecific clinical manifestation and a high misdiagnosis rate, which is an epidemic disease that occurred in several endemic areas. Cases of histoplasmosis were sporadic in China. Objective We detected the clinical characteristics and endemic trend of histoplasmosis to understand it more profoundly. Method The clinical data of 34 cases of histoplasmosis hospitalized in Xiangya Hospital of Central South University from 2003 to 2016 were analyzed retrospectively. The relevant literature were reviewed roundly which were about histoplasmosis from 2001 to 2019 reported in the Chinese mainland. Results Thirty‐four patients were included in the study, male predominance. About 44.1% were combined with underlying disease and HIV infection was observed in eight patients. Common clinical manifestations were fever (94.1%), followed by lymphadenopathy (70.6%) and anemia (67.6%). Organ involvement included lungs (52.9%), oral cavity (5.9%) and intestine (5.9%). Patients were diagnosed by bone marrow smears (44.1%), lymph node biopsy (41.1%), lung tissue biopsy (8.8%) and intestinal tissue biopsy (5.9%). About 70.6% received amphotericin B, while 38.2% received itraconazole therapy and 79.4% were improved. About 611 cases of histoplasmosis in the Chinese mainland were obtained in the study from the related literature, with 217 (37.0%) cases occurred in Yunnan province, 69 (11.9%) cases in Hunan province and 67 (11.6%) cases in Hubei province. All of them were high incidence area of histoplasmosis. Conclusion Histoplasmosis is a rare mycosis with high diagnosis rate and has a prominent geographical distribution in China, which should be considered highly in clinical work.

Disseminated Histoplasmosis Infection Diagnosed by Metagenomic Next-Generation Sequencing: A Case Report

“… 25 However, Histoplasmosis mold form requires 4–6 weeks to grow in culture, in the literature review of histoplasmosis from 2001 to 2019 in the Chinese mainland, only 8.6% of cases were diagnosed by culture. 26 In our case, the patient’s three times cultures were negative. It may delay patient treatment.…”

The Review of Histoplasmosis Endemicity and Current Status in Asia

“…The number of cases from China (611 cases) was based on the recent report from Xin et al with most of the cases reported from Yunnan province, followed by Hunan and Hubei provinces [7]. These three regions are located along the Yangtze River flows.…”

“…Among the 611 cases, 34 cases from Hunan were reviewed for clinical history. It showed 13 patients were immunocompromised with most of them (8 patients) confirmed as HIV-positive cases [7]. Twenty-one patients were considered as immunocompetent.…”

“…Human immunodeficiency virus (HIV) is a classical risk factor in histoplasmosis although there are a growing number of reports of histoplasmosis among other immunocompromised patients as well as immunocompetent patients in Asia [5][6][7]. The mortality of histoplasmosis among immunocompromised patients was 27.5%; this rate is significantly higher than the rate in immunocompetent patients (10%) [5].…”

Disseminated Histoplasmosis in HIV-Patient in Nepal: A Case Report

“…It manifests as acute, sub-acute, chronic and progressive disseminated disease. [1][2][3][4] Histoplasma capsulatum is endemic in United states, certain parts of Mexico, Central and South America, Africa. [5][6][7] However, recently cases have been increasing in other non-endemic regions due to HIV, primary immunodeficiency, immunosuppressive drugs and solid organ transplantation.…”