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

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.

Histoplasmosis at a Reference Center for Infectious Diseases in Southeast Brazil: Comparison between HIV Positive and HIV Negative Individuals

“…The vast majority of HIVinfected individuals with histoplasmosis in INI were not taking ART: a proportion had stopped HIV treatment (18.5%) and many were naïve to antiretroviral therapy (41.5%), and the median CD4+ was 70 cells/mm3, indicating severe immunological impairment. This finding is like other series 11,13,14 . It is well established that histoplasmosis is an opportunistic and overwhelming disease in patients with very low CD4 counts, and therefore, we believe that screening is necessary and desirable in immunosuppressed patients, particularly those with CD4+<100, for both cryptococcosis and histoplasmosis, the most important systemic mycoses in HIV/AIDS.…”

“…Hepatosplenomegaly, splenomegaly, anemia, thrombocytopenia, and leukopenia were significantly more frequently found in HIV+ patients and should alert clinicians about histoplasmosis. Thrombocytopenia was not a feature of histoplasmosis in our series, differently from others 11 , although it had a near association to death in our multivariate analysis.…”

Diagnosing disseminated histoplasmosis in advanced HIV/AIDS disease in Cameroon using a point of care lateral flow assay

“… 1 , 2 It is an AIDS-defining opportunistic infection. 3 Disseminated histoplasmosis (DH) can be fatal without early diagnosis and treatment initiation 4 . The first local cases of histoplasmosis were published through cases reports, the definitive diagnosis here established through culture and histopathology, and a 100% death rate.…”

Diagnosing disseminated histoplasmosis in advanced HIV/AIDS disease in Cameroon using a point of care lateral flow assay – a case series

“…It is an AIDS-de ning opportunistic infection [3]. Disseminated histoplasmosis (DH) can be fatal without early diagnosis and treatment initiation [4]. The gold standard diagnosis is culture of the organism, but this is slow and often facilities for culture are not available.…”