Differences in Histoplasmosis in Patients with Acquired Immunodeficiency Syndrome in the United States and Brazil

Karimi, Kian; Wheat, L. Joseph; Connolly, Patricia; Cloud, Gretchen; Hajjeh, Rana; Wheat, Emerson; Alves, Katia; Lacaz, Carlos da Silva; Keath, Elizabeth J.

doi:10.1086/345724

Cited by 95 publications

(86 citation statements)

References 23 publications

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“…The high mortality rate (40.0%) found in the 25 HIVpositive patients in the present study was similar to that reported in the study by KARIMI et al 5 . These high mortality rates reinforce the importance of an early and precise laboratory diagnosis.…”

Section: Discussionsupporting

confidence: 92%

Study of 30 cases of histoplasmosis observed in the Mato Grosso do Sul State, Brazil

Chang

Taira

Paniago

et al. 2007

Rev. Inst. Med. trop. S. Paulo

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Thirty cases of histoplasmosis observed at the University Hospital of the Federal University of Mato Grosso do Sul (HU-UFMS) from January 1998 to December 2005 are reported. Most (83.3%) of the patients were men, average 33.4 years old, 63.3% of them were born and living in Mato Grosso do Sul and 83.3% presented AIDS as an underlying disease. In almost all cases (96.7%) the disease occurred in its disseminated form and the most frequent clinical manifestations were: fever (83.3%), weight loss (70.0%), cough (63.3%), hepatomegaly and splenomegaly (40.0%), and lymph node enlargement (36.7%). The laboratory diagnosis was obtained in 29 patients by isolation of Histoplasma capsulatum from various clinical specimens cultivated in Sabouraud dextrose and brain heart infusion agar and in 16 patients the fungus was observed by direct microscopy of Giemsa-stained smears. The observed mortality was 40%. This is the first report in the literature of the occurrence of histoplasmosis in Mato Grosso do Sul State.

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Section: Discussionsupporting

confidence: 92%

Study of 30 cases of histoplasmosis observed in the Mato Grosso do Sul State, Brazil

Chang

Taira

Paniago

et al. 2007

Rev. Inst. Med. trop. S. Paulo

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“…It should be noticed that skin lesions are seldom observed in North American patients (8,9). Virulence and tropism of the isolates predominant in the sub-continents may explain these differences (8) although late diagnosis in Latin American countries may also explain the more extensive dissemination observed in these patients.…”

Section: Diagnostic Methodsmentioning

confidence: 99%

“…Disseminated histoplasmosis was later included in the list of opportunistic infection defining AIDS. Despite the increased use of highly active antiretroviral therapy (HAART), histoplasmosis remains an important opportunistic infection among HIV patients in endemic areas and frequently appears as the first manifestation of HIV infection or as the AIDS-defining illness (6)(7)(8)(9).…”

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confidence: 99%

Histoplasmosis en Colombia: resultados de la encuesta nacional, 1992-2008

et al. 2011

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Introduction. Histoplasmosis, a fungal disorder characterized by a wide spectrum of manifestations that range from subclinical infections to disseminated processes, affects both immunocompetent and immunosuppressed individuals. Histoplasmosis is not a reportable disease in Colombia and consequently, a survey was designed to collect histoplasmosis cases diagnosed in the country. Objective. The aim of this work was to analyze the data collected from 1992 to 2008. Materials and methods. The survey included demographic data, risk factors, clinical manifestations, imaging data, diagnostic methods and antifungal treatment. Patients were grouped according to risk factors and comparisons of the various findings were done. Results. A total of 434 surveys were gathered from 20 of the country's Departments. Most patients (96.1%) were adults, 77% were males with a mean age of 38.4 years. Only 3.9% were children less than 15 years of age. In the adult population, AIDS was reported in 70.5% of the cases; additionally, in 7.0% patients other immunosuppressive conditions were informed. The most frequent clinical manifestations were fever (76.1%), cough (54.8%) and constitutional symptoms (56.8%). X rays abnormalities were represented mainly by infiltrates (65.9%) and nodules (17.1%). Diagnosis was made by microscopic observation of H. capsulatum in 49.6% patients, by culture in 58.0% and by serological test in 14.6% cases. Antifungal use was recorded in 52.5% cases. Conclusions. Histoplasmosis is frequent in Colombia, especially in certain risk factor groups such as the HIV-infected population. Data collected from this large number of cases has allowed valid comparisons on various aspects of histoplasmosis in Colombia.Key words: histoplasmosis, surveillance, acquired immunodeficiency syndrome, children, disseminated histoplasmosis, Colombia. Author contributions:Myrtha Arango played an important role in the development of the project, revised the questionnaires and ascertained their completeness, participated in the analysis of the data and in the writing process. Elizabeth Castañeda conceived the plan for the surveillance program, orchestrated connections with hospitals, diagnostic centers and worked all along the development of the study, including writing and analyzing the manuscript. Clara Inés Agudelo worked all along in the surveillance study, played an important role in preparation of the manuscript and in analysis of the data, including statistical tests. Catalina De Bedout was in charge of the mycologic diagnosis for all CIB cases, established links with physicians in charge of patients, and controlled receipt of questionnaires. Carlos A. Agudelo was the physician in charge of most of the CIB patients, checked the questionnaire's contents for medical accuracy, and analyzed the data statistics. Ángela María Tobón examined many of the CIB patients, filled in the corresponding questionnaires, supervised the clinical aspects of most patients, and served as a consultant for other physicians in charge of histoplasmosis patie...

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“…8 In developing countries and in some regions of the United States that include resource-poor areas, high mortality rates are reported for PLWHA who have progressive disseminated histoplasmosis (PDH). [9][10][11][12][13][14][15][16][17][18][19][20] For these reasons, health-care providers should be aware of the incidence of histoplasmosis in Colombia, and consider the possibility of this diagnosis in PLWHA patients with clinically compatible illness.…”

Section: Introductionmentioning

confidence: 99%

“…5,8,21,22 Histoplasmosis is a common and important public health problem in these susceptible populations. [9][10][11][12][13][14][15][16][17][18][19][20] The aim of this study was to identify a clinical and laboratory profile associated with histoplasmosis in PLWHA that could allow early suspicion of the disease, reducing the time to diagnosis and thus the disease's high mortality rate.…”

Section: Introductionmentioning

confidence: 99%

Clinical and Laboratory Profile of Persons Living with Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome and Histoplasmosis from a Colombian Hospital

Cáceres

Tobón

Cleveland

et al. 2016

The American Society of Tropical Medicine and Hygiene

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Abstract. Histoplasmosis is common among persons living with human immunodeficiency virus/acquired immune deficiency syndrome (PLWHA) in Latin America, but its diagnosis is difficult and often nonspecific. We conducted prospective screening for histoplasmosis among PLWHA with signs or symptoms suggesting progressive disseminated histoplasmosis (PDH) and hospitalized in Hospital La María in Medellín, Colombia. The study's aim was to obtain a clinical and laboratory profile of PLWHA with PDH. During 3 years (May 2008 to August 2011), we identified 89 PLWHA hospitalized with symptoms suggestive of PDH, of whom 45 (51%) had histoplasmosis. We observed tuberculosis (TB) coinfection in a large proportion of patients with PDH (35%), so all analyses were performed adjusting for this coinfection and, alternatively, excluding histoplasmosis patients with TB. Results showed that the patients with PDH were more likely to have Karnofsky score ≤ 30 (prevalence ratio [PR] = 1.98, 95% confidence interval [CI] = 0.97-4.06), liver compromised with hepatomegaly and/or splenomegaly (PR = 1.77, CI = 1.03-3.06) and elevation in serum of alanine aminotransferase and aspartate aminotransferase to values > 40 mU/mL (PR = 2.06, CI = 1.09-3.88 and PR = 1.53, CI = 0.99-2.35, respectively). Using multiple correspondence analyses, we identified in patients with PDH a profile characterized by the presence of constitutional symptoms, namely weight loss and Karnofsky classification ≤ 30, gastrointestinal manifestations with alteration of liver enzymes and hepatosplenomegaly and/or splenomegaly, skin lesions, and hematological alterations. Study of the profiles is no substitute for laboratory diagnostics, but identifying clinical and laboratory indicators of PLWHA with PDH should allow development of strategies for reducing the time to diagnosis and thus mortality caused by Histoplasma capsulatum.

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Differences in Histoplasmosis in Patients with Acquired Immunodeficiency Syndrome in the United States and Brazil

Cited by 95 publications

References 23 publications

Study of 30 cases of histoplasmosis observed in the Mato Grosso do Sul State, Brazil

Study of 30 cases of histoplasmosis observed in the Mato Grosso do Sul State, Brazil

Histoplasmosis en Colombia: resultados de la encuesta nacional, 1992-2008

Clinical and Laboratory Profile of Persons Living with Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome and Histoplasmosis from a Colombian Hospital

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