Histoplasmosis: a new endemic fungal infection in China? Review and analysis of cases

Abstract

Histoplasmosis occurs in specific endemic areas, including the mid-western United States, Africa and most of Latin America. Sporadic cases have also been reported in China. The aim of this study was to summarise the epidemiological and clinical data of histoplasmosis in China. We searched the PubMed, CBMdisk and CNKI databases to identify publications related to histoplasmosis in China. Case reports/series on patients with histoplasmosis were included. A comprehensive literature review identified additional cases. The relevant material was evaluated and reviewed. Overall, 300 cases of histoplasmosis were reported in China from 1990 to 2011, and 75% were from regions through which the Yangtze River flows. Most of the patients were autochthonous infections. Of these, 43 patients had pulmonary histoplasmosis and 257 patients had disseminated histoplasmosis. Common underlying diseases included HIV infection, diabetes mellitus and liver diseases. Fever was the most frequently reported clinical feature in disseminated histoplasmosis, followed by splenomegaly and hepatomegaly. Cases of histoplasmosis had a prominent geographical distribution in China. Histoplasmosis should be considered in the diagnosis of patients with relevant symptoms and a history of travel to or residence in these areas.

Disseminated Histoplasmosis with Skin Lesions and Osteomyelitis in a Patient from the Philippines

“…13 Skin lesions are also more common with South American histoplasmosis, 14 possibly because of underlying genetic differences in fungal strains. In contrast, cutaneous lesions are infrequent in cases of histoplasmosis in Asia (6.6% in a study form China), 3 but notably, both the patient described here and the previously reported case from the Philippines presented with disseminated papular lesions, some of which were umbilicated lesions. Skin lesions in histoplasmosis can be easily confused with those of penicilliosis, an endemic fungal infection in southeast Asia, as well as cryptococcal skin lesions, common in patients with AIDS.…”

Detection and Phylogenetic Characterization of a Case of Histoplasma capsulatum Infection in Mainland China

“…Most of the patients were from regions through which the Yangtze River flows. 4 These regions include the two provinces where our patient had resided. Our patient had never been abroad.…”

“…1 However, sporadic cases of autochthonous histoplasmosis have been encountered in China, which was traditionally considered nonendemic for H. capsulatum. [2][3][4] Recently, a multilocus sequence typing (MLST) approach and a sequence database were available for H. capsulatum, which helped us to better understand the molecular epidemiology of this disease. 5 Here, we reported a case of disseminated histoplasmosis in an human immunodeficiency virus (HIV)-negative patient who had never been outside China.…”

Histoplasmosis in Pulmonary Infection Patients from Hospitals in Hanoi, Vietnam

“…Histoplasmosis usually presents as in immune-compromised individuals with serious underlying disease, including AIDS [10,11]. The occurrence of histoplasmosis in Asia has been recently reviewed with cases of histoplasmosis from India, Malaysia, Singapore, Indonesia, Thailand, South Vietnam and Japan, but the autochthonous nature of the cases reported has not been established unequivocally [8,12,13]. Recently, H. capsulatum was recovered from environmental sources contaminated with bat guano and chicken droppings in Thailand [14].…”

“…Most Histoplasma infections are subclinical, however, occasionally disease occurs linked in to the host immune response [4]. The disease is the most common pulmonary mycosis in North America and Central America, but the organism is known to exist in many areas around the world [5][6][7][8][9]. Histoplasmosis usually presents as in immune-compromised individuals with serious underlying disease, including AIDS [10,11].…”