Histoplasmosis diseminada con síndrome hemofagocítico en un paciente con sida: descripción de un caso y revisión de la literatura española

Gil-Brusola, Ana; Pemán, Javier; Santos, Maria Goreth; Salavert, Miguel; Lacruz, J; Gobernado, M

doi:10.1016/s1130-1406(07)70063-3

Cited by 29 publications

(10 citation statements)

References 20 publications

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“…Our series presents severe forms of HLH with 5 cases requiring ICU and, in these, a mortality below 50%. The mortality results of our series (14% globally and 17% only for disseminated histoplasmosis cases) seems lower than the mean mortality rates of HLH in HIV patients with histoplasmosis, evaluated at 41% for HLH linked to disseminated histoplasmosis (Koduri et al, 1995 ; Chemlal et al, 1997 ; Kumar et al, 2000 ; Gil-Brusola et al, 2007 ; Guiot et al, 2007 ; De Lavaissière et al, 2009 ; Vaid and Patel, 2011 ; Chandra et al, 2012 ; Huang, 2014 ; Castelli et al, 2015 ; Subedee and Van Sickels, 2015 ; Townsend et al, 2015 ; Le Joncour et al, 2016 ; Usman et al, 2016 ). The hypothetical explanation would be that knowledge of the local epidemiology leads to the use of an aggressive diagnostic and therapeutic strategy with a rapid first line treatment strategy using empirical systemic antifungals targeting disseminated histoplasmosis, the most frequent opportunistic infection in HIV patients in French Guiana.…”

Section: Discussioncontrasting

confidence: 56%

Hemophagocytic Lymphohistiocytosis During HIV Infection in Cayenne Hospital 2012–2015: First Think Histoplasmosis

Nguyen

Epelboin

Melzani

et al. 2020

Front. Cell. Infect. Microbiol.

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Introduction: Haemophagocytic Lymphohistiocytosis (HLH), during HIV infection is a rare complication with a poor prognosis. There are few data on HLH within the Amazon region. The objective was to describe epidemiological, clinical and therapeutic features of HIV-related HLH in French Guiana. Methods: A retrospective analysis of adult HIV patients at Cayenne hospital with HLH between 2012 and 2015. A diagnosis of HLH was given if the patient presented at least 3 of 8 criteria of the HLH-2004 classification. Results: Fourteen cases of HLH were tallied during the study period. The mean age was 46 years with a sex ratio of 1.8. The most frequent etiology of HLH was an associated infection (12/14). Confirmed disseminated histoplasmosis, was found in 10 of 14 cases, and it was suspected in 2 other cases. The CD4 count was below 200/mm 3 in 13/14 cases. An HIV viral load >100,000 copies/ml was observed in 13/14 cases. An early treatment with liposomal amphotericin B was initiated in 12/14 cases. The outcome was favorable in 12/14 of all cases and in 10/12 cases involving histoplasmosis. Case fatality was 2/14 among all cases (14.3%) et 1/10 among confirmed disseminated histoplasmosis with HLH (10%). During the study period 1 in 5 cases of known HIV-associated disseminated histoplasmosis in French Guiana was HLH. Conclusion: Histoplasmosis was the most frequent etiology associated with HLH in HIV-infected patients in French Guiana. The prognosis of HLH remains severe. However, a probabilistic empirical first line treatment with liposomal amphotericin B seemed to have a favorable impact on patient survival.

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Section: Discussioncontrasting

confidence: 56%

Hemophagocytic Lymphohistiocytosis During HIV Infection in Cayenne Hospital 2012–2015: First Think Histoplasmosis

Nguyen

Epelboin

Melzani

et al. 2020

Front. Cell. Infect. Microbiol.

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“…In our series, uncontrolled HIV was the dominant risk factor for this condition, while renal transplant patients are also at risk [ 33 ]. HIV patients may be uniquely vulnerable to HLH given the depletion of NK cells in HIV, which has been connected to multiple manifestations of immune dysregulation [ 20 , 34 , 35 ]. The predominance of males is difficult to explain, as no gender predilection has been reported for HLH or histoplasmosis, but may be related to a higher prevalence of HIV in males in Dallas.…”

Section: Discussionmentioning

confidence: 99%

Histoplasmosis-Induced Hemophagocytic Syndrome: A Case Series and Review of the Literature

Townsend

Shanbhag

Hancock

et al. 2015

Open Forum Infectious Diseases

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Background. Histoplasmosis-associated hemophagocytic lymphohistiocytosis (HLH) is a relatively rare disorder for which data are limited regarding optimal treatment and clinical outcomes in adults. We describe the clinical features, treatment, and outcomes of patients with histoplasmosis-associated HLH at our institution.Methods. We performed a retrospective chart review of all inpatients at Parkland Hospital diagnosed with HLH associated with Histoplasma capsulatum from 2003 to 2013.Results. Eleven cases of histoplasmosis-associated HLH over this time period were identified. Nine of eleven cases were males (82%). Nine of these patients had human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS), 1 was a renal transplant patient on immunosuppressants, and the other had no documented immunocompromise. The most common HLH criteria were splenomegaly (n = 10), fever (n = 10), and ferritin >500 ng/dL (n = 9). Urine Histoplasma antigen was positive in every patient tested (n = 9 of 9), and most antibodies for Histoplasma were positive if checked (n = 4 of 5). A majority of patients received liposomal amphotericin B (n = 9) with an average treatment duration of 11 days, and 5 patients also received prednisone, intravenous immunoglobulin (IVIG), or both. Overall, 5 patients died within 30 days (45.5%), and 7 patients died within 90 days (63.6%). Of the 5 patients that received immunosuppression, 4 died (80%), whereas in the group not given additional immunosuppression (n = 5), 2 died (40%).Conclusions. Histoplasmosis-associated HLH among adults is a lethal disease of highly immunocompromised patients, especially patients with HIV/AIDS. Clinical features such as splenomegaly, elevated ferritin, and cytopenias should prompt evaluation for HLH in this population. Further data are needed to define the role of immunosuppression, IVIG, and highly active antiretroviral therapy in treating this condition.

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“…As fungal diseases are not reportable, exact data are not available and the current number of fungal infections occurring each year in Ecuador is not known. There is dearth of data from Ecuador on the burden of these life threatening diseases entities, where only a very few groups of scientists have reported their experiences, mainly in endemic fungal diseases [3][4][5][6][7].…”

Section: Introductionmentioning

confidence: 99%

Serious fungal infections in Ecuador

Zurita

Denning

Paz-y-Miño³

et al. 2017

Eur J Clin Microbiol Infect Dis

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Histoplasmosis diseminada con síndrome hemofagocítico en un paciente con sida: descripción de un caso y revisión de la literatura española

Cited by 29 publications

References 20 publications

Hemophagocytic Lymphohistiocytosis During HIV Infection in Cayenne Hospital 2012–2015: First Think Histoplasmosis

Hemophagocytic Lymphohistiocytosis During HIV Infection in Cayenne Hospital 2012–2015: First Think Histoplasmosis

Histoplasmosis-Induced Hemophagocytic Syndrome: A Case Series and Review of the Literature

Serious fungal infections in Ecuador

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