Histoplasmosis of the Central Nervous System: A Case Series between 1990 and 2019 in French Guiana

Abstract

Disseminated histoplasmosis is the most frequent acquired immunodeficiency syndrome–defining illness in French Guiana. Paradoxically, central nervous system (CNS) involvement has been scarcely described. We aimed to identify CNS histoplasmosis in our territory. We conducted an observational, multicentric, descriptive, and retrospective study including patients with proven or probable CNS histoplasmosis according to the European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group (EORTC/MGS). The study population consisted of patients admitted in one of the hospitals of French Guiana between January 1, 1990 and December 31, 2019. During the study period, 390 cases of HIV-associated histoplasmosis were recorded, in which six of them had CNS infections with Histoplasma capsulatum. The male to female sex ratio was 0.25, and the median age at diagnosis was 37.5 years. The median CD4 count was 42 cells/mm3 ([IQR: 29–60]). All patients had disseminated histoplasmosis. Usual signs of meningitis were observed in three patients and focal signs in four patients. One patient had no neurological signs. The median time between the first cerebral symptoms and diagnosis was 22.4 days (IQR 9.5–36.2). Two patients died within a month after diagnosis. In conclusion, few proven CNS localizations of histoplasmosis were observed on 30-year study in French Guiana. This low proportion suggests that the documentation of CNS involvement is often not ascertained for lack of awareness of this particular presentation, and for lack of rapid and sensitive diagnostic tools.

Forty Years of HIV Research in French Guiana: Comprehend to Combat

“…Disseminated histoplasmosis is proteiform [ 56 ], and it may be severe, moderately severe or mild, with fuzzy boundaries between categories. The histoplasmosis cohort allowed us to determine prognostic factors for early death [ 57 ], with a recent update and prognostic score [ 58 ] to help determine what induction antifungal treatment should be given, itraconazole or liposomal amphotericin b; the cohort also allowed us to describe the various presentations [ 59 , 60 , 61 , 62 , 63 , 64 ], the proportion of severe forms and its relation with common clinical presentations [ 44 , 59 , 65 , 66 ].…”

Clinical, radiological and laboratory characteristics of central nervous system histoplasmosis: A systematic review of a severe disease

“…We found 1159 studies and included 108 manuscripts published between 1962 and 2022, totaling 298 patients 7–10,12–115 . We excluded 38 articles that could not be retrieved.…”

Paediatric Histoplasmosis 2000–2019: A Review of 83 Cases

“…Delay in diagnosis and/or routine screening for CNS involvement might explain the observed differences. Involvement of the CNS in adult patients with histoplasmosis is a rare finding [106,107].…”