Histoplasmosis on bone marrow aspirate cytological examination associated with hemophagocytosis and pancytopenia in an AIDS patient

Chandra, Harish; Chandra, Smita; Sharma, Anita

doi:10.5045/kjh.2012.47.1.77

Cited by 21 publications

(11 citation statements)

References 8 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: Discussionmentioning

confidence: 53%

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: Discussionmentioning

confidence: 53%

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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“…Previously reported data on the prevalence of fungal disease in South Korea has come from either a hospital-based retrospective study [ 5 ] or case reports on fungal infections [ 6 - 10 ]. Therefore, representative data on the status of fungal infection in South Korea has never been published.…”

Section: Introductionmentioning

confidence: 99%

Prevalence of fungal infections using National Health Insurance data, 2009-2013, Republic of Korea

Yoon¹,

Choi²,

Kim

et al. 2014

Epidemiol Health

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OBJECTIVESThe symptoms of fungal infections vary from minor to severe. According to recent reports, fungal infection prevalence is increasing due to increases in the aging population and in patients with compromised immune systems. However, the total prevalence of fungal infections in South Korea is unknown. We investigated the recent 5-year prevalence of each type of fungal infection in South Korea across age, sex, and regional groups.METHODSNationwide data from the National Health Insurance of South Korea were used. The target population included patients who had received treatment for a fungal infection that was listed as the main disease. For each patient, multiple treatments were counted as one case per year in the data analysis.RESULTSThe annual prevalence of all-type mycoses increased from 6.9% in 2009 to 7.4% in 2013. Among the specific groups, the prevalence of dermatophytosis was highest (5.2%), followed by that of opportunistic mycoses (1.7%) and superficial mycoses (0.2%). The prevalence of subcutaneous mycoses and generalized mycoses was very low (8 cases per 100,000 persons and 3 cases per 1 million persons, respectively).CONCLUSIONSEvery year, approximately 7.1% of the Korean population receives treatment for fungal diseases. Cases of opportunistic mycoses are assumed to increase each year. Therefore, further research is needed to understand and monitor the prevalence of mycoses to establish management policies to reduce the burden of fungal diseases.

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“…showed hemophagocytic picture in eight patients with HIV and haematological abnormalities but only two patients fulfilled the HLH diagnostic criteria [3]. Isolated case reports of HIV patients with leishmaniasis or histoplasmosis who developed HLH has been reported [4, 5]. HLH in HIV patient can either be due to the disease itself or because of the opportunistic infections or malignancy associated with HIV [6, 7].…”

Section: Discussionmentioning

confidence: 99%

“…Isolated case reports of HIV patients with leishmaniasis or histoplasmosis who developed HLH has been reported [4, 5]. HLH in HIV patient can either be due to the disease itself or because of the opportunistic infections or malignancy associated with HIV [6, 7]. In the first patient, we extensively looked for an opportunistic infection that could have caused the secondary HLH but did not find any.…”

Section: Discussionmentioning

confidence: 99%

Haemophagocytic lymphohistiocytosis in patients with human immunodeficiency virus infection: to treat or not to treat

et al. 2019

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Haemophagocytic lymphohistiocytosis (HLH) in Human Immunodeficiency Virus (HIV) infected individuals can either be due to the disease itself or due to associated infections/malignancies. The treatment for HLH requires immunosuppressive therapy but administering immunosuppressive therapy to an already immunosuppressed patient (HIV infection) is complex. We present two such cases of HLH in patients infected with HIV. In the first case, no alternate cause for HLH was found even after extensive investigations and it was attributed to the uncontrolled HIV replication. Patient was started on dexamethasone for the same but succumbed to hospital acquired pneumonia. The second patient was diagnosed with Hodgkin's lymphoma but he succumbed to his illness before initiating immunosuppressive therapy for HLH. We report these cases to highlight the dilemma and a need for further research in this direction.

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Histoplasmosis on bone marrow aspirate cytological examination associated with hemophagocytosis and pancytopenia in an AIDS patient

Cited by 21 publications

References 8 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

Prevalence of fungal infections using National Health Insurance data, 2009-2013, Republic of Korea

Haemophagocytic lymphohistiocytosis in patients with human immunodeficiency virus infection: to treat or not to treat

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