Maxillary African histoplasmosis: unusual diagnostic problems of an unusual presentation

N'Golet, A; N’Gouoni, Boniface Gérard; Moukassa, Donatien; Nkoua-Mbon, J. B.

doi:10.1016/j.prp.2004.07.005

Cited by 11 publications

(7 citation statements)

References 7 publications

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“… 4 , 5 , 26 , 48 Clinical manifestations include the following: malaise, prolonged fever, cough, dyspnea, interstitial pneumonitis, weight loss, diarrhea, abdominal pain, peripheral edema, generalized lymphadenopathy, angina, headache, seizures, abnormal gait, altered consciousness, cytopenia(s), coagulopathy, oropharyngeal/gastrointestinal ulcerations, erythematous nodular/ulcerative cutaneous lesions, and failure to thrive. 22 , 35 , 43 – 45 Symptoms are nonspecific and can mimic many other clinical conditions including malaria, sepsis, hepatic failure, hematologic disorders, and malignancies. 22 , 26 , 30 , 35 , 43 – 45 Commonly affected sites include liver, spleen, bone marrow, gastrointestinal tract, heart, adrenal glands, central nervous system, eyes, and skin.…”

Section: Resultsmentioning

confidence: 99%

“…22 , 35 , 43 – 45 Symptoms are nonspecific and can mimic many other clinical conditions including malaria, sepsis, hepatic failure, hematologic disorders, and malignancies. 22 , 26 , 30 , 35 , 43 – 45 Commonly affected sites include liver, spleen, bone marrow, gastrointestinal tract, heart, adrenal glands, central nervous system, eyes, and skin. 11 , 13 , 22 , 26 , 30 , 35 , 43 – 45 Chest radiograph may be normal, or it may reveal interstitial, reticulonodular, or miliary infiltrates.…”

Section: Resultsmentioning

confidence: 99%

“…22 , 26 , 30 , 35 , 43 – 45 Commonly affected sites include liver, spleen, bone marrow, gastrointestinal tract, heart, adrenal glands, central nervous system, eyes, and skin. 11 , 13 , 22 , 26 , 30 , 35 , 43 – 45 Chest radiograph may be normal, or it may reveal interstitial, reticulonodular, or miliary infiltrates. 11 , 13 , 27 …”

Section: Resultsmentioning

confidence: 99%

“…Diagnostic modalities for histoplasmosis used in the cases reviewed were mostly histopathology ( n = 33, 75%). Others included microscopy ( n = 3,6.8%), bone marrow aspirate and cytology ( n = 3,6.8%), culture ( n = 1,2.3%), and serology ( n = 1,2.3%) 11 – 16 , 22 – 35 , 37 , 41 – 44 , 46 Molecular diagnosis was not used in any of the cases. The diagnosis of histoplasmosis in children can be challenging.…”

Section: Resultsmentioning

confidence: 99%

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Histoplasmosis in African children: clinical features, diagnosis and treatment

Ekeng

Edem

Akintan

et al. 2022

Therapeutic Advances in Infection

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Most of the reviews on histoplasmosis documented in literature have been in the adult population. Very few studies highlight the peculiarities associated with histoplasmosis in Africa especially in the pediatric population. This review addresses the above concerns with clinical summaries and diagnosis of some case reports of histoplasmosis in African children. We highlighted 44 case reports of histoplasmosis in African children (1950–2021) distributed across Western Africa (38.6%, n = 17), Eastern Africa (9.1%, n = 4), Southern Africa (9.1%, n = 4), and Central Africa (43.2%, n = 19). No case report was found from Northern Africa. The age range was 1–17 years, with a mean of 9.2. Of the 44 case reports, 8 cases (18.2%, 8/44) were caused by Histoplasma capsulatum var capsulatum, 33 cases (75%, 33/44) were caused by Histoplasma capsulatum var duboisii, and specie identification was not found in 3 cases. Only three (6.8%) cases were HIV positive; 56.8% (25/44) were disseminated histoplasmosis, pulmonary histoplasmosis accounted for just one case (2.3%, 1/44). Extrapulmonary presentation included skin lesions (ulcers, fistulas, nodules, patches, pigmentations, papules, and abscesses), bone lesions, osteoarthritis, and fractures. The commonest sites affected were skin ( n = 29, 65.9%), bones ( n = 20, 45.5%), and lymph nodes ( n = 15, 34.1%). Histopathology was the commonest diagnostic method ( n = 33, 75%). Amphotericin B was first-line therapy in 45.5% of the cases ( n = 20) followed by ketoconazole (20.5%, n = 9); 27 cases (61.4%) had favorable outcomes, 8 cases (18.2%) had fatal outcomes, while in 9 cases, the outcome was not revealed. This review revealed several cases of histoplasmosis misdiagnosed as other conditions including tuberculosis ( n = 3, 6.8%), pneumonia ( n = 1, 2.3%), cancers ( n = 4, 9.1%), nephritic syndrome ( n = 1, 2.3%), leishmaniasis ( n = 1, 2.3%), and hyperreactive malarial splenomegaly syndrome ( n = 1, 2.3%). In addition, histoplasmosis was not considered in some case reports even when symptoms were suggestive. Diagnosis of histoplasmosis was made at autopsy with postmortem findings suggestive of histoplasmosis ( n = 3, 6.8%). This report highlights the need for a paradigm shift on the part of pediatricians in Africa. They need to look beyond clinical conditions considered common in our environment for this age group and evaluate for other diseases including histoplasmosis.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 2 more Smart Citations

Histoplasmosis in African children: clinical features, diagnosis and treatment

Ekeng

Edem

Akintan

et al. 2022

Therapeutic Advances in Infection

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“…The WHO-endorsed essential diagnostic tests (2019) for fungal diseases are direct microscopy and histopathology, fungal culture, blood culture, and Histoplasma antigen [44]. In the RoC, most of the reported cases were diagnosed by histopathology [20,21,45] and mycological examination (direct microscopy and culture) [14,21]. It is important to recall that due to the coexistence of the two H. capsulatum varieties in Africa, differential diagnosis cannot be made only based on culture, as it is similar for both.…”

Section: Discussionmentioning

confidence: 99%

Histoplasmosis in the Republic of Congo dominated by African histoplasmosis, Histoplasma capsulatum var. duboisii

et al. 2021

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The Republic of Congo (RoC) is one of the African countries with the most histoplasmosis cases reported. This review summarizes the current status regarding epidemiology, diagnostic tools, and treatment of histoplasmosis in the RoC. A computerized search was performed from online databases Medline, PubMed, HINARI, and Google Scholar to collect literature on histoplasmosis in the RoC. We found 57 cases of histoplasmosis diagnosed between 1954 and 2019, corresponding to an incidence rate of 1–3 cases each year without significant impact of the AIDS epidemic in the country. Of the 57 cases, 54 (94.7%) were cases of Histoplasma capsulatum var. duboisii (Hcd) infection, African histoplasmosis. Three cases (5.3%) of Histoplasma capsulatum var. capsulatum infection were recorded, but all were acquired outside in the RoC. The patients’ ages ranged between 13 months to 60 years. An equal number of cases were observed in adults in the third or fourth decades (n = 14; 24.6%) and in children aged ≤15 years. Skin lesions (46.3%), lymph nodes (37%), and bone lesions (26%) were the most frequent clinical presentations. Most diagnoses were based on histopathology and distinctive large yeast forms seen in tissue. Amphotericin B (AmB) was first line therapy in 65% of the cases and itraconazole (25%) for maintenance therapy. The occurrence of African histoplasmosis in apparently normal children raises the possibility that African histoplasmosis is linked to environmental fungal exposure.

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