Paediatric Histoplasmosis 2000–2019: A Review of 83 Cases

Abstract

Histoplasmosis is an endemic fungal infection that is confined to specific geographical regions. Histoplasma spp. are primary pathogens that cause disease in both immunocompetent and immunocompromised patients, ranging from a single-organ (mostly affecting the lungs) infection to life-threatening disseminated disease. Knowledge about the clinical epidemiology relies on data from adult populations; little is known about the patient and disease characteristics in the paediatric population. Therefore, a structured review of published cases of paediatric histoplasmosis between 2000 and 2019 was performed. A literature search of PubMed was conducted and the epidemiological and clinical data from 83 cases were analysed. The mean age at presentation was 9.5 ± 5.5 years, and 51% were girls. Two-thirds of the children were immunocompromised. The majority of children presented with disseminated disease. The most frequently observed clinical symptoms were respiratory symptoms, alongside non-specific systemic features, including fever, myalgia, fatigue and weight loss. The mortality rate was 11%. Histoplasmosis affects children of any age. Being immunocompromised is a risk factor for severe and disseminated disease. The lack of specific presenting features leads to underreporting and delay in diagnosis. To improve the recognition and outcome of histoplasmosis in childhood, increased awareness and surveillance systems are warranted.

Prevalence of Histoplasmosis and Molecular Characterization of Histoplasma species in Patients with Presumptive Pulmonary Tuberculosis in Calabar, Nigeria

“…The greatest attributable risk factor for histoplasmosis is HIV/AIDS [ 1 ]. However, in the pediatric population, histoplasmosis is predominantly associated with risk factors other than HIV including environmental exposures and toxins, autoimmune diseases, childhood malignancies as well as their treatment, chronic lung diseases, immunosuppressive therapies, pancytopenia, T-cell deficiency, and malnutrition [ 4 , 5 ]. The diagnosis of histoplasmosis in resource-limited settings like ours is particularly challenging because it mimics TB, a clinical entity that is very common in this region [ 1 , 2 , 5–7 ].…”

Pulmonary and Extrapulmonary Manifestations of Fungal Infections Misdiagnosed as Tuberculosis: The Need for Prompt Diagnosis and Management

“…Histoplasmosis occurs worldwide, is endemic in the United States of America and Latin America; and is commonly associated with HIV/AIDS in the adult population [ 80 ]. In the pediatric population, on the other hand, histoplasmosis is predominantly associated with risk factors other than HIV including environmental exposures and toxins, autoimmune diseases, childhood malignancies as well as their treatment, lung diseases, immunosuppressive therapies, pancytopenia, T-cell deficiency and malnutrition [ 80 , 81 ]. Histoplasma capsulatum var capsulatum is associated with infections in humans, while the variety farciminosum causes infection in horses.…”

Case report: Disseminated histoplasmosis in a renal transplant recipient from a non-endemic region

“…If symptomatic, histoplasmosis in pediatric populations predominantly manifests as acute pulmonary histoplasmosis. However, hematogenous spread can result in disseminated disease, and other isolated single-organ infections have been rarely reported including meningeal involvement ( 4 ). Signs and symptoms of pulmonary involvement include fever, chest pain, and cough and may include anorexia, weight loss, lymphadenopathy, hepatosplenomegaly, and skin findings.…”

“…The differential for histoplasmosis is broad given the large variety of relatively non-specific symptomatology and encompasses a range of infectious, autoimmune, and hematologic/oncologic etiologies as well as system-specific diagnoses ( 4 ). As such, a comprehensive evaluation is necessary involving laboratory testing, advanced imaging, and biopsies of affected areas ( 5 ).…”