Temporal trends of cutaneo-mucous histoplasmosis in persons living with HIV in French Guiana: Early diagnosis defuses South American strain dermotropism

Abstract

Histoplasmosis is the most frequent opportunistic infection and the first cause of mortality in HIV-infected patients in French Guiana and presumably in much of Latin America. Mucocutaneous lesions of histoplasmosis are considered as rare and late manifestations of the disease. It has been debated whether the greater proportion of cutaneo-mucous presentations in South America relative to the USA was the reflection of Histoplasma strains with increased dermotropism or simply delayed diagnosis and advanced immunosuppression. The objective of this study was to describe the clinical presentation, frequency, prognosis and temporal trends of cutaneomucous histoplasmosis in French Guiana. A retrospective study of patients with AIDS-related disseminated histoplasmosis followed in the three hospitals of French Guiana was performed between 1981 and 2014. Incident cases of histoplasmosis, proved by pathology and/or mycological examinations, were studied. Mucocutaneous histoplasmosis was confirmed by a positive cutaneous or mucosal biopsy. Mucocutaneous lesions were polymorphic. Ninety percent of patients were profoundly immunocompromised patients (CD4<50/mm3) and over 80% were not on antiretroviral treatment. The frequency of mucocutaneous forms and case fatality of disseminated histoplasmosis within one month of antifungal treatment significantly decreased over time (p<0,001). In this South American territory, diagnostic and therapeutic improvements have led to the quasi disappearance of cutaneous manifestations. There may be South American dermotropism in the laboratory but at the bedside early diagnosis seems to be the main parameter explaining the proportion of cutaneomucous presentations in South America relative to the USA.

Cytological and Histopathological Spectrum of Histoplasmosis: 15 Years of Experience in French Guiana

“…For American Histoplasmosis, different genotypes may be associated with differences in clinical phenotype, with South American genetic lineages being more dermotropic, and leading to acute pulmonary diseases whereas North American strains would be linked to more chronic pulmonary disease. These differences however, may be confounded by differences in access to care and further studies are still needed to disentangle what is attributable to differences in Histoplasma genetics and patient health care trajectories (Couppie et al, 2006;Morote et al, 2020;Rodrigues et al, 2020).…”

Prevalence of Histoplasmosis among Persons with Advanced HIV Disease, Nigeria

“…However, among participants with lesions, histoplasma urinary antigen was no more common (p = 0.329). Skin lesions, which occur in 10%-25% of AIDS patients with disseminated histoplasmosis, have been linked with genetic variation among specific strains of the fungus that are dermatotropic or might be markers of histoplasmosis diagnosis when made at a very late stage (29). When present, biopsied lesions provide useful specimens for diagnostic confirmation of histoplasmosis.…”

Gastrointestinal disseminated histoplasmosis in HIV-infected patients: A descriptive and comparative study

“…capsulatum has disseminated. [ 3 , 4 ] Hence, tissue samples from the skin, oral mucosa, bone marrow, lymphnodes, liver, and, very frequently, the gastrointestinal system, were examined and cultured in order to identify H . capsulatum .…”