The occurrence of histoplasmosis in Brazil: A systematic review

Abstract

Background: Histoplasmosis is a systemic disease caused by the dimorphic fungus Histoplasma capsulatum. Diagnosis is often delayed, or it is misdiagnosed as tuberculosis. In Brazil, the infection is common and cases of histoplasmosis have been described in all regions of the country; however, the real problem is underestimated since notification of histoplasmosis is not mandatory. Methods: Human histoplasmosis cases diagnosed in Brazil and published up to December 2018 were identified through a search conducted in the PubMed/MEDLINE, SciELO, and Web of Science databases. Moreover, the isolation of H. capsulatum from animals or environmental sources in Brazil was also evaluated. Results: A total of 207 articles fulfilled the inclusion criteria and were evaluated, involving a total of 3530 patients with a diagnosis of histoplasmosis during the period studied. Of these patients, 78.3% were male, giving a male-to-female ratio of approximately 4:1. Histoplasmosis presented a higher frequency in individuals between the fourth and fifth decades of life. Disseminated disease was the most common form of histoplasmosis. Isolation of H. capsulatum on culture media and histopathology using staining methods were the diagnostic methods with the best efficiency. The best results in the identification of the H. capsulatum were achieved for samples from mononuclear phagocyte system components, skin and mucosa, and hematological samples. Regarding predisposing factors for histoplasmosis, HIV infection was the most common underlying condition. The overall mortality rate was 33.1%. Conclusions: This study represents the first available systematic review demonstrating Brazilian cases of histoplasmosis in the literature and highlights that the disease is more widespread in the Brazilian territory than has previously been thought.

A 8- year Bangladeshi girl with disseminated histoplasmosis, presented as chronic liver disease with portal hypertension: a rare case report

“…Histoplasma detection can be done by growth in culture, fungal stains (Bone marrow aspirate, peripheral blood smear, lymph node biopsy, bronchoalveolar lavage fluid, transbrochial biopsy specimen and biopsy from Fig. 2 The arrow mark is showing Histoplasma capsulatum cutaneous lesions), serologic tests involving detection of antigen and antibodies, PCR and DNA assay for Histoplasma capsulatum [7]. Use of Histoplasma antigen in urine for rapid diagnosis of suspected disseminated histoplasmosis can be done [8].…”

Introductory Chapter: The Global Distribution of Human Histoplasmosis - An Overview

“…In HIV population, globally, about half a million people get infected with Histoplasma infection every year. However, approximately 100,000 people develop disseminated disease [24,25], with mortality rates if treated ranging between 30 to 50% and 100% if not [20,21,[26][27][28][29]. Accordingly, WHO has recognised as a killer of patients with advanced HIV and has currently recognised histoplasmosis as a neglected tropical diseases and has included Histoplasma antigen tests on the WHO essential diagnostic list [30].…”

“…In 2012, about 6710-15, 657 cases of symptomatic HIV-associated histoplasmosis were estimated in Latin America, with areas such as Central America, the northernmost part of South America, and Argentina having a prevalence above 30% and incidence >15 cases per 100 people living with HIV, resulting to about 671-9394 deaths related to histoplasmosis, compared with 5062 deaths related to tuberculosis reported in the region [32]. In Brazil, AIDS-associated disseminated histoplasmosis had a mortality as high as 33.1% [27]. In Guatemala, 31.2% of patients with advanced HIV had histoplasmosis [33].…”

The Role of Molecular Tests in the Diagnosis of Disseminated Histoplasmosis

“…In Brazil, 3530 patients were diagnosed with histoplasmosis between the years 1939 and 2018, which is likely to be underestimated. Histoplasmosis is endemic in all Brazilian regions, particularly in the Northeast, Central-West, Southeast, and South [3].…”

“…Histoplasmosis mainly affects the lungs from which it can disseminate to other body sites such as the adrenal glands, bone marrow, gastrointestinal tract, joints and the brain [2]. Disseminated histoplasmosis (DH)-the more severe and common form of the disease-generally occurs in AIDS patients, in addition to immunocompromised person on treatment with steroids, presenting with severe neutropenia as a result of cancer chemotherapy, as well as recipients of hematopoietic stem cell and solid organ transplantation [2,3].…”