Disseminated Histoplasmosis; A Threat in Advanced HIV Disease Population in Sub-Saharan Africa? (original) (raw)
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Journal of Fungi, 2019
Histoplasmosis is a common but neglected AIDS-defining condition in endemic areas for Histoplasma capsulatum. At the advanced stage of HIV infection, the broad spectrum of clinical features may mimic other frequent opportunistic infections such as tuberculosis and makes it difficult for clinicians to diagnose histoplasmosis in a timely manner. Diagnosis of histoplasmosis is difficult and relies on a high index of clinical suspicion along with access to medical mycology facilities with the capacity to implement conventional diagnostic methods (direct examination and culture) in a biosafety level 3 laboratory as well as indirect diagnostic methods (molecular biology, antibody, and antigen detection tools in tissue and body fluids). Time to initiation of effective antifungals has an impact on the patient’s prognosis. The initiation of empirical antifungal treatment should be considered in endemic areas for Histoplasma capsulatum and HIV. Here, we report on 30 years of experience in man...
Prevalence of Histoplasmosis among Persons with Advanced HIV Disease, Nigeria
Emerging Infectious Diseases
H istoplasmosis, an invasive fungal infection endemic in the Americas, Africa, and Asia, with a few cases reported among immigrants to Europe, was classified as an AIDS-defining disease in 1987 (1,2). Incidence of disseminated histoplasmosis is 5%-25% in persons with advanced HIV disease (AHD; World Health Organization [WHO]-preferred term for AIDS), and according to recent data from South America, mortality rates are similar to those for tuberculosis among this patient group (3,4). In Latin America, high prevalence rates have been reported for disseminated histoplasmosis in AHD populations in Brazil (22%; 123/570) and Mexico (30%; 85/288) (5,6). Histoplasmosis is the most common AIDS-defining infection in Guatemala, more common than tuberculosis (7). In a recent study from Cameroon, 26% (36/138) of HIV patients had Histoplasma antigen in their urine regardless of CD4 count; a 2015 report indicated a 13% (7/56) prevalence in the AHD population (8,9). WHO in 2020 published its first guidelines for disseminated histoplasmosis among persons with AHD, including recommendations for diagnosis (10). WHO and the US President's Emergency Plan for AIDS Relief (PEPFAR) recommend providing differentiated care tailored to the unique needs of different HIV patient populations. Screening, treatment, and prophylaxis for major opportunistic infections is recommended for AHD (10). These key evidence-based interventions reduce illness and death among this clinically unstable population. Nigeria recently adopted a package of care for AHD that includes histoplasmosis screening, which has yet to be implemented. Nigeria has the 7th highest global tuberculosis
Histoplasmosis in HIV-Infected Patients: A Review of New Developments and Remaining Gaps
Current tropical medicine reports, 2014
Histoplasma capsulatum is responsible for histoplasmosis, a fungal disease with worldwide distribution that can affect both immunocompromised and imunocompetent individuals. During the highly active antiretroviral therapy (HAART) era, morbidity and mortality due to histoplasmosis remained a public heatlh problem in low-income and high-income countries. The true burden of HIV-associated histoplasmosis is either not fully known or neglected since it is not a notifiable disease. Progress has been made in DNA patterns of strains and understanding of pathogenesis, and hopefully these will help identify new therapeutic targets. Unfortunately, histoplasmosis is still widely mistaken for multidrug-resistant tuberculosis, leading to numerous avoidable deaths, even if they are easily distinguishable. The new diagnostic tools and therapeutics developments have still not been made available in most endemic regions. Still, recent developments are promising because of their good clinical characte...
Epidemiology and Knowledge Gap of Histoplasmosis in Africa
Infectious diseases, 2023
A dimorphic fungus called Histoplasma capsulatum is the cause of the granulomatous disease known as histoplasmosis. Histoplasma capsulatum var. capsulatum (Hcc) and Histoplasma capsulatum var. duboisii (Hcd), 2 variants of this fungus can infect humans and cause, classical or American histoplasmosis and African histoplasmosis, respectively. To improve the knowledge of health professionals, awareness of most fungal diseases, such as histoplasmosis, has been increased in Africa. In this review, we provide an overview of the current status of histoplasmosis in Africa, identify information gaps, and suggest targets for further study. The histoplasmosis literature in medical mycology textbooks and published articles from Google Scholar on histoplasmosis in Africa and the rest of the world were searched and reviewed. There was no restriction on the year of publications Conclusions were drawn from this review. Whereas the Western world has advanced technologies to diagnose histoplasmosis, this is not the case in Africa. Pulmonary histoplasmosis is therefore usually misdiagnosed as pulmonary tuberculosis because it has a similar clinical presentation. Due to a lack of knowledge and diagnostic tools, most national health systems in Africa are unable to correctly diagnose histoplasmosis, leading to misdiagnosis of the disease despite the fact that the continent has a sizable population of HIV/AIDS patients who are susceptible to contracting the illness. Under-recognition and under-diagnosis remain key issues caused by the lack of competent workers and diagnostic facilities. Therefore, this issue must be addressed by coordinated efforts. Also, it is crucial for doctors practicing outside of endemic areas to understand this illness' symptoms and treatment options. This is especially significant in light of African migration patterns.
Guidelines for Diagnosing and Managing Disseminated Histoplasmosis among People Living with HIV
2020
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Summary of Guidelines for Managing Histoplasmosis among People Living with HIV
Journal of Fungi
Histoplasmosis is a frequent fungal opportunistic infection in people living with HIV (PLHIV), associated every year to a total of 5% to 15% of AIDS-related deaths among this population. In 2020, the first global guidelines for diagnosing and managing disseminated histoplasmosis among PLHIV was published. This document recommends (1) detection of circulating Histoplasma antigens as the recommended laboratory assay to diagnose histoplasmosis among PLHIV; (2) the use of liposomal amphotericin for induction therapy in severe or moderately severe disease, followed by a maintenance therapy with itraconazole for 12 months; a shorter maintenance therapy could be considered if the patient is clinically stable and if immune status has improved; (3) antiretroviral therapy initiation as soon as possible among patients with histoplasmosis without involvement of central nervous system; and (4) that for the treatment of co-infection with histoplasmosis and tuberculosis (TB), treatment of TB shoul...
Medical Mycology
Poster session 2, September 22, 2022, 12:30 PM - 1:30 PM Background The inhalation of the thermally dimorphic fungus Histoplasma capsulatum, may result in a wide spectrum of clinical manifestations, ranging from asymptomatic to acute or chronic pulmonary infection to disseminated infection. Symptomatic infections usually occur with high-level exposures or in immunocompromised patients mainly people with HIV. Despite the improved access to antiretroviral therapy, HIV-associated histoplasmosis remains a significant opportunistic infection in endemic regions including Africa. Unfortunately, histoplasmosis is rarely on the diagnostic radar of clinicians in several African countries such as Ghana due to insufficient awareness, inadequate epidemiological data, and poor fungal diagnostic capacity. Herein, we present a case of disseminated histoplasmosis in an HIV/AIDS patient in a tertiary hospital in Ghana. Case Presentation Clinical history: A 43-year-old female was referred to the Der...
International Journal of Medical Microbiology, 2014
In South America, disseminated histoplasmosis due to Histoplasma capsulatum var. capsulatum (H. capsulatum), is a severe and frequent opportunistic infection in AIDS patients. In areas outside the USA where specific-Histoplasma antigen detection is not available, the diagnosis is difficult. With the galactomannan antigen (GM) detection, a test commonly used for invasive aspergillosis diagnosis, there is a cross-reactivity with H. capsulatum that can be helpful for the diagnosis of histoplasmosis. The aim of this study was to evaluate the GM detection for the diagnosis of disseminated histoplasmosis in AIDS patients. The performance of the GM detection was evaluated with serum collected in French Guiana where H. capsulatum is highly endemic. Sera from AIDS patients with disseminated histoplasmosis occurring from 2002 to 2009 and from control HIV-positive patients without histoplasmosis were tested with the GM detection and Histoplasma-specific antibody detection (IEP). In 39 AIDS patients with proven disseminated histoplasmosis, the sensitivity of the Histoplasma IEP was only 35.9% and was linked to the TCD4+ lymphocyte level. For the GM detection, the sensitivity (Se) was 76.9% and specificity (Sp) was 100% with the recommended threshold for aspergillosis diagnosis (0.5). The test was more efficient with a threshold of 0.4 (Se: 0.82 [95% CI: 0.66-0.92], Sp: 1.00 [95% CI: 0.86-1.00], LR+: >10, LR-: 0.18). This study confirms that the GM detection can be a surrogate marker for the diagnosis of disseminated histoplasmosis in AIDS patients in endemic areas where Histoplasma EIA is not available.