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Morote S, Nacher M, Blaizot R, Ntab B, Blanchet D, Drak Alsibai K, Demar M, Djossou F, Couppié P, Adenis A. Temporal trends of cutaneo-mucous histoplasmosis in persons living with HIV in French Guiana: Early diagnosis defuses South American strain dermotropism. PLoS Negl Trop Dis 2020; 14:e0008663. [PMID: 33075084 PMCID: PMC7595617 DOI: 10.1371/journal.pntd.0008663] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 10/29/2020] [Accepted: 07/31/2020] [Indexed: 01/17/2023] Open
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. 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. 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. Hence, 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.
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Affiliation(s)
- Sophie Morote
- Service de Dermatologie-vénéréologie, Centre Hospitalier de Cayenne, Cayenne, French Guiana
| | - Mathieu Nacher
- Centre d'Investigation Clinique Antilles Guyane, INSERM 1424, Centre Hospitalier de Cayenne, Cayenne, French Guiana
- COREVIH Guyane, Centre Hospitalier de Cayenne, Cayenne, French Guiana
- DFR Santé, Université de Guyane, Cayenne, French Guiana
- * E-mail:
| | - Romain Blaizot
- Service de Dermatologie-vénéréologie, Centre Hospitalier de Cayenne, Cayenne, French Guiana
- COREVIH Guyane, Centre Hospitalier de Cayenne, Cayenne, French Guiana
- UMR TBIP, Université de Guyane, Cayenne, French Guiana
| | - Balthazar Ntab
- Département d’Information Médicale, Centre Hospitalier de l’Ouest Guyanais, Saint Laurent du Maroni, French Guiana
| | - Denis Blanchet
- UMR TBIP, Université de Guyane, Cayenne, French Guiana
- Laboratory, Centre Hospitalier de Cayenne, Cayenne, French Guiana
| | - Kinan Drak Alsibai
- Service d’Anatomopathologie, Centre Hospitalier de Cayenne, Cayenne, French Guiana
| | - Magalie Demar
- DFR Santé, Université de Guyane, Cayenne, French Guiana
- UMR TBIP, Université de Guyane, Cayenne, French Guiana
- Laboratory, Centre Hospitalier de Cayenne, Cayenne, French Guiana
- Service des Maladies Infectieuses et Tropicales, Centre Hospitalier de Cayenne, Cayenne, French Guiana
| | - Félix Djossou
- DFR Santé, Université de Guyane, Cayenne, French Guiana
- Laboratory, Centre Hospitalier de Cayenne, Cayenne, French Guiana
- Service des Maladies Infectieuses et Tropicales, Centre Hospitalier de Cayenne, Cayenne, French Guiana
| | - Pierre Couppié
- Service de Dermatologie-vénéréologie, Centre Hospitalier de Cayenne, Cayenne, French Guiana
- DFR Santé, Université de Guyane, Cayenne, French Guiana
| | - Antoine Adenis
- Centre d'Investigation Clinique Antilles Guyane, INSERM 1424, Centre Hospitalier de Cayenne, Cayenne, French Guiana
- COREVIH Guyane, Centre Hospitalier de Cayenne, Cayenne, French Guiana
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Comparison of Disseminated Histoplasmosis with and without Cutaneo-Mucous Lesions in Persons Living with HIV in French Guiana. J Fungi (Basel) 2020; 6:jof6030133. [PMID: 32806526 PMCID: PMC7557946 DOI: 10.3390/jof6030133] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 08/06/2020] [Accepted: 08/10/2020] [Indexed: 11/30/2022] Open
Abstract
Introduction: Histoplasmosis is the main opportunistic infection and cause of death in HIV-infected persons living with HIV in French Guiana and probably in most of Latin America. The objective of the present study was to compare cutaneomucous histoplasmosis to non-cutaneomucous histoplasmosis in French Guiana. Methods: Between 1981 and 2014 AIDS-related disseminated histoplasmosis patients followed in the three hospitals of French Guiana were retrospectively studied. Only proven incident cases of histoplasmosis, either by pathology and/or mycological analysis, were considered. Mucocutaneous histoplasmosis was ascertained by a positive mucosal or cutaneous biopsy. Results: Thirty-one patients had mucocutaneous lesions, and 318 had no mucocutaneous lesions. Patients with cutaneomucous lesions were more likely to have had prior opportunistic infections (35.5%) than those who did not have cutaneomucous lesions (19.5%). They were more likely to be very severely immunocompromised (CD4 count < 50) (90.3% versus 62.8%) and less likely to have digestive signs (32.3% versus 74.1%) and superficial adenopathies (29% versus 50.2%) than those without cutaneomucous lesions. In terms of simple biological examinations, patients with cutaneomucous lesions had fewer signs of cholestasis. The diagnosis was significantly more likely to be performed by direct examination and pathology in those with cutaneomucous lesions than in those without such lesions. On the contrary, patients with cutaneomucous lesions were less likely to be diagnosed by fungal culture than those without cutaneomucous lesions. There was a greater but non-significant risk of early death in those with cutaneomucous lesions relative to those without (OR = 2.28 (95%CI = 0.83–5.7), p = 0.056. Conclusions: Mucocutaneous forms were associated with more profound immunosuppression and perhaps risk of early death. They are easily accessible for diagnosis.
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Couppié P, Herceg K, Bourne-Watrin M, Thomas V, Blanchet D, Alsibai KD, Louvel D, Djossou F, Demar M, Blaizot R, Adenis A. The Broad Clinical Spectrum of Disseminated Histoplasmosis in HIV-Infected Patients: A 30 Years' Experience in French Guiana. J Fungi (Basel) 2019; 5:jof5040115. [PMID: 31847076 PMCID: PMC6958354 DOI: 10.3390/jof5040115] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 09/12/2019] [Accepted: 09/17/2019] [Indexed: 12/22/2022] Open
Abstract
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 managing HIV-associated histoplasmosis based on a synthesis of clinical findings in French Guiana with considerations regarding the difficulties in determining its differential diagnosis with other opportunistic infections.
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Affiliation(s)
- Pierre Couppié
- Service de Dermatologie-Vénérologie, Centre Hospitalier de Cayenne, Avenue des Flamboyants, BP 6006, 97300 Cayenne, France; (M.B.-W.); (R.B.)
- Equipe EA3593, Ecosystèmes Amazoniens et Pathologie Tropicale, Université de Guyane, 97300 Cayenne, France; (K.H.); (D.B.); (F.D.); (M.D.); (A.A.)
- Correspondence: ; Tel.: +594-594-395325; Fax: +594-594-395041
| | - Katarina Herceg
- Equipe EA3593, Ecosystèmes Amazoniens et Pathologie Tropicale, Université de Guyane, 97300 Cayenne, France; (K.H.); (D.B.); (F.D.); (M.D.); (A.A.)
| | - Morgane Bourne-Watrin
- Service de Dermatologie-Vénérologie, Centre Hospitalier de Cayenne, Avenue des Flamboyants, BP 6006, 97300 Cayenne, France; (M.B.-W.); (R.B.)
| | - Vincent Thomas
- Service de Médecine B, Centre Hospitalier de Cayenne, 97300 Cayenne, France; (V.T.); (D.L.)
| | - Denis Blanchet
- Equipe EA3593, Ecosystèmes Amazoniens et Pathologie Tropicale, Université de Guyane, 97300 Cayenne, France; (K.H.); (D.B.); (F.D.); (M.D.); (A.A.)
- Laboratoire de Parasitologie-Mycologie, Centre Hospitalier de Cayenne, 97300 Cayenne, France
| | - Kinan Drak Alsibai
- Laboratoire d’Anatomie et Cytologie Pathologique, Centre Hospitalier de Cayenne, 97300 Cayenne, France;
| | - Dominique Louvel
- Service de Médecine B, Centre Hospitalier de Cayenne, 97300 Cayenne, France; (V.T.); (D.L.)
| | - Felix Djossou
- Equipe EA3593, Ecosystèmes Amazoniens et Pathologie Tropicale, Université de Guyane, 97300 Cayenne, France; (K.H.); (D.B.); (F.D.); (M.D.); (A.A.)
- Unité de Maladies Infectieuses et Tropicales, Centre Hospitalier de Cayenne, 97300 Cayenne, France
| | - Magalie Demar
- Equipe EA3593, Ecosystèmes Amazoniens et Pathologie Tropicale, Université de Guyane, 97300 Cayenne, France; (K.H.); (D.B.); (F.D.); (M.D.); (A.A.)
- Laboratoire de Parasitologie-Mycologie, Centre Hospitalier de Cayenne, 97300 Cayenne, France
| | - Romain Blaizot
- Service de Dermatologie-Vénérologie, Centre Hospitalier de Cayenne, Avenue des Flamboyants, BP 6006, 97300 Cayenne, France; (M.B.-W.); (R.B.)
- Equipe EA3593, Ecosystèmes Amazoniens et Pathologie Tropicale, Université de Guyane, 97300 Cayenne, France; (K.H.); (D.B.); (F.D.); (M.D.); (A.A.)
| | - Antoine Adenis
- Equipe EA3593, Ecosystèmes Amazoniens et Pathologie Tropicale, Université de Guyane, 97300 Cayenne, France; (K.H.); (D.B.); (F.D.); (M.D.); (A.A.)
- Centre d’Investigation Clinique Antilles Guyane, Inserm CIC 1424, Centre Hospitalier de Cayenne, 97300 Cayenne, France
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Chroboczek T, Dufour J, Renaux A, Aznar C, Demar M, Couppie P, Adenis A. Histoplasmosis: An oral malignancy-like clinical picture. Med Mycol Case Rep 2018; 19:45-48. [PMID: 29379706 PMCID: PMC5775070 DOI: 10.1016/j.mmcr.2017.11.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Revised: 09/12/2017] [Accepted: 11/24/2017] [Indexed: 12/27/2022] Open
Abstract
HIV-associated histoplasmosis is mainly misdiagnosed for granulomatous diseases, such as tuberculosis. Nonetheless, malignancy-like lesions have been reported sporadically in HIV-infected patients. Although the main reported lesions are erosive or ulcerated, here a rare case of oral tumor is reported. This case raises the awareness of this presentation, and the importance of accurate identification in the laboratory. Performing systematic specific stains for fungal elements and culture on tissue samples ensures accurate differential diagnosis.
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Affiliation(s)
| | - Julie Dufour
- Service de Dermatologie Vénérologie, CH de Cayenne, Cayenne, France
| | - Alain Renaux
- Service d'Oto-Rhino-Laryngologie, CH de Cayenne, Cayenne, France
| | - Christine Aznar
- Laboratoire Hospitalo-Universitaire de Parasitologie-Mycologie, CH de Cayenne, Cayenne, France.,Ecosystèmes Amazoniens et Pathologies Tropicales, EA3593, Université de Guyane, Cayenne, France
| | - Magalie Demar
- Laboratoire Hospitalo-Universitaire de Parasitologie-Mycologie, CH de Cayenne, Cayenne, France.,Ecosystèmes Amazoniens et Pathologies Tropicales, EA3593, Université de Guyane, Cayenne, France
| | - Pierre Couppie
- Service de Dermatologie Vénérologie, CH de Cayenne, Cayenne, France.,Ecosystèmes Amazoniens et Pathologies Tropicales, EA3593, Université de Guyane, Cayenne, France
| | - Antoine Adenis
- Ecosystèmes Amazoniens et Pathologies Tropicales, EA3593, Université de Guyane, Cayenne, France.,Centre d'Investigation Clinique Antilles-Guyane, Inserm CIC1424, CH de Cayenne, Cayenne, France
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Sirait SP, Bramono K, Hermanto N. Correlation of CD4 counts with clinical and histopathological findings in disseminated histoplasmosis: a 10-year retrospective study. Int J Dermatol 2017; 56:926-931. [PMID: 28677260 DOI: 10.1111/ijd.13679] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Revised: 05/01/2017] [Accepted: 05/22/2017] [Indexed: 11/27/2022]
Abstract
BACKGROUND Disseminated cutaneous histoplasmosis (DCH) is one of the manifestations of systemic histoplasmosis infection in HIV-positive patients. Interaction between host immune status and histoplasmosis infection is still poorly understood. It is thought that immune status, represented by CD4 counts, may be correlated with clinical and histopathological findings. OBJECTIVE To correlate the CD4 counts with the different clinical and histopathological findings in cutaneous histoplasmosis. METHODS This was a serial case report of seven HAART-treated HIV positive patients with disseminated histoplasmosis observed within the period of January 2004 through December 2014 from the Dermatology and Venereology Department, Cipto Mangunkusumo Hospital, Jakarta, Indonesia. The patients came with different complaints and clinical findings. CD4 counts were recorded prior to lesion biopsy. RESULTS The CD4 counts were independent from clinical morphology and distribution of lesions. Lower CD4 counts were associated with the presence of intraepidermal yeast-like cells, whereas there is the ability of forming granulomas at higher CD4 counts. CONCLUSION CD4 count correlates to histopathological findings of cutaneous histoplasmosis.
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Affiliation(s)
- Sondang P Sirait
- Department of Dermatovenerology, Medical Faculty Universitas Indonesia - Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Kusmarinah Bramono
- Department of Dermatovenerology, Medical Faculty Universitas Indonesia - Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Nathalia Hermanto
- Department of Dermatovenerology, Medical Faculty Universitas Indonesia - Cipto Mangunkusumo Hospital, Jakarta, Indonesia
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Lehur AC, Zielinski M, Pluvy J, Grégoire V, Diamantis S, Bleibtreu A, Rioux C, Picard A, Vallois D. Case of disseminated histoplasmosis in a HIV-infected patient revealed by nasal involvement with maxillary osteolysis. BMC Infect Dis 2017; 17:328. [PMID: 28476105 PMCID: PMC5418854 DOI: 10.1186/s12879-017-2419-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2016] [Accepted: 04/25/2017] [Indexed: 11/10/2022] Open
Abstract
Background Disseminated Histoplasmosis (DH) is a rare manifestation of Acquired Immune Deficiency Syndrome (AIDS) in European countries. Naso-maxillar osteolysis due to Histoplasma capsulatum var. capsulatum (Hcc) is unusual in endemic countries and has never been reported in European countries. Differential diagnoses such as malignant tumors, cocaine use, granulomatosis, vasculitis and infections are more frequently observed and could delay and/or bias the final diagnosis. Case presentation We report the case of an immunocompromised patient infected by Human Immunodeficiency Virus (HIV) with naso-maxillar histoplasmosis in a non-endemic country. Our aim is to describe the clinical presentation, the diagnostic and therapeutic issues. A 53-year-old woman, originated from Haiti, was admitted in 2016 for nasal deformation with alteration of general condition evolving for at least 6 months. HIV infection was diagnosed in 2006 and classified at AIDS stage in 2008 due to cytomegalovirus infection associated with pulmonary histoplasmosis. At admission, CD4 cell count was 9/mm3. Surgical biopsies were performed and ruled out differential or associated diagnoses. Mycological cultures identified Hcc and Blood Polymerase Chain Reaction (PCR) for Hcc was positive. The patient was given daily Amphothericin B liposomal infusion during 1 month. Hcc PCR became negative in the blood under treatment, and then oral switch by itraconazole was introduced. Antiretroviral treatment was reintroduced after a 3-week histoplasmosis treatment. Normalization of naso-maxillar mucosa enabled a palatal prosthesis. Conclusion Naso-maxillar histoplasmosis is extremely rare; this is the first case ever reported in a non-endemic country. Differential diagnoses must be ruled out by conducting microbiologic tools and histological examinations on surgical biopsies. Early antifungal treatment should be initiated in order to prevent DH severe outcomes.
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Affiliation(s)
- A C Lehur
- Infectious and Tropical Diseases Department, University Hospital Bichat-Claude Bernard, APHP, 46 rue Henri Huchard, 75018, Paris, France
| | - M Zielinski
- Otorhinolaryngology Department, University Hospital Bichat-Claude Bernard, APHP, Paris, France
| | - J Pluvy
- Infectious and Tropical Diseases Department, University Hospital Bichat-Claude Bernard, APHP, 46 rue Henri Huchard, 75018, Paris, France
| | - V Grégoire
- Hematology Department, Meaux Hospital, Meaux, France
| | - S Diamantis
- General Medecine and Infectious Diseases Department, Melun Hospital, Melun, France
| | - A Bleibtreu
- Infectious and Tropical Diseases Department, University Hospital Bichat-Claude Bernard, APHP, 46 rue Henri Huchard, 75018, Paris, France
| | - C Rioux
- Infectious and Tropical Diseases Department, University Hospital Bichat-Claude Bernard, APHP, 46 rue Henri Huchard, 75018, Paris, France
| | - A Picard
- Otorhinolaryngology Department, University Hospital Bichat-Claude Bernard, APHP, Paris, France
| | - D Vallois
- Infectious and Tropical Diseases Department, University Hospital Bichat-Claude Bernard, APHP, 46 rue Henri Huchard, 75018, Paris, France.
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Bhattacharya JB, Rani P, Aggarwal R, Kaushal S. Primary Cutaneous Histoplasmosis Masquerading as Lepromatous Leprosy. J Clin Diagn Res 2017; 11:ED01-ED02. [PMID: 28273974 DOI: 10.7860/jcdr/2017/19676.9145] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2016] [Accepted: 10/17/2016] [Indexed: 11/24/2022]
Abstract
Histoplasmosis is a genus of dimorphic fungi having various varieties of which the commonest one causing infection is Histoplasma capsulatum known to cause histoplasmosis. It has a varied disease spectrum ranging from an acute infection to chronic disease especially in lungs, disseminated disease and cutaneous disorder. Histoplasma capsulatum usually causes subclinical infection and serious infections only manifest in immunocompromised patients. Frank cases of infection are seen in pulmonary histoplasmosis. The spores of these organisms are seen to be strongly associated with droppings of birds and bats. A combination of these droppings and some soil types provide for an excellent environment for the proliferation of spores. Pulmonary histoplasmosis and disseminated disease are very common in AIDS patients and are a great cause of morbidity and mortality in these patients. Primary cutaneous histoplasmosis is very rare and occurs due to penetrating injuries. Once diagnosis is made, the lesions respond very well to oral itraconazole, fluconazole or amphotericicn B. We report a rare case of Cutaneous Histoplasmosis (CHP) in a 70-year-old male with complaints of multiple nodules all over his body in a HIV seronegative and otherwise immunocompetent patient.
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Affiliation(s)
| | - Poonam Rani
- Senior Resident, Department of Pathology, Maulana Azad Medical College , New Delhi, India
| | - Radhika Aggarwal
- Junior Resident, Department of Pathology, Maulana Azad Medical College , New Delhi, India
| | - Seema Kaushal
- Associate Professor, Department of Pathology, Maulana Azad Medical College , New Delhi, India
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Mandengue CE, Ngandjio A, Atangana PJA. Histoplasmosis in HIV-Infected Persons, Yaoundé, Cameroon. Emerg Infect Dis 2016; 21:2094-6. [PMID: 26488076 PMCID: PMC4622240 DOI: 10.3201/eid2111.150278] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Klein IP, Martins MAT, Martins MD, Carrard VC. Diagnosis of HIV infection on the basis of histoplasmosis-related oral ulceration. SPECIAL CARE IN DENTISTRY 2015; 36:99-103. [PMID: 26597996 DOI: 10.1111/scd.12147] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Histoplasmosis is an endemic systemic mycosis caused by the dimorphic fungus Histoplasma capsulatum. In immunocompromised patients, histoplasmosis generally occurs as an opportunistic disease, with dissemination to various organs. Cutaneous involvement is observed in 38% to 85% of cases, with oral mucosal involvement in 30% to 60% of cases. This article describes the case study of a 32-year-old woman who presented an extensive tongue ulcer due to histoplasmosis and had the HIV infection diagnosis based on laboratory tests requested by the dentist.
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Affiliation(s)
- Isadora Peres Klein
- Master's degree student, Department of Conservative Dentistry, School of Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Marco Antonio Trevizani Martins
- Assistant professor, Department of Conservative Dentistry, School of Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Manoela Domingues Martins
- Assistant professor, Department of Conservative Dentistry, School of Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Vinicius Coelho Carrard
- Assistant professor, Department of Conservative Dentistry, School of Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
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New clinical and histological patterns of acute disseminated histoplasmosis in human immunodeficiency virus-positive patients with acquired immunodeficiency syndrome. Am J Dermatopathol 2013; 35:205-12. [PMID: 22157244 DOI: 10.1097/dad.0b013e31822fd00a] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Histoplasmosis has attained increasing relevance in the past 3 decades because of the appearance of the human immunodeficiency virus (HIV). In most immunocompetent persons, the infection is asymptomatic or can produce a respiratory condition with symptoms and radiological images similar to those observed in pulmonary tuberculosis; in non-HIV+ immunocompromised patients, it can cause respiratory symptoms or evolve into a disseminated infection. The same can occur in acquired immunodeficiency syndrome (AIDS) patients. We have observed a series of HIV+ patients with AIDS who presented with cutaneous histoplasmosis and in whom the clinical and histopathological features were highly unusual, including variable mucocutaneous lesions that were difficult to diagnose clinically. These patients displayed unusual, previously undescribed, histological patterns, including lichenoid pattern, nodular pseudomyxoid pattern, pyogenic granuloma-like pattern, perifollicular pattern, and superficial (S), mid (M), and deep perivascular dermatitis; and more commonly encountered patterns, such as histiocytic lobular panniculitis and focal nodular dermatitis. The novel histopathological patterns of cutaneous involvement by histoplasmosis seen in these patients resembled other common inflammatory and infectious conditions and required a high level of suspicion and the application of special stains for organisms for confirmation. These new, clinical, and histological findings do not seem to be commonly encountered in HIV- patients infected with the fungus but seem to be displayed most prominently in HIV+ patients with AIDS.
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Perforation of the nasal septum as the first sign of histoplasmosis associated with AIDS and review of published literature. Mycopathologia 2013; 176:145-50. [PMID: 23661050 DOI: 10.1007/s11046-013-9662-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2012] [Accepted: 04/27/2013] [Indexed: 10/26/2022]
Abstract
Disseminated histoplasmosis in South America is associated with AIDS in 70-90 % of cases. It is visceral and cutaneous, compromising the oral, pharynx, and laryngeal mucous membranes. The involvement of the nasal mucosa is unusual. Two patients with perforation of the nasal septum as the only sign of their disease were clinically and histopathologically diagnosed as leishmaniasis. The revision of the biopsies and the culture of nasal discharge secretions showed that the pathogens seen were not amastigotes but Histoplasma capsulatum. Other mycotic lesions were not detected, nor there was history of cutaneous leishmaniasis. The leishmanin skin test, available only for the male patient, was negative. The PCR and immunofluorescence antibody titers for Leishmania were negative in both patients. They were HIV positive; in the male, his CD4+ T cell count was 60/mm(3) and in the female 133/mm(3). The nasal ulcer was the only manifestation of histoplasmosis and the first of AIDS in both patients. The male patient recovered with amphotericin B and itraconazole treatment. The female has improved with itraconazole. Both patients received antiretroviral treatment. Nasal mucous membrane ulcers should include histoplasmosis among the differential diagnosis. In conclusion, two patients had perforation of their nasal septum as the only manifestation of histoplasmosis, a diagnosis confirmed by nasal mucosa biopsy and by culture of H. capsulatum, findings which demonstrated that both patients had AIDS.
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Dasmasceno LS, Novaes Jr AR, Alencar CHM, Lima DT, Sidrim JJC, Gonçalves MVF, de Mesquita JRL, Leitão TDMJS. Disseminated histoplasmosis and aids: relapse and late mortality in endemic area in north-eastern Brazil. Mycoses 2013; 56:520-6. [DOI: 10.1111/myc.12067] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2012] [Revised: 02/03/2013] [Accepted: 02/07/2013] [Indexed: 11/27/2022]
Affiliation(s)
| | - Alberto Ramos Novaes Jr
- Department of Community Health; School of Medicine; Federal University of Ceará; Fortaleza; CE; Brazil
| | | | - Daniel Teixeira Lima
- Specialized Medical Mycology Center; Federal University of Ceará; Fortaleza; CE; Brazil
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Srivastava B, King B, Galan A. An unusual clinical and histologic presentation of disseminated cutaneous histoplasmosis. J Am Acad Dermatol 2011; 65:e146-8. [PMID: 22000884 DOI: 10.1016/j.jaad.2010.12.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2010] [Revised: 12/13/2010] [Accepted: 12/16/2010] [Indexed: 10/16/2022]
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Cunha VS, Pereira PR, Sprinz E. Medical imagery. Cutaneous histoplasmosis as initial presentation of AIDS. Int J Infect Dis 2009; 14:e271-2. [PMID: 19648046 DOI: 10.1016/j.ijid.2009.04.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2009] [Revised: 03/30/2009] [Accepted: 04/13/2009] [Indexed: 11/26/2022] Open
Affiliation(s)
- Vanessa Santos Cunha
- Hospital de Clínicas de Porto Alegre, Ramiro Bracelos Street, 2350 Porto Alegre, Rio Grande do Sul, Brazil.
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Bonifaz A, Chang P, Moreno K, Fernández-Fernández V, Montes de Oca G, Araiza J, Ponce RM. Disseminated cutaneous histoplasmosis in acquired immunodeficiency syndrome: report of 23 cases. Clin Exp Dermatol 2009; 34:481-6. [DOI: 10.1111/j.1365-2230.2008.02974.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Saheki MN, Schubach ADO, Salgueiro MDM, Conceição-Silva F, Wanke B, Lazera M. [Primary cutaneous histoplasmosis: case report on an immunocompetent patient and review of the literature]. Rev Soc Bras Med Trop 2009; 41:680-2. [PMID: 19142453 DOI: 10.1590/s0037-86822008000600024] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2007] [Accepted: 11/25/2008] [Indexed: 11/21/2022] Open
Abstract
This report describes a case of primary cutaneous histoplasmosis in a 45-year-old male. The presentation consisted of an erythematous nodule on the back of the right hand, accompanied by nontender regional lymphadenomegaly that developed following local trauma that occurred during military training in a tunnel inhabited by bats. Histological examination of a biopsy specimen from the skin lesion showed granulomatous infiltrate, but did not show fungal elements. Culturing of this material, incubated in Sabouraud agar, showed growth of Histoplasma capsulatum. No evidence of systemic involvement or immunosuppression was found. Treatment with 400 mg/day of itraconazole orally for six months resulted in complete remission of the lesion, which was maintained one year after the end of the treatment.
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Affiliation(s)
- Mauricio Naoto Saheki
- Serviço de Infectologia, Instituto de Pesquisa Clínica Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brazil.
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Nico MMS, Higashino HR, Yeh Li H, Carvalho NB, Lourenço SV. Exuberant mucocutaneous lesions of disseminated histoplasmosis in a human immunodeficiency virus (HIV) positive patient. Int J Dermatol 2009; 48:157-9. [DOI: 10.1111/j.1365-4632.2009.03580.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Two specific strains of Histoplasma capsulatum causing mucocutaneous manifestations of histoplasmosis: preliminary analysis of a frequent manifestation of histoplasmosis in southern Brazil. Mycopathologia 2008; 167:181-6. [PMID: 19112605 DOI: 10.1007/s11046-008-9171-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2008] [Accepted: 12/02/2008] [Indexed: 10/21/2022]
Abstract
OBJECTIVES Skin lesions, uncommon in US cases (<10%), occur in 38-85% of cases reported from Latin America. Although these differences may reflect reporting bias, delayed diagnosis, or differences in host immune response among different ethnic groups, they also could result from genetic differences changing the pathobiology of the organism. It is possible that genetic differences among strains of H. capsulatum may influence the pathogenesis and clinical manifestations of histoplasmosis. METHODS We examined the clinical features of patients with mucocutaneous manifestations of histoplasmosis and performed genetic analysis based on nucleotide sequence variations in the internal transcribed spacer regions of rRNA genes of H. capsulatum isolates of patients. Two pairs of PCR primers were designed to develop and amplify the ITS regions of H. capsulatum, 5'-TACCCGGCCACCCTTGTCTA-3' and 5'-AGCGGGTGGCAAAGCCC-3'. These primers were based on the ITS sequence of Ajellomyces capsulatus, the ascomycetous teleomorph form of H. capsulatum, deposited in the GenBank (accession number U18363). Eight patients attending a tertiary-care hospital in southern Brazil were enrolled into the study. All case patients had skin cultures growing H. capsulatum at the mycology laboratory. RESULTS Six of eight (75%) patients were HIV-positive and presented involvement of multiples organs by H. capsulatum. Two HIV-negative patients did not present evidence of involvement of other organs besides mucosa and skin. ITS sequencing of a DNA H. capsulatum fragment of 485-bp from isolates of 8 patients revealed two distinct strains. The 2 distinct fragments (Hc1, Hc2) differed from each other at 7 positions in the ITS regions. They were identical to strains of H. capsulatum isolated in patients from Colombia and Argentina, but different from strains isolated in US. Hc1 and Hc2 were isolated in 5 patients and 3 patients, respectively, with mucocutaneous manifestations of histoplasmosis. Both Hc1 and Hc2 strains were isolated in HIV-infected and non-HIV-infected patients. CONCLUSIONS Mucocutaneous manifestations of histoplasmosis, which are frequently seen in Brazilian patients were caused by 2 specific strains in our institution. Those strains have been isolated in patients with these particular clinical features of histoplasmosis in Latin America. Our study suggests that unique pathogenic characteristics among the Latin American species of H. capsulatum might explain its increased dermatotropism.
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AIDS-related Histoplasma capsulatum var. capsulatum infection: 25 years experience of French Guiana. AIDS 2008; 22:1047-53. [PMID: 18520348 DOI: 10.1097/qad.0b013e3282ffde67] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVE Histoplasma capsulatum var. capsulatum infection is a major AIDS-defining illness in French Guiana. Although it affects South and Central American countries, the number of published cases is low. We present the largest series of AIDS-related histoplasmosis. The aim of this work is to describe clinical features and to help optimize investigations in settings where antigen detection methods are not available. DESIGN Two hundred cases of AIDS-related histoplasmosis, diagnosed in the hospitals of French Guiana, were included retrospectively between 1982 and 2007. RESULTS At the time of diagnosis, 92% of patients did not receive highly active antiretroviral therapy. CD4 cell count was less than 100 cells/microl for 80% of them. Most patients had fever, lymphadenopathies, and pulmonary and digestive symptoms. Neurological signs and skin/mucosal locations were less common. Other opportunistic infections were associated in 36.6% of cases (mostly tuberculosis). In most of the patients, lactic dehydrogenase was at least four times the normal value, and there was a moderate increase of aspartate aminotransaminase but not alanine aminotransaminase levels. Bone marrow aspirations were useful, but cultures of liver and lymphadenopathy specimens were the most contributive. Following treatment initiation, 17.5% died within a month. Presumptive treatment was started before diagnostic confirmation in 14.3% of the cases. CONCLUSION In high prevalence settings, histoplasmosis often revealed AIDS in severely immunodeficient and poorly followed patients. In the absence of a quick sensitive technique, skin smear and fungal tissue cultures are contributive. Nevertheless, given the diagnostic delays and the poor prognosis, presumptive treatment with amphotericin B-containing regimens should be recommended when clinical and epidemiological contexts are evocative.
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Cunha VS, Zampese MS, Aquino VR, Cestari TF, Goldani LZ. Mucocutaneous manifestations of disseminated histoplasmosis in patients with acquired immunodeficiency syndrome: particular aspects in a Latin-American population. Clin Exp Dermatol 2007; 32:250-5. [PMID: 17397349 DOI: 10.1111/j.1365-2230.2007.02392.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Mucocutaneous lesions in human immunodeficiency virus (HIV)-infected patients with disseminated histoplasmosis have a wide spectrum of clinical manifestations, making its diagnosis difficult. Studies have been restricted to case reports and series with small numbers of patients not specifically focusing on the dermatological aspects of histoplasmosis. AIMS To describe the characteristics of mucocutaneous lesions of disseminated histoplasmosis in HIV-infected patients. METHODS A retrospective and prospective study was conducted on 36 HIV-infected patients with mucocutaneous histoplasmosis in a tertiary-care hospital in Brazil. RESULTS Mucocutaneous histoplasmosis was diagnosed by histopathology in 33 of the 36 patients (91%) and/or culture in 23 (64%). Their CD4+ cell counts ranged from 2 to 103 cells/mm(3). The average number of different morphological types of lesions was three per patient. Despite the variability of the lesions, papules (50%), crusted papules (64%) and oral mucosal erosions and/or ulcers (58%) were the most frequent dermatological lesions. A diffuse pattern of distribution of the skin lesions was found in 58% of the cases. There was significant association between the CD4+ cell counts and the morphological variability of lesions per patient. Variation in the lesions seemed to be associated with higher CD4+ cell counts. CONCLUSION Doctors caring for HIV-infected patients should be aware of the wide spectrum of dermatological lesions observed in disseminated histoplasmosis and the importance of detecting and isolating the fungus in mucocutaneous tissues.
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Affiliation(s)
- V S Cunha
- Department of Dermatology, Porto Alegre Clinical Hospital, Federal University of Rio Grande do Sul, Brazil.
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Couppié P, Aznar C, Carme B, Nacher M. American histoplasmosis in developing countries with a special focus on patients with HIV: diagnosis, treatment, and prognosis. Curr Opin Infect Dis 2006; 19:443-9. [PMID: 16940867 DOI: 10.1097/01.qco.0000244049.15888.b9] [Citation(s) in RCA: 95] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE OF REVIEW Histoplasmosis due to Histoplasma capsulatum var capsulatum is a frequent systemic fungal infection in the Americas. Diagnostic and therapeutic options differ between North and South America. Disseminated histoplasmosis is an AIDS-defining infection. Prognostic factors of potentially severe presentations must be evaluated in order to facilitate the initial therapeutic choice. RECENT FINDINGS Patients with HIV with disseminated infections presenting with severe pulmonary and renal impairment have a poor prognosis. Cutaneous presentations are more frequent in HIV patients in South America than in North America. A murine model has shown that South American isolates have a greater virulence that North American isolates. These differences are due in part to diagnostic delays in resource-poor countries. SUMMARY Direct examination of May-Grünwald-Giemsa-stained smears or tissues in suspected histoplasmosis is a simple means of confirming the diagnosis in resource-poor settings. Studies of prognostic factors should further refine indication criteria to guide first-line treatment choice between amphotericin B and itraconazole. The association of tuberculosis and histoplasmosis is frequent in HIV patients and presents diagnostic and therapeutic challenges that may be difficult to resolve in resource-poor settings. It is important that affordable generic drugs for treating histoplasmosis be made widely available in resource-poor countries.
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Affiliation(s)
- Pierre Couppié
- Service de Dermatologie, French Guiana, Centre Hospitalier de Cayenne, Centre Hospitalier de Cayenne, Cayenne, French Guiana.
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Nacher M, Aznar C, Blanchet D, Demar M, El Guedj M, Vaz T, Clyti E, Carme B, Couppié P. AIDS-related disseminated histoplasmosis in the greater Caribbean: how frequent is it? AIDS 2006; 20:951-2. [PMID: 16549988 DOI: 10.1097/01.aids.0000218568.43391.78] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Shelburne SA, Visnegarwala F, Adams C, Krause KL, Hamill RJ, White AC. Unusual manifestations of disseminated Histoplasmosis in patients responding to antiretroviral therapy. Am J Med 2005; 118:1038-41. [PMID: 16164892 DOI: 10.1016/j.amjmed.2005.02.006] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2004] [Indexed: 11/26/2022]
Affiliation(s)
- Samuel A Shelburne
- Infectious Diseases Section, Department of Medicine (VA), Baylor College of Medicine, Houston, TX 77030, USA
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Couppié P, Roussel M, Thual N, Aznar C, Laifaoui J, Demar M, Sainte-Marie D, Huerre M, Grosshans E, Carme B. [Disseminated histoplasmosis: an atypical ulcerous form in an HIV-infected patient]. Ann Dermatol Venereol 2005; 132:133-5. [PMID: 15798563 DOI: 10.1016/s0151-9638(05)79224-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Histoplasma capsulatum var capsulatum is a dimorphic fungi predominating on the American continent. It is responsible for disseminated histoplasmosis associated with AIDS. The presentation in the form of cutaneous ulceration is uncommon and misleading. OBSERVATION A 25 year-old man presented with 3 ulcerations, of 2 to 4 cm in diameter, localized on the lower lip and knees. The patient exhibited fever, alteration in his general status of health and a pulmonary interstitial syndrome. He was seropositive for the human immunodeficiency syndrome (HIV). His lymphocyte CD4+ level was of 1/mm3. Diagnosis of histoplasmosis was established by direct examination and culture of the cutaneous ulcerations and bronchoalveolar washing fluid. DISCUSSION The clinical aspect of cutaneous localizations of disseminated histoplasmosis is usually multiple, disseminated, papular or nodular-type lesions. Ulcerations represent less than 20% of the cases described. In our patient, the aspect of the lesions at first evoked cutaneous leishmaniosis. Direct mycological examination followed by culture confirmed the final diagnosis.
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Affiliation(s)
- P Couppié
- Service de Dermatologie, Centre Hospitalier de Cayenne, Guyane
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Disseminated histoplasmosis in five immunosuppressed patients: clinical, diagnostic, and therapeutic perspectives. ACTA ACUST UNITED AC 2005. [DOI: 10.1097/00013542-200501000-00001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Loeb I, Keiani-Motlagh K, Dargent JL, Hermans P, Van Reck J. [Histoplasmosis of the oral cavity]. ACTA ACUST UNITED AC 2004; 105:215-8. [PMID: 15510072 DOI: 10.1016/s0035-1768(04)72310-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Histoplasmosis is an endemic mycosis. Histoplasma capsulatum, and duboisiï are the pathogenic agents in humans. The disease is reported as endemic in more than 30 countries. Three clinical forms are distinguished; acute, chronic and disseminated. Oral lesions may take on different clinical aspects which are often associated with disseminated histoplasmosis. Disseminated histoplasmosis is frequently diagnosed in immunocompromised hosts. High risk of mortality dictates rapid diagnosis and treatment.
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Affiliation(s)
- I Loeb
- Service de stomatologie et chirurgie Maxillo-faciale, CHU Saint-Pierre, Bruxelles, Belgique
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