Disseminated histoplasmosis: case report and review of the literature

Histoplasmosis in patients living with HIV in Europe: review of literature

Histoplasma capsulatum (var. capsulatum Hcc and duboisii Hcd), is a dimorphic fungus that causes histoplasmosis. It usually affects people coming from endemic areas, causing a variety of clinical manifestations up to progressive disseminated histoplasmosis (PDH), especially among people living with HIV (PLWH). We conducted a systematic review to assess histoplasmosis burden of PLWH in Europe. The review follows PRISMA guidelines, with protocol registered in PROSPERO (CRD42023429779). Seventy-eight articles were selected, including 109 patients (32 women). On overall, median age was 37 years. Forty-six patients were Americans, 39 Africans, 17 Europeans, 5 Asians, in 2 cases nationality was not specified. Cases were mainly diagnosed in Italy (28.4%), France (17.3%) and Spain (17.4%), with a north-south gradient. Six cases lacked epidemiologic links with endemic areas. Concerning CDC HIV staging at diagnosis, the information was available for 60 PLWH (55%) and all subjects were at stage C3 except for two subjects at stage B3. PDH was the AIDS-presenting illness in 39 patients. Most patients had a PDH (80.7%); other common extrapulmonary forms were isolated cutaneous histoplasmosis (7.3%), or lymphatic localization (2.7%). In 30 cases, the diagnosis was made by analyzing only one sample. For the remaining 79 cases, multiple samples were collected from each patient. Regarding the biological sample more frequently used for the diagnosis of histoplasmosis, bronchoalveolar lavage sample was taken from 39 patients, and tested positive in 51.3% of cases; 36 patients underwent a skin biopsy which was positive in 86.1% of cases and 28 patients performed bone-marrow biopsy, which led to the diagnosis of histoplasmosis in 92.9% of cases. The identification of Histoplasma capsulatum was available in 97 PLWH through examination of different samples: Hcc and Hcd were identified in 89 and 8 PLWH, respectively. Concerning therapies, 67.9% were treated with liposomal amphotericin B, 18.3% with itraconazole, 10 died pre-treatment. The overall mortality rate was 23.6%. Non-survivors exhibited more frequently gastrointestinal symptoms (p = 0.017), while cutaneous signs correlated with better survival (p = 0.05). Untreated patients faced higher mortality (p < 0.001). Histoplasmosis should be considered amongst opportunistic infection in PLWH, even in Europe, especially if patients originate from or have travelled to endemic areas. Systematic review registration: The registration number is CRD42023429779.

An Interesting Case of Disseminated Histoplasmosis in a Patient With Hemophagocytic Lymphohistiocytosis

Histoplasmosisis a common mycosis in North and Central America caused by Histoplasma capsulatum. Affected patients typically remain asymptomatic. However, in some individuals, histoplasmosis can present as a severe illness, usually occurring in patients with underlying risk factors such as the immunocompromised (e.g., acquired immunodeficiency syndrome (AIDS), treatment with immunosuppressive agents), and the elderly without underlying immunocompromised conditions. Here, we present a case of disseminated histoplasmosis diagnosed as an incidental finding on bone marrow biopsy while treating a hospitalized patient for hemophagocytic lymphohistiocytosis. The patient presented with weight loss, anorexia, fatigue, and generalized weakness. The patient was successfully treated with amphotericin B and eventually transitioned to itraconazole.

Histoplasmosis Diagnosed in Europe and Israel: A Case Report and Systematic Review of the Literature from 2005 to 2020

Human histoplasmosis is a mycosis caused by two distinct varieties of a dimorphic fungus: Histoplasma capsulatum var. capsulatum and H. capsulatum var. duboisii. In Europe, it is usually imported by migrants and travellers, although there have been some autochthonous cases, especially in Italy; however, most European physicians are unfamiliar with its clinical and pathological picture, particularly among immunocompromised patients without HIV infection. This systematic review of all the cases of histoplasmosis reported in Europe and Israel between 2005 and 2020 identified 728 cases diagnosed in 17 European countries and Israel described in 133 articles. The vast majority were imported (mainly from Central and South America), but there were also seven autochthonous cases (six in Europe and one in Israel). The patients were prevalently males (60.4%), and their ages ranged from 2 to 86 years. The time between leaving an endemic region and the diagnosis of histoplasmosis varied from a few weeks to more than 40 years. Progressive disseminated histoplasmosis was the most frequent clinical picture among people living with HIV infection (89.5%) or a different immunocompromising condition (57.1%), but it was also recorded in 6.2% of immunocompetent patients. Twenty-eight cases were caused by Histoplasma duboisii. Immunocompromised patients without HIV infection had the worst outcomes, with a mortality rate of 32%.

Difficult to Diagnose: An Unusual Cause of Cavitary Lung Lesion

Patient: Male, 40-year-old

Final Diagnosis: Histoplasmosis

Symptoms: Dyspnea

Medication:—

Clinical Procedure: Bronchoscopy

Specialty: Pulmonology

Disseminated Histoplasmosis and Miliary Tuberculosis Imitating Colon Cancer in Patient with HIV Who Refuses to Antirretroviral Treatment

Simultaneous infection with histoplasmosis and miliary tuberculosis is rare and mainly affects people with severe immunosuppression, they can present very diverse clinical forms, similar to other infectious and neoplastic pathologies. We present the case of a 27-year-old woman diagnosed with HIV infection for 08 years who refuses to receive antiretroviral treatment (ART) and conceals her diagnosis, comes to the Hospital for pain, abdominal distension and ulcer in the oral cavity. The patient was diagnosed with likely cancer by presenting irregular intestinal thickening with homogeneous gray pattern in colon tomography and signs of intestinal obstruction, that after hemicolectomy was evidenced histoplasmosis in the pathological study, during the treatment with amphotericin B deoxycholate and improvement of the oral ulcer, the patient presented dyspnea, micronodular pattern on the chest radiograph that had not previously existed and the lipoarabinomanan antigen in the urine was positive for tuberculosis. In immunosuppressed patients, intestinal histoplasma infection may have clinical and tomographic characteristics similar to colon cáncer.

Presentation of histoplasmosis as mononucleosis syndrome in an immunocompetent patient

Histoplasmosis is a fungal disease usually occurring in endemic areas that can affect immuno-impaired patients in whom pulmonary involvement is the rule. We present the case of an 18 year-old immunocompetent, male patient, resident of the State of Florida, who showed signs of mononucleosis syndrome that included odynophagia, cervical adenomegaly, sporadic fever and rash; however, no pulmonary involvement or visceromegaly were present. Faced with this atypical and unexpected clinical picture, histoplasmosis infection was eventually diagnosed following cervical lymph-node biopsy. Disseminated histoplasmosis may have unexpected manifestations, as is pointed out in the case described below.