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Kontogiannis D, Di Lorenzo A, Zaçe D, Benvenuto D, Moccione M, Muratore G, Giacalone ML, Montagnari G, Carnevale L, Mulas T, Coppola L, Campogiani L, Sarmati L, Iannetta M. Histoplasmosis in patients living with HIV in Europe: review of literature. Front Microbiol 2024; 15:1418530. [PMID: 38993488 PMCID: PMC11238259 DOI: 10.3389/fmicb.2024.1418530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Accepted: 06/12/2024] [Indexed: 07/13/2024] Open
Abstract
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.
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Affiliation(s)
- Dimitra Kontogiannis
- Department of Systems Medicine, Infectious Disease Clinic, Tor Vergata University, Rome, Italy
| | - Andrea Di Lorenzo
- Department of Systems Medicine, Infectious Disease Clinic, Tor Vergata University, Rome, Italy
| | - Drieda Zaçe
- Department of Systems Medicine, Infectious Disease Clinic, Tor Vergata University, Rome, Italy
| | - Domenico Benvenuto
- Department of Systems Medicine, Infectious Disease Clinic, Tor Vergata University, Rome, Italy
| | - Martina Moccione
- Department of Systems Medicine, Infectious Disease Clinic, Tor Vergata University, Rome, Italy
| | - Gianmarco Muratore
- Department of Systems Medicine, Infectious Disease Clinic, Tor Vergata University, Rome, Italy
| | - Maria L. Giacalone
- Department of Systems Medicine, Infectious Disease Clinic, Tor Vergata University, Rome, Italy
| | - Giulia Montagnari
- Department of Systems Medicine, Infectious Disease Clinic, Tor Vergata University, Rome, Italy
| | - Laura Carnevale
- Department of Systems Medicine, Infectious Disease Clinic, Tor Vergata University, Rome, Italy
| | - Tiziana Mulas
- Infectious Disease Clinic, Policlinico Tor Vergata, Rome, Italy
| | - Luigi Coppola
- Infectious Disease Clinic, Policlinico Tor Vergata, Rome, Italy
| | | | - Loredana Sarmati
- Department of Systems Medicine, Infectious Disease Clinic, Tor Vergata University, Rome, Italy
- Infectious Disease Clinic, Policlinico Tor Vergata, Rome, Italy
| | - Marco Iannetta
- Department of Systems Medicine, Infectious Disease Clinic, Tor Vergata University, Rome, Italy
- Infectious Disease Clinic, Policlinico Tor Vergata, Rome, Italy
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Zerbato V, Di Bella S, Pol R, D’Aleo F, Angheben A, Farina C, Conte M, Luzzaro F, Luzzati R, Principe L. Endemic Systemic Mycoses in Italy: A Systematic Review of Literature and a Practical Update. Mycopathologia 2023; 188:307-334. [PMID: 37294504 PMCID: PMC10386973 DOI: 10.1007/s11046-023-00735-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Accepted: 04/02/2023] [Indexed: 06/10/2023]
Abstract
Endemic systemic mycoses such as blastomycosis, coccidioidomycosis, histoplasmosis, talaromycosis, paracoccidioidomycosis are emerging as an important cause of morbidity and mortality worldwide. We conducted a systematic review on endemic systemic mycoses reported in Italy from 1914 to nowadays. We found out: 105 cases of histoplasmosis, 15 of paracoccidioidomycosis, 10 of coccidioidomycosis, 10 of blastomycosis and 3 of talaromycosis. Most cases have been reported in returning travelers and expatriates or immigrants. Thirtytwo patients did not have a story of traveling to an endemic area. Fortysix subjects had HIV/AIDS. Immunosuppression was the major risk factor for getting these infections and for severe outcomes. We provided an overview on microbiological characteristics and clinical management principles of systemic endemic mycoses with a focus on the cases reported in Italy.
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Affiliation(s)
- Verena Zerbato
- Infectious Diseases Unit, Trieste University Hospital (ASUGI), Piazza dell’Ospitale 1, 34125 Trieste, Italy
| | - Stefano Di Bella
- Clinical Department of Medical, Surgical and Health Sciences, Trieste University, 34149 Trieste, Italy
| | - Riccardo Pol
- Infectious Diseases Unit, Trieste University Hospital (ASUGI), Piazza dell’Ospitale 1, 34125 Trieste, Italy
| | - Francesco D’Aleo
- Microbiology and Virology Unit, Great Metropolitan Hospital “Bianchi Melacrino Morelli”, 89124 Reggio Calabria, Italy
| | - Andrea Angheben
- Department of Infectious, Tropical Diseases and Microbiology, IRCCS Sacro Cuore - Don Calabria Hospital, 37024 Negrar di Valpolicella, Verona, Italy
| | - Claudio Farina
- Microbiology and Virology Laboratory, ASST “Papa Giovanni XXIII”, 24127 Bergamo, Italy
| | - Marco Conte
- Microbiology and Virology Unit, Great Metropolitan Hospital “Bianchi Melacrino Morelli”, 89124 Reggio Calabria, Italy
| | - Francesco Luzzaro
- Clinical Microbiology and Virology Unit, “A. Manzoni” Hospital, 23900 Lecco, Italy
| | | | - Roberto Luzzati
- Clinical Department of Medical, Surgical and Health Sciences, Trieste University, 34149 Trieste, Italy
| | - Luigi Principe
- Clinical Pathology and Microbiology Unit, “S. Giovanni di Dio” Hospital, 88900 Crotone, Italy
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Antinori S, Magni C, Nebuloni M, Parravicini C, Corbellino M, Sollima S, Galimberti L, Ridolfo AL, Wheat LJ. Histoplasmosis among human immunodeficiency virus-infected people in Europe: report of 4 cases and review of the literature. Medicine (Baltimore) 2006; 85:22-36. [PMID: 16523050 DOI: 10.1097/01.md.0000199934.38120.d4] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
We reviewed the clinical, microbiologic, and outcome characteristics of 72 patients with human immunodeficiency virus (HIV)-associated histoplasmosis (4 newly described) reported in Europe over 20 years (1984-2004). Seven cases (9.7%) were acquired in Europe (autochthonous), whereas the majority involved a history of travel or arrival from endemic areas. The diagnosis of progressive disseminated histoplasmosis (PDH) was made during life in 63 patients (87.5%) and was the acquired immunodeficiency syndrome (AIDS)-presenting illness in 44 (61.1%). Disease was widespread in 66 patients (91.7%) and localized in 6 (8.3%), with the skin being the most frequent site of localized infection. Overall skin involvement was reported in 47.2% of the patients regardless of whether histoplasmosis was acquired in Africa or South America. Reticulonodular or diffuse interstial infiltrates occurred in 52.8%. The diagnosis was made during life by histopathology plus culture in 44 patients (69.8%), histopathology alone in 18 (28.5%), and culture alone in 1 (1.5%). During the induction phase amphotericin B and itraconazole (74.6%) were the single most frequently used drugs. Both drugs were also used either in combination (10.2%) or in sequential therapy (11.8%). Cumulative mortality rate during the induction phase of treatment was 15.2%. Overall, 37 patients died (57.8%); death occurred early in the course in 18 (28.1%). Seven of 40 patients (17.5%) who responded to therapy subsequently relapsed. Autopsy data in 13 patients confirmed the widespread disseminated nature of histoplasmosis (85%) among AIDS patients with a median of 4.5 organs involved. The results of the present report highlight the need to consider the diagnosis of PDH among patients with AIDS in Europe presenting with a febrile illness who have traveled to or who originated from an endemic area.
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Affiliation(s)
- Spinello Antinori
- From Department of Clinical Sciences, Section of Infectious and Tropical Diseases (SA, MC, SS, LG, ALR), University of Milan, Milan; Institute of Pathology (MN, CP), and I Infectious Diseases Unit (CM), Luigi Sacco Hospital, Milan, Italy; and MiraVista Diagnostics (LJW), Indianapolis, Indiana, United States
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