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Yin J, Balachandar N, Karamchandani D, Vemulapalli R, Fudman DI. Isolated gastrointestinal histoplasmosis with a negative urine antigen test mimicking ulcerative colitis flare: a case report. Gastroenterol Rep (Oxf) 2024; 12:goae013. [PMID: 38566848 PMCID: PMC10987204 DOI: 10.1093/gastro/goae013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 02/01/2024] [Indexed: 04/04/2024] Open
Affiliation(s)
- Jianyi Yin
- Division of Digestive and Liver Diseases, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Neeraja Balachandar
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Dipti Karamchandani
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Roopa Vemulapalli
- Division of Digestive and Liver Diseases, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - David I Fudman
- Division of Digestive and Liver Diseases, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
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Ekeng BE, Itam-Eyo AE, Osaigbovo II, Warris A, Oladele RO, Bongomin F, Denning DW. Gastrointestinal Histoplasmosis: A Descriptive Review, 2001-2021. Life (Basel) 2023; 13:689. [PMID: 36983844 PMCID: PMC10051669 DOI: 10.3390/life13030689] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 02/15/2023] [Accepted: 02/27/2023] [Indexed: 03/08/2023] Open
Abstract
Gastrointestinal histoplasmosis (GIH) is infrequently described in people without underlying HIV infection. We aimed to compare the clinical presentation of GIH in people with and without HIV infection. We conducted a literature search of published cases of GIH from 2001-2021 and found 212 cases. Of these, 142 (67.0%) were male, and 124 (58.5%) had HIV infection. Most cases were from North America (n = 88, 41.5%) and South America (n = 79, 37.3%). Of the 212 cases, 123 (58.0%) were included in both clinical and pathological analyses. The remainder were excluded as details about clinical and pathological findings were not available. Of the 123 cases, 41 had HIV infection while 82 were without HIV infection. The diagnosis was predominantly by histopathology (n = 109, 88.6%). A significant proportion of people with HIV infection had abdominal pain as the most predominant symptom of GIH compared to those without HIV infection (65.9% versus 41.9%, p < 0.05). The colon was the most affected site with a slightly higher proportion in those with HIV infection compared with cases without HIV infection (46.3% versus 42.7%). The commonest pathologic findings were caecal and ileal ulcers. Caecal ulcers were significantly more frequent in cases with HIV infection compared to those without HIV (32.1% versus 7.1%, p < 0.05). Despite being more common in people with HIV infection, GIH also affects people without HIV infection with similar clinical presentations.
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Affiliation(s)
- Bassey E. Ekeng
- Medical Mycology Society of Nigeria, Lagos 101017, Nigeria
- Department of Medical Microbiology and Parasitology, University of Calabar Teaching Hospital, Calabar 540271, Nigeria
| | - Asa E. Itam-Eyo
- Department of Internal Medicine, University of Calabar Teaching Hospital, Calabar 540271, Nigeria
| | - Iriagbonse I. Osaigbovo
- Medical Mycology Society of Nigeria, Lagos 101017, Nigeria
- Department of Medical Microbiology, School of Medicine, College of Medical Sciences, University of Benin, Benin City 300213, Nigeria
| | - Adilia Warris
- Medical Research Council Centre for Medical Mycology, University of Exeter, Exeter EX4 4QD, UK
| | - Rita O. Oladele
- Medical Mycology Society of Nigeria, Lagos 101017, Nigeria
- Department of Medical Microbiology and Parasitology, Faculty of Basic Medical Sciences, College of Medicine, University of Lagos, Lagos 101017, Nigeria
| | - Felix Bongomin
- Department of Medical Microbiology & Immunology, Faculty of Medicine, Gulu University, Gulu P.O. Box 166, Uganda
| | - David W. Denning
- Manchester Fungal Infection Group, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester M13 9WL, UK
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Stefan AJ, Herc ES, Gudipati S, Brar I, Vitale A, Tariq Z. Atypical presentation of progressive disseminated histoplasmosis in a patient recently diagnosed with AIDS. Int J Infect Dis 2023; 127:45-47. [PMID: 36462572 DOI: 10.1016/j.ijid.2022.11.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 10/24/2022] [Accepted: 11/25/2022] [Indexed: 12/03/2022] Open
Abstract
Opportunistic infections, including progressive disseminated histoplasmosis (PDH), may have variable and surprising presentations in patients with AIDS. This can be either a primary infection or reactivation of a latent infection. Latent infections may occur due to being unmasked by the immune reconstitution inflammatory syndrome after the initiation of combined antiretroviral therapy. PDH can be difficult to diagnose in patients with AIDS due to its variable presentation and many overlapping symptoms with other opportunistic infections. Serum and urine antigen testing are highly sensitive and typically used as the initial diagnostic test to workup suspected PDH. However, negative antigen and antibody tests do not rule out Histoplasmosis capsulatum infection and suspicion should remain high for PDH in the right clinical context. A definitive diagnosis may require biopsy-proven narrow-based budding yeast. We present an interesting patient with AIDS who presented with worsening cognitive decline and was ultimately diagnosed with PDH based on biopsy histopathology in the setting of negative antigen and antibody testing.
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Affiliation(s)
- Andrew J Stefan
- Wayne State University School of Medicine, Detroit, MI, USA.
| | - Erica S Herc
- Department of Infectious Disease, Henry Ford Health, Detroit, MI, USA
| | - Smitha Gudipati
- Department of Infectious Disease, Henry Ford Health, Detroit, MI, USA
| | - Indira Brar
- Department of Infectious Disease, Henry Ford Health, Detroit, MI, USA
| | - Alyssa Vitale
- Department of Pathology, Henry Ford Health, Detroit, MI, USA
| | - Zain Tariq
- Department of Infectious Disease, Medical City, Fort Worth, TX, USA
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Isolated Ileal Stricture Secondary to Antigen-Negative GI Histoplasmosis in a Patient on Immunosuppressive Therapy. ACG Case Rep J 2017; 4:e10. [PMID: 28144615 PMCID: PMC5247624 DOI: 10.14309/crj.2017.10] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 10/28/2016] [Indexed: 01/21/2023] Open
Abstract
We present a case of antigen-negative disseminated histoplasmosis manifesting as an isolated ileal stricture in a patient on chronic infliximab and methotrexate. Diagnosis can be challenging due to imperfect tests, and this condition should remain in the differential, even with negative testing. Mortality of untreated disseminated histoplasmosis can be as high as 80%.
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Wheat LJ, Knox KS, Hage CA. Approach to the Diagnosis of Histoplasmosis, Blastomycosis and Coccidioidomycosis. CURRENT TREATMENT OPTIONS IN INFECTIOUS DISEASES 2014. [DOI: 10.1007/s40506-014-0020-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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