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Gupta NY, Al Diffalha S, Russ KB. An Unusual Case of Colitis in a Bone Marrow Transplant Patient. Gastroenterology 2024; 167:e1-e4. [PMID: 38253187 DOI: 10.1053/j.gastro.2024.01.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 01/15/2024] [Accepted: 01/16/2024] [Indexed: 01/24/2024]
Affiliation(s)
- Nikita Y Gupta
- Department of Medicine, State University of New York Upstate Medical University, Syracuse, New York
| | - Sameer Al Diffalha
- Department of Pathology, University of Alabama at Birmingham Hospital, Birmingham, Alabama
| | - Kirk B Russ
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Alabama at Birmingham Hospital, Birmingham, Alabama.
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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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Sepúlveda VE, Goldman WE, Matute DR. Genotypic diversity, virulence, and molecular genetic tools in Histoplasma. Microbiol Mol Biol Rev 2024; 88:e0007623. [PMID: 38819148 DOI: 10.1128/mmbr.00076-23] [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] [Indexed: 06/01/2024] Open
Abstract
SUMMARYHistoplasmosis is arguably the most common fungal respiratory infection worldwide, with hundreds of thousands of new infections occurring annually in the United States alone. The infection can progress in the lung or disseminate to visceral organs and can be difficult to treat with antifungal drugs. Histoplasma, the causative agent of the disease, is a pathogenic fungus that causes life-threatening lung infections and is globally distributed. The fungus has the ability to germinate from conidia into either hyphal (mold) or yeast form, depending on the environmental temperature. This transition also regulates virulence. Histoplasma and histoplasmosis have been classified as being of emergent importance, and in 2022, the World Health Organization included Histoplasma as 1 of the 19 most concerning human fungal pathogens. In this review, we synthesize the current understanding of the ecological niche, evolutionary history, and virulence strategies of Histoplasma. We also describe general patterns of the symptomatology and epidemiology of histoplasmosis. We underscore areas where research is sorely needed and highlight research avenues that have been productive.
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Affiliation(s)
- Victoria E Sepúlveda
- Department of Biology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - William E Goldman
- Department of Microbiology and Immunology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Daniel R Matute
- Department of Biology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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4
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Aissaoui H, Bourne-Watrin M, Lemarie B, Guillot G, Aboikoni A, Chhorn P, Gaudard D, Hadj-Amara G, Manasse R, Ouedraogo M, Salloum C, Demar M, Epelboin L, Kallel H, Adenis A, Nacher M, Drak Alsibai K, Louvel D. Histoplasmosis in Non-HIV Infected Patients: Another Neglected Infection in French Guiana. J Fungi (Basel) 2024; 10:400. [PMID: 38921386 PMCID: PMC11205039 DOI: 10.3390/jof10060400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Revised: 05/27/2024] [Accepted: 05/28/2024] [Indexed: 06/27/2024] Open
Abstract
(1) Background: Only a few studies on histoplasmosis in immunocompetent patients have been reported in French Guiana. Therefore, we conducted a detailed clinical description of hospitalized patients suffering with histoplasmosis among non-HIV patients. (2) Methods: This is a single-center, retrospective study conducted at Cayenne Hospital Center between 2008 and 2022. (3) Results: Our cohort was composed of 31 (91%) adults (>18 years of age) and 3 (9%) children, with a sex ratio, M:F, of 1:2. The median age was higher among the women than among the men (70 versus 54 years). The collection of respiratory samples constituted the majority of the performed examinations (38%). Fever (>37 °C) was found in 56% of patients. Surprisingly, the histoplasmosis was disseminated in 82% of patients with an overall case fatality rate of 14.7%. However, immunosuppressive conditions were found in 52% (16/31) of the adult patients, including lymphoid hemopathies, diabetes and immunosuppressive drugs. Conclusions: This disease, though rare and usually considered a mostly benign disease in non-HIV patients, presented a relatively high mortality rate in our cohort. Thus, histoplasmosis should be suspected, screened and investigated as a first line of defense in highly endemic areas, even in immunocompetent and non-HIV patients, especially those with fever or chronic respiratory symptoms.
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Affiliation(s)
- Houari Aissaoui
- Department of Medicine, Pneumology and Gastroenterology Units, Cayenne Hospital Center, Cayenne F-97300, French Guiana; (H.A.); (G.G.); (A.A.); (D.G.); (D.L.)
| | - Morgane Bourne-Watrin
- Unité des Maladies Infectieuses Tropicales (UMIT), Cayenne Hospital Center, Cayenne F-97300, French Guiana; (M.B.-W.); (L.E.)
| | - Benoit Lemarie
- Pneumology Department, Cochin University Hospital AP-HP, F-75014 Paris, France;
| | - Genevieve Guillot
- Department of Medicine, Pneumology and Gastroenterology Units, Cayenne Hospital Center, Cayenne F-97300, French Guiana; (H.A.); (G.G.); (A.A.); (D.G.); (D.L.)
| | - Alolia Aboikoni
- Department of Medicine, Pneumology and Gastroenterology Units, Cayenne Hospital Center, Cayenne F-97300, French Guiana; (H.A.); (G.G.); (A.A.); (D.G.); (D.L.)
| | | | - Dana Gaudard
- Department of Medicine, Pneumology and Gastroenterology Units, Cayenne Hospital Center, Cayenne F-97300, French Guiana; (H.A.); (G.G.); (A.A.); (D.G.); (D.L.)
| | - Ghazi Hadj-Amara
- Department of Pathology, Cayenne Hospital Center, Cayenne F-97300, French Guiana; (G.H.-A.); (R.M.)
| | - Ricardo Manasse
- Department of Pathology, Cayenne Hospital Center, Cayenne F-97300, French Guiana; (G.H.-A.); (R.M.)
| | - Mahamado Ouedraogo
- Laboratory of Mycology, Cayenne Hospital Center, Cayenne F-97300, French Guiana; (M.O.); (M.D.)
| | - Charles Salloum
- Department of Orthopidic Surgery and Neurosurgery, Cayenne Hospital Center, Cayenne F-97300, French Guiana;
| | - Magalie Demar
- Laboratory of Mycology, Cayenne Hospital Center, Cayenne F-97300, French Guiana; (M.O.); (M.D.)
| | - Loïc Epelboin
- Unité des Maladies Infectieuses Tropicales (UMIT), Cayenne Hospital Center, Cayenne F-97300, French Guiana; (M.B.-W.); (L.E.)
| | - Hatem Kallel
- Intensif Care Unit, Cayenne Hospital Center, Cayenne F-97300, French Guiana;
| | - Antoine Adenis
- Amazin PopHealth, Departement of Research and Innovation in Public Health (DRISP), Clinical Investigation Center (CIC Inserm 1424), Cayenne Hospital Center, Cayenne F-97300, French Guiana; (A.A.); (M.N.)
| | - Mathieu Nacher
- Amazin PopHealth, Departement of Research and Innovation in Public Health (DRISP), Clinical Investigation Center (CIC Inserm 1424), Cayenne Hospital Center, Cayenne F-97300, French Guiana; (A.A.); (M.N.)
| | - Kinan Drak Alsibai
- Department of Pathology, Cayenne Hospital Center, Cayenne F-97300, French Guiana; (G.H.-A.); (R.M.)
- Amazin PopHealth, Departement of Research and Innovation in Public Health (DRISP), Clinical Investigation Center (CIC Inserm 1424), Cayenne Hospital Center, Cayenne F-97300, French Guiana; (A.A.); (M.N.)
- Center of Biological Resources (CRB Amazonie), Cayenne Hospital Center, Cayenne F-97306, French Guiana
| | - Dominique Louvel
- Department of Medicine, Pneumology and Gastroenterology Units, Cayenne Hospital Center, Cayenne F-97300, French Guiana; (H.A.); (G.G.); (A.A.); (D.G.); (D.L.)
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Nacher M, Lucarelli A, Van-Melle A, Basurko C, Rabier S, Chroum M, Santana T, Verin K, Bienvenu K, El Guedj M, Vaz T, Cisse H, Epelboin L, Le Turnier P, Abboud P, Djossou F, Pradinaud R, Adenis A, Couppié P. Forty Years of HIV Research in French Guiana: Comprehend to Combat. Pathogens 2024; 13:459. [PMID: 38921756 PMCID: PMC11206598 DOI: 10.3390/pathogens13060459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Revised: 05/10/2024] [Accepted: 05/17/2024] [Indexed: 06/27/2024] Open
Abstract
The drivers of the HIV epidemic, the viruses, the opportunistic infections, the attitudes and the resources allocated to the fight against HIV/AIDS, vary substantially across countries. French Guiana, at the crossroads between Amazonian South America and the Caribbean, constitutes a singular context with poor populations and rich country health funding, which has allowed researchers to gather lots of information on the particulars of our epidemic. We aimed to focus on the little known story of forty years of HIV research in French Guiana and emphasize how local research intertwined with public health action has yielded continuous progress, despite the difficult social conditions of the affected population. We searched Web of Science and associated local experts who worked through much of the epidemic in selecting the most meaningful products of local research for clinical and public health outcomes in French Guiana. Research tools and facilities included, from 1991 onwards, the HIV hospital cohort and the HIV-histoplasmosis cohort. Ad hoc studies funded by the ANRS or the European Regional Development fund shed light on vulnerable groups. The cumulative impact of prospective routine collection and focused efforts has yielded a breadth of knowledge, allowing for informed decisions and the adaptation of prevention, testing and care in French Guiana. After this overview, we emphasize that the close integration of research and public health was crucial in adapting interventions to the singular context of French Guiana.
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Affiliation(s)
- Mathieu Nacher
- Comité de Coordination Régionale de la Lutte contre le VIH et les IST, Centre Hospitalier de Cayenne, 97300 Cayenne, French Guiana; (A.L.); (S.R.); (M.C.); (T.S.); (K.V.); (K.B.); (A.A.)
- Centre d’Investigation Clinique INSERM 1424, Centre Hospitalier de Cayenne, 97300 Cayenne, French Guiana; (A.V.-M.); (C.B.)
- Département Formation Recherche en Santé, Université de Guyane, 97300 Cayenne, French Guiana;
- Institut Santé des Populations en Amazonie, Centre Hospitalier de Cayenne, 97300 Cayenne, French Guiana
| | - Aude Lucarelli
- Comité de Coordination Régionale de la Lutte contre le VIH et les IST, Centre Hospitalier de Cayenne, 97300 Cayenne, French Guiana; (A.L.); (S.R.); (M.C.); (T.S.); (K.V.); (K.B.); (A.A.)
| | - Astrid Van-Melle
- Centre d’Investigation Clinique INSERM 1424, Centre Hospitalier de Cayenne, 97300 Cayenne, French Guiana; (A.V.-M.); (C.B.)
| | - Célia Basurko
- Centre d’Investigation Clinique INSERM 1424, Centre Hospitalier de Cayenne, 97300 Cayenne, French Guiana; (A.V.-M.); (C.B.)
| | - Sébastien Rabier
- Comité de Coordination Régionale de la Lutte contre le VIH et les IST, Centre Hospitalier de Cayenne, 97300 Cayenne, French Guiana; (A.L.); (S.R.); (M.C.); (T.S.); (K.V.); (K.B.); (A.A.)
| | - Malorie Chroum
- Comité de Coordination Régionale de la Lutte contre le VIH et les IST, Centre Hospitalier de Cayenne, 97300 Cayenne, French Guiana; (A.L.); (S.R.); (M.C.); (T.S.); (K.V.); (K.B.); (A.A.)
| | - Thiago Santana
- Comité de Coordination Régionale de la Lutte contre le VIH et les IST, Centre Hospitalier de Cayenne, 97300 Cayenne, French Guiana; (A.L.); (S.R.); (M.C.); (T.S.); (K.V.); (K.B.); (A.A.)
| | - Karine Verin
- Comité de Coordination Régionale de la Lutte contre le VIH et les IST, Centre Hospitalier de Cayenne, 97300 Cayenne, French Guiana; (A.L.); (S.R.); (M.C.); (T.S.); (K.V.); (K.B.); (A.A.)
| | - Ketty Bienvenu
- Comité de Coordination Régionale de la Lutte contre le VIH et les IST, Centre Hospitalier de Cayenne, 97300 Cayenne, French Guiana; (A.L.); (S.R.); (M.C.); (T.S.); (K.V.); (K.B.); (A.A.)
| | - Myriam El Guedj
- Hôpital de Jour Adultes, Centre Hospitalier de Cayenne, 97300 Cayenne, French Guiana
| | - Tania Vaz
- Hôpital de Jour Adultes, Centre Hospitalier de Cayenne, 97300 Cayenne, French Guiana
| | - Hawa Cisse
- Hôpital de Jour Adultes, Centre Hospitalier de Cayenne, 97300 Cayenne, French Guiana
| | - Loïc Epelboin
- Service des Maladies Infectieuses et Tropicales, Centre Hospitalier de Cayenne, 97300 Cayenne, French Guiana; (L.E.); (P.L.T.); (P.A.); (F.D.)
| | - Paul Le Turnier
- Service des Maladies Infectieuses et Tropicales, Centre Hospitalier de Cayenne, 97300 Cayenne, French Guiana; (L.E.); (P.L.T.); (P.A.); (F.D.)
| | - Philippe Abboud
- Service des Maladies Infectieuses et Tropicales, Centre Hospitalier de Cayenne, 97300 Cayenne, French Guiana; (L.E.); (P.L.T.); (P.A.); (F.D.)
| | - Félix Djossou
- Service des Maladies Infectieuses et Tropicales, Centre Hospitalier de Cayenne, 97300 Cayenne, French Guiana; (L.E.); (P.L.T.); (P.A.); (F.D.)
| | - Roger Pradinaud
- Service de Dermatologie Vénéréologie, Centre Hospitalier de Cayenne, 97300 Cayenne, French Guiana;
| | - Antoine Adenis
- Comité de Coordination Régionale de la Lutte contre le VIH et les IST, Centre Hospitalier de Cayenne, 97300 Cayenne, French Guiana; (A.L.); (S.R.); (M.C.); (T.S.); (K.V.); (K.B.); (A.A.)
- Centre d’Investigation Clinique INSERM 1424, Centre Hospitalier de Cayenne, 97300 Cayenne, French Guiana; (A.V.-M.); (C.B.)
- Département Formation Recherche en Santé, Université de Guyane, 97300 Cayenne, French Guiana;
- Institut Santé des Populations en Amazonie, Centre Hospitalier de Cayenne, 97300 Cayenne, French Guiana
| | - Pierre Couppié
- Département Formation Recherche en Santé, Université de Guyane, 97300 Cayenne, French Guiana;
- Institut Santé des Populations en Amazonie, Centre Hospitalier de Cayenne, 97300 Cayenne, French Guiana
- Service de Dermatologie Vénéréologie, Centre Hospitalier de Cayenne, 97300 Cayenne, French Guiana;
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Yee AC, Huang S, Singh R, Rizzi D, Shama N, Khoury N, Weisberg IS. Disseminated histoplasmosis in an HIV/AIDS transgender male-to-female with atypical and persistent GI manifestations. JGH Open 2024; 8:e13011. [PMID: 38268953 PMCID: PMC10805500 DOI: 10.1002/jgh3.13011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Revised: 11/09/2023] [Accepted: 11/12/2023] [Indexed: 01/26/2024]
Abstract
Disseminated histoplasmosis is a rare complication of infection due to Histoplasma capsulatum. Typically, histoplasmosis is self-limiting and asymptomatic in infected individuals with immunocompetence. Disseminated disease, however, can arise in high-risk populations with primary or acquired cellular immunodeficiency including HIV/AIDS, transplant recipients, and those undergoing immunosuppressive therapy. Here we describe a unique case of extrapulmonary gastrointestinal histoplasmosis by infiltrative Peyer's patch disease with bone marrow involvement in a transgender HIV-infected woman.
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Affiliation(s)
- Aaron C Yee
- Department of Internal MedicineNew York‐Presbyterian Brooklyn Methodist HospitalBrooklynNew YorkUSA
| | - Sarah Huang
- Department of Internal MedicineNew York‐Presbyterian Brooklyn Methodist HospitalBrooklynNew YorkUSA
| | - Ranbir Singh
- Department of Internal MedicineNew York‐Presbyterian Brooklyn Methodist HospitalBrooklynNew YorkUSA
| | - Dean Rizzi
- Department of Internal MedicineNew York‐Presbyterian Brooklyn Methodist HospitalBrooklynNew YorkUSA
| | | | - Neil Khoury
- University of Connecticut Health CenterFarmingtonConnecticutUSA
| | - Ilan S Weisberg
- Department of GastroenterologyNew York‐Presbyterian Brooklyn Methodist HospitalBrooklynNew YorkUSA
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7
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Sangiorgi F, Torelli R, Castri F, Siciliano V, Cauda R, Fantoni M, Sanguinetti M, Taccari F. Colonic histoplasmosis. J Travel Med 2023; 30:taad007. [PMID: 36637418 DOI: 10.1093/jtm/taad007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 01/04/2023] [Accepted: 01/05/2023] [Indexed: 01/14/2023]
Abstract
An Ivorian woman presented to us with a 2-month history of fever, abdominal pain and nausea. Human immunodeficiency virus serology was positive. Abdominal ultrasound showed enlarged abdominal lymph nodes and wall thickening of the right colon. Colonic biopsy was suggestive of fungal infection and polymerase chain reaction for Histoplasma capsulatum on biopsy was positive.
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Affiliation(s)
- Flavio Sangiorgi
- Dipartimento di Sicurezza e Bioetica, Università Cattolica del S. Cuore, Rome, Italy
| | - Riccardo Torelli
- Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Federica Castri
- Dipartimento di Scienze della salute della donna, del bambino e di sanità pubblica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Valentina Siciliano
- Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Roberto Cauda
- Dipartimento di Sicurezza e Bioetica, Università Cattolica del S. Cuore, Rome, Italy
- Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Massimo Fantoni
- Dipartimento di Sicurezza e Bioetica, Università Cattolica del S. Cuore, Rome, Italy
- Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Maurizio Sanguinetti
- Dipartimento di Sicurezza e Bioetica, Università Cattolica del S. Cuore, Rome, Italy
- Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Francesco Taccari
- Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
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8
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Albandak M, Azar J, Ayyad M, Salah Q, Toqan A, Giacaman N, Marzouqa N, Al-Tawil M, Wishah B, Barabrah A. Chronic Cavitary Pulmonary Histoplasmosis in an Immunocompetent Patient. Cureus 2023; 15:e37095. [PMID: 37153264 PMCID: PMC10158553 DOI: 10.7759/cureus.37095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/04/2023] [Indexed: 04/07/2023] Open
Abstract
Histoplasma capsulatum is a fungal organism that causes systemic histoplasmosis. It is commonly asymptomatic in healthy immunocompetent individuals. The clinical symptoms of chronic cavitary histoplasmosis are typically seen in the immunodeficient population, particularly in smokers with pre-existing structural lung disease. We report a case of chronic cavitary histoplasmosis in an immunocompetent patient from an endemic area without pre-existing structural lung pathology. She presented complaining of right hypochondrial pain and had no history of respiratory symptoms nor history suggestive of immunosuppression, tuberculosis, or recent travel. CT scan revealed a cavitary lung lesion and a hilar mediastinal mass. Biopsies obtained by bronchoscopy revealed signs of necrosis, granulomas, and the presence of fungal organisms consistent with histoplasmosis. Histoplasma antibodies by complement fixation for yeast antibodies test were positive establishing the diagnosis of chronic cavitary pulmonary histoplasmosis (CCPH). She was then started on itraconazole with good tolerance. On follow-up three months later, a chest CT done along with measurement of inflammatory markers and liver enzymes demonstrated complete clinical recovery. This case emphasizes the importance of expanding our current understanding of the clinical presentation and manifestations of histoplasmosis beyond the conventional assumption that severe disease only affects immunocompromised individuals.
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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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10
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Inayat F, Nawaz G, Afzal A, Ajmal M, Haider M, Sarfraz M, Haq ZU, Taj S, Ishtiaq R. Isolated Colonic Histoplasmosis in Patients Undergoing Immunomodulator Therapy: A Systematic Review. J Investig Med High Impact Case Rep 2023; 11:23247096231179448. [PMID: 37293945 PMCID: PMC10262664 DOI: 10.1177/23247096231179448] [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: 07/14/2022] [Revised: 05/04/2023] [Accepted: 05/14/2023] [Indexed: 06/10/2023] Open
Abstract
Gastrointestinal histoplasmosis remains an inconspicuous clinicopathologic entity. It is predominantly considered a protean manifestation of disseminated disease. We hereby delineate a unique case of biopsy-proven isolated colonic histoplasmosis in a patient undergoing methotrexate therapy. Furthermore, we present the first systematic review of the MEDLINE, Google Scholar, Embase, and Scopus databases regarding isolated colonic histoplasmosis in adult patients receiving immunomodulator therapy (IMT). A total of 13 case reports (level of clinical evidence: IV) were identified. The mean age was 55.6 ± 11.1 years, with 9 (69.2%) cases reported in women. Patients with subclinical disease (5, 38.5%) were often incidentally diagnosed by screening colonoscopy. Symptomatic individuals predominantly presented with diarrhea (4, 30.8%), weight loss (3, 23.1%), and/or abdominal pain (3, 23.1%). IMT was mainly administered for liver transplant (4, 30.8%), renal transplant (4, 30.8%), and ulcerative colitis (2, 15.4%). Common colonoscopy features included colonic ulcerations (7, 53.8%), polyps or pseudopolyps (3, 23.1%), and/or mass-like lesions (3, 23.1%). Diagnosis was made by histology of colonic biopsy in 11 (84.6%) and resected specimens in 2 (15.4%) patients. Treatment consisted of a combination of amphotericin B with oral itraconazole in 6 (46.2%), oral itraconazole alone in 5 (38.5%), and amphotericin B alone in 2 (15.4%) patients. Complete clinical recovery was achieved in all patients. This article illustrates that isolated colonic involvement can be the only clinical presentation of histoplasmosis. It may masquerade as other bowel disorders, presenting diagnostic and therapeutic conundrums. Gastroenterologists should rule out colonic histoplasmosis in IMT recipients who develop unexplained colitis symptoms.
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Affiliation(s)
| | - Gul Nawaz
- Marshfield Clinic Health System, Marshfield, WI, USA
| | | | - Maleeha Ajmal
- Marshfield Clinic Health System, Marshfield, WI, USA
| | - Marjan Haider
- Marshfield Clinic Health System, Marshfield, WI, USA
| | | | | | - Sobaan Taj
- Hackensack Meridian Health, Edison, NJ, USA
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11
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Antinori S, Giacomelli A, Corbellino M, Torre A, Schiuma M, Casalini G, Parravicini C, Milazzo L, Gervasoni C, Ridolfo AL. Histoplasmosis Diagnosed in Europe and Israel: A Case Report and Systematic Review of the Literature from 2005 to 2020. J Fungi (Basel) 2021; 7:jof7060481. [PMID: 34198597 PMCID: PMC8231918 DOI: 10.3390/jof7060481] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 06/07/2021] [Accepted: 06/10/2021] [Indexed: 12/22/2022] Open
Abstract
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%.
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Affiliation(s)
- Spinello Antinori
- Luigi Sacco Department of Biomedical and Clinical Sciences, Università di Milano, 20157 Milan, Italy; (A.G.); (M.S.); (G.C.)
- III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, 20157 Milan, Italy; (M.C.); (A.T.); (L.M.); (C.G.); (A.L.R.)
- Correspondence: ; Tel.: +39-0250319765; Fax: +39-0250319758
| | - Andrea Giacomelli
- Luigi Sacco Department of Biomedical and Clinical Sciences, Università di Milano, 20157 Milan, Italy; (A.G.); (M.S.); (G.C.)
- III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, 20157 Milan, Italy; (M.C.); (A.T.); (L.M.); (C.G.); (A.L.R.)
| | - Mario Corbellino
- III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, 20157 Milan, Italy; (M.C.); (A.T.); (L.M.); (C.G.); (A.L.R.)
| | - Alessandro Torre
- III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, 20157 Milan, Italy; (M.C.); (A.T.); (L.M.); (C.G.); (A.L.R.)
| | - Marco Schiuma
- Luigi Sacco Department of Biomedical and Clinical Sciences, Università di Milano, 20157 Milan, Italy; (A.G.); (M.S.); (G.C.)
- III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, 20157 Milan, Italy; (M.C.); (A.T.); (L.M.); (C.G.); (A.L.R.)
| | - Giacomo Casalini
- Luigi Sacco Department of Biomedical and Clinical Sciences, Università di Milano, 20157 Milan, Italy; (A.G.); (M.S.); (G.C.)
- III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, 20157 Milan, Italy; (M.C.); (A.T.); (L.M.); (C.G.); (A.L.R.)
| | | | - Laura Milazzo
- III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, 20157 Milan, Italy; (M.C.); (A.T.); (L.M.); (C.G.); (A.L.R.)
| | - Cristina Gervasoni
- III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, 20157 Milan, Italy; (M.C.); (A.T.); (L.M.); (C.G.); (A.L.R.)
| | - Anna Lisa Ridolfo
- III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, 20157 Milan, Italy; (M.C.); (A.T.); (L.M.); (C.G.); (A.L.R.)
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