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American histoplasmosis in developing countries with a special focus on patients with HIV: diagnosis, treatment, and

Pierre Couppié1, Christine Aznar, Bernard Carme

  • 1Service de Dermatologie, French Guiana, Centre Hospitalier de Cayenne, Centre Hospitalier de Cayenne, Cayenne, French Guiana. couppie.pierre@voila.fr

Current Opinion in Infectious Diseases
|August 31, 2006
PubMed
Abstract

Insights

Histoplasmosis diagnosis and treatment vary across the Americas, especially in HIV patients. Early diagnosis and accessible treatments are crucial for managing this systemic fungal infection, particularly in resource-limited settings.

Area of Science:

  • Mycology
  • Infectious Diseases
  • Public Health

Background:

  • Histoplasmosis, caused by Histoplasma capsulatum var capsulatum, is a common systemic fungal infection in the Americas.
  • Diagnostic and therapeutic approaches for histoplasmosis differ between North and South America.
  • Disseminated histoplasmosis is an AIDS-defining illness, necessitating evaluation of prognostic factors for severe cases.

Purpose of the Study:

  • To evaluate prognostic factors for severe histoplasmosis presentations to guide initial therapeutic choices.
  • To highlight regional differences in histoplasmosis diagnosis and treatment between North and South America.
  • To address the challenges of diagnosing and treating co-infections like tuberculosis and histoplasmosis in HIV patients, especially in resource-poor settings.

Main Methods:

  • Review of diagnostic and therapeutic options for histoplasmosis.
  • Analysis of prognostic factors in patients with disseminated infections, particularly those with HIV.
  • Comparison of clinical presentations and isolate virulence between North and South American strains.

Main Results:

  • Patients with HIV and disseminated histoplasmosis with severe pulmonary and renal impairment have a poor prognosis.
  • Cutaneous presentations are more common in HIV patients in South America, where isolates show greater virulence compared to North American strains.
  • Diagnostic delays in resource-poor countries contribute to disparities in outcomes.

Conclusions:

  • Direct examination of stained smears is a simple diagnostic method in resource-limited settings.
  • Further studies on prognostic factors are needed to guide the choice between amphotericin B and itraconazole.
  • Accessible generic medications and improved diagnostic/therapeutic strategies are vital for resource-poor countries, especially for co-infections like tuberculosis and histoplasmosis in HIV patients.

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