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Histoplasmosis in patients with acquired immunodeficiency syndrome. Hematologic and bone marrow manifestations
P J Kurtin1, D S McKinsey, M R Gupta
1Department of Pathology, Research Medical Center and Infectious Disease Associates of Kansas City, Missouri.
Abstract:
In areas where Histoplasma capsulatum infections are endemic in the United States, there is an increasing frequency of progressive disseminated histoplasmosis (PDH) as an opportunistic infection in patients with acquired immune deficiency syndrome (AIDS). The bone marrow and peripheral blood (PB) specimens in 13 patients with AIDS and PDH were reviewed. Anemia, leukopenia, and thrombocytopenia were found in 12, 10, and 7 patients, respectively. Circulating organisms were detected in the blood smears or buffy coat preparations from five patients and were associated with PB nRBCs and severe absolute monocytopenia. Morphologically, the marrow specimens showed one of four patterns: (1) no morphologic evidence of infection (two patients, one with a positive marrow culture); (2) discrete granulomas (two patients, both with positive marrow cultures); (3) lymphohistiocytic aggregates (six patients, four with positive marrow cultures); and (4) diffuse macrophage infiltrates (three patients, all with positive marrow cultures). Morphologic examination of the bone marrow combined with cultures is useful in diagnosing disseminated histoplasmosis in patients with AIDS. However, the morphologic findings in the bone marrow may be different in patients with AIDS compared with non-AIDS patients, and seemingly nondiagnostic morphologic features must be approached with a high degree of suspicion in diagnosing infections with H. capsulatum in this population.
Insights
Progressive disseminated histoplasmosis (PDH) is increasing in patients with acquired immune deficiency syndrome (AIDS). Bone marrow morphology and cultures aid diagnosis, but findings may differ in AIDS patients.
Area of Science:
- Mycology
- Infectious Diseases
- Hematology
Background:
- Progressive disseminated histoplasmosis (PDH) is an opportunistic infection increasingly diagnosed in patients with acquired immune deficiency syndrome (AIDS).
- Histoplasma capsulatum endemic areas in the United States are experiencing a rise in PDH cases among immunocompromised individuals.
Purpose of the Study:
- To review bone marrow and peripheral blood findings in patients with AIDS and PDH.
- To evaluate the utility of bone marrow morphology and cultures in diagnosing PDH in AIDS patients.
Main Methods:
- Review of bone marrow and peripheral blood specimens from 13 patients diagnosed with AIDS and PDH.
- Morphological analysis of bone marrow specimens, categorizing findings into four patterns.
- Correlation of morphological findings with peripheral blood results and culture data.
Main Results:
- Anemia, leukopenia, and thrombocytopenia were prevalent (12, 10, and 7 patients, respectively).
- Circulating Histoplasma capsulatum organisms were detected in five patients, associated with nucleated red blood cells and monocytopenia.
- Bone marrow findings varied, including no morphologic evidence of infection, granulomas, lymphohistiocytic aggregates, or diffuse macrophage infiltrates, with culture positivity in 7/13 patients.
Conclusions:
- Bone marrow morphologic examination combined with cultures is valuable for diagnosing disseminated histoplasmosis in patients with AIDS.
- Morphological patterns in the bone marrow of AIDS patients with PDH may differ from non-AIDS patients.
- A high index of suspicion is necessary for diagnosing H. capsulatum infections, even with seemingly nondiagnostic bone marrow findings in this population.