HIV-associated disseminated histoplasmosis in western French Guiana, 2002-2012

Disseminated histoplasmosis (DH) is the most current revelation mode of AIDS in French Guiana. We describe the clinical and paraclinical presentation of DH, diagnostic tools, evolution and factors associated with 1-year mortality in HIV-infected patients from western French Guiana. Microbiologically proven AIDS-related DH in Saint Laurent du Maroni's hospital between May 2002 and May 2012 were retrospectively included. Among the 82 patients included, 58 (71%) were male, 44 (53%) presented concurrent histoplasmosis and HIV diagnosis and 63 (80%) had a CD4 cell count under 50 cells μL(-1). Almost all patients had weight loss (97%) and fever (95%), while 84% had digestive symptoms (63% diarrhoea), 55% lymphadenopathy, and 49% respiratory symptoms. Documented and presumed locations of H. capsulatum var capsulatum (Hcc) concerned almost all organs, with a particular affinity for the bone marrow and the digestive system. Co-infections were associated in 65%. Following treatment initiation, 10 patients (13%) died within 1 month and 17 patients (25%) died within a year. DH is a polymorphous systemic mycosis with haematological and digestive tropism. Co-infections are frequent and mortality rate is high.