[Disseminated histoplasmosis and HIV infection: Case series in a Peruvian hospital]

Area of Science:

• Infectious Diseases
• Mycology
• Public Health

Background:

• Histoplasmosis is endemic in Peru.
• HIV coinfection complicates diagnosis and increases mortality.
• Disseminated histoplasmosis (DH) poses a significant challenge in HIV-positive individuals.

Purpose of the Study:

• To characterize the clinical, epidemiological, and outcome data of patients with HIV and disseminated histoplasmosis.
• To provide insights into the management of this co-infection at a major hospital in Lima, Peru.

Main Methods:

• Retrospective descriptive study.
• Data collected from patient computer registries (1996-2014).
• Analysis of clinical, epidemiological, treatment, and outcome characteristics.

Main Results:

• 27 HIV patients with DH identified; 92.6% were male, mean age 36.7 years.
• 81.5% had an epidemiological contact history; 59.3% presented with DH as an AIDS-defining illness.
• Median CD4 count was 65 cells/mm3; only 25.9% received combination antiretroviral therapy at diagnosis.
• Common symptoms included fever (66.7%), chronic diarrhea (40.7%), and lymphadenopathy (33.3%).
• Diagnosis primarily by histopathology; 22.2% died during the acute phase.
• 25.9% were initially treated empirically for tuberculosis.

Conclusions:

• Disseminated histoplasmosis in HIV-coinfected patients remains a quasi-endemic reality in Peru.
• The study highlights the complex clinical presentation and challenges in managing DH in this population.
• Findings underscore the need for heightened awareness and improved diagnostic and treatment strategies.