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[Histoplasmosis in AIDS patients without tegumentary manifestations]

Fernando A Messina1, Marcelo Corti2, Ricardo Negroni1

  • 1Unidad de Micología, Hospital de Enfermedades Infecciosas, Buenos Aires, Argentina.

Revista Chilena De Infectologia : Organo Oficial De La Sociedad Chilena De Infectologia
|February 7, 2019
PubMed
Abstract

Insights

Early empiric treatment for AIDS-associated histoplasmosis is crucial for patients with fever, splenomegaly, and miliary lung patterns. Prompt diagnosis and treatment, especially with amphotericin B, can improve outcomes in these high-risk individuals.

Area of Science:

  • Medical Mycology
  • Infectious Diseases
  • Immunocompromised Host Research

Background:

  • Histoplasmosis is a significant fungal infection in Human Immunodeficiency Virus (HIV)/Acquired Immunodeficiency Syndrome (AIDS) patients.
  • Diagnosis can be delayed for weeks, especially without skin lesions.
  • This study focuses on optimizing diagnosis and treatment for this specific patient group.

Purpose of the Study:

  • To define clinical, microbiological, and biochemical features of AIDS-associated histoplasmosis without skin lesions.
  • To establish guidelines for early empiric treatment in difficult diagnostic cases.
  • To reduce mortality associated with delayed diagnosis.

Main Methods:

  • Retrospective review of medical records for 86 histoplasmosis patients.
  • Detailed analysis of 31 patients with AIDS-associated histoplasmosis and no cutaneous lesions.
  • Evaluation of clinical symptoms, imaging, blood cultures, and serology.

Main Results:

  • Fever (96.7%) and lung involvement (70.9%) were most common; miliary pattern seen in 54.5% of lung cases.
  • Splenomegaly occurred in 19 patients.
  • High blood culture sensitivity (93.3%) contrasted with low serology positivity (23.5%).
  • Factors predicting unfavorable outcomes included CD4+ T cell count < 50 cells/μl, low albumin (< 2.5 g/dl), and pancytopenia.
  • Mortality rate was 25.8%.

Conclusions:

  • Empiric amphotericin B treatment should be considered for HIV-seropositive patients with fever, splenomegaly, and bilateral miliary lung patterns, especially if unfavorable outcome indicators are present.
  • Collecting microbiological samples before treatment initiation is vital for accurate diagnosis.
  • Early intervention is critical due to diagnostic delays and high mortality.

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