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Histoplasmosis and tuberculosis are common AIDS-defining illnesses in the Amazon region. While tuberculosis is well-known and included in public health programs, disseminated histoplasmosis is often neglected in South and Central America. Both diseases can be fatal if left untreated, and diagnosis can be slow. In French Guiana, where HIV is a major public health problem, clinicians often need to consider both diseases when treating severely immunocompromised patients. Longitudinal data from the French Hospital Database on HIV infection in French Guiana showed that histoplasmosis had a higher incidence than tuberculosis, and histoplasmosis-related deaths were more common. Therefore, clinicians may be better off starting treatment with amphotericin B for patients with CD4 counts below 200 and a tuberculosis-like syndrome. [Extracted from the article]

Human immunodeficiency virus (HIV)-associated disseminated Histoplasma capsulatum capsulatum infection often mimics tuberculosis. This disease is well know in the United States but is dramatically underdiagnosed in Central and South America. In the Amazon region, given the available incidence data and the regional HIV prevalence, it is expected that, every year, 1,500 cases of histoplasmosis affect HIV patients in that region alone. Given the mortality in undiagnosed patients, at least 600 patients would be expected to die from an undiagnosed but treatable disease. The lack of a simple diagnostic tool and the lack of awareness by clinicians spiral in a vicious cycle and made a major problem invisible for 30 years. The HIV/acquired immunodeficiency syndrome community should tackle this problem now to prevent numerous avoidable deaths from HIV-associated histoplasmosis in the region and elsewhere.