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Background Hemophagocytic lymphohistiocytosis (HLH) is considered a rare disease with high morbidity and mortality risks. Most research on this disease is conducted in pediatric settings. Therefore, this study aimed to describe the clinical characteristics, laboratory findings, and outcomes related to HLH in people living with human immunodeficiency virus (HIV)/AIDS) and disseminated histoplasmosis. Methods A retrospective and descriptive study was conducted in a tertiary hospital in México City from January 2018 to December 2022, including people living with HIV who had disseminated histoplasmosis confirmed through direct microbiological or immunological methods with an HScore ≥169 or who met 5 of the 8 HLH-2004 criteria. Results HLH occurred in 36.1% (n = 26) of patients with HIV and disseminated histoplasmosis; the majority were men (84.9%), and their mean age (standard deviation) was 30.19 (5.6) years. The most frequent clinical manifestations were hepatomegaly (100%), fever (96.2%), and dyspnea (84.6%). The most common biochemical changes were hyperferritinemia (100%), elevated lactate dehydrogenase (100%), and bicytopenia (61.5%). Partial thromboplastin time (P =.012) and prothrombin time (P =.004) were associated with the 30-day mortality rate, and the 30-day survival rate was 65.4%. Conclusions We detected a high frequency of HLH; therefore, we encourage physicians to use diagnostic prediction tools (HLH-2004 and HScore criteria) in each reassessment for timely detection. [ABSTRACT FROM AUTHOR]

Histoplasmosis presents a substantial clinical challenge globally, with a particular prevalence in South America, especially among patients with concurrent Human Immunodeficiency Virus (HIV) infection. Despite itraconazole's established efficacy, investigating alternative therapeutic approaches remains imperative. This is the largest study in our region to date, assessing the effectiveness of the less explored posaconazole treatment. This observational study, conducted at Fundación Valle del Lili (FVL) from 2016 to 2022, encompassed adults with disseminated histoplasmosis. Patients (n  = 31) were treated with liposomal amphotericin B as an initial treatment, followed by consolidation treatment with posaconazole or itraconazole. Patients with single-organ cases, those lacking microbiological diagnosis, those who received initial treatment with antifungals other than liposomal Amphotericin B and those with < 6 months follow-up were excluded (Figure 1). Analyses considered population characteristics, treatments, and outcomes. Patients (average age: 45.6; 58.1% female) had common comorbidities (HIV 38.7%, solid organ transplantation 29% and oncologic disease 12.9%). Lungs (48.4%) and lymph nodes (16.1%) were commonly affected. Biopsy (64.5%) was the primary diagnostic method. Initial treatment with liposomal amphotericin B (100%) was given for 14 days on average. Follow-up indicated 71% completion with 19.4% requiring treatment modifications. Notably, 70.9% completed a posaconazole consolidation regimen over 350 days on average. Drug interactions during consolidation (80.6%) were common. No relapses occurred, and three deaths unrelated to histoplasmosis were reported. Traditionally, itraconazole has been the prevalent initial treatment; however, in our cohort, 55.9% of patients received posaconazole as the primary option. Encouragingly, posaconazole showed favorable tolerance and infection resolution, suggesting its potential as an effective and well-tolerated alternative for consolidation treatment. This finding prompts further exploration of posaconazole, potentially leading to more effective patient care and better outcomes. [ABSTRACT FROM AUTHOR]

Postmortem studies show gastrointestinal tract involvement in as many as 70% of patients affected by disseminated histoplasmosis. Although gastrointestinal involvement is common in disseminated disease, the presentation of small intestinal perforation is exceedingly rare with few reported cases in the literature. Herein we present our institutional case series. The aim of the study is to describe small intestinal perforation in gastrointestinal histoplasmosis with attention to management and outcomes. This is a retrospective single-institution review of patients ≥ 18 years of age treated for small intestinal perforation due to gastrointestinal histoplasmosis. A prospectively maintained institutional database was searched from 2002 to 2022. Data obtained included demographics, comorbidities, treatment course, and outcomes. Five patients with a mean age of 54 years (range 25–72) were identified. Pertinent underlying comorbid conditions included Crohn's disease, psoriatic arthritis, rheumatoid arthritis, and solid organ transplantation. All patients were on chronic immunosuppressive medication(s) with the most common being tumor necrosis factors alpha inhibitors and corticosteroids. Four had a clinical diagnosis of perforation based on physical examination and imaging. All patients underwent segmental resection(s) of the small intestine and received medical treatment with intravenous amphotericin B and eventual transition to an oral antifungal. No patients experienced complications related to surgery. The limitations of the study include nonrandomized retrospective review, single-institution experience, and small patient sample size. Although rare, histoplasmosis should be considered in the differential of patients on chronic immunosuppressive therapy who present with gastrointestinal symptoms concerning perforation, especially from endemic areas. Small intestinal perforation due to gastrointestinal histoplasmosis can be successfully treated with resection and antifungal therapy. [ABSTRACT FROM AUTHOR]

Disseminated histoplasmosis is the form of a mycosis caused by the fungus Histoplasma capsulatum that mainly occurs in immunosuppressed hosts, usually with non-specific symptoms. In non-endemic areas, where the disease is rarely involved in the differential diagnosis, a delay in treatment may lead to severe medical complications. Due to the rising prevalence of disseminated histoplasmosis in these areas, a thorough medical history is regarded as the decisive factor in prompt diagnosis of the disease.We, herein, report the case of an immunocompetent Greek farmer with disseminated histoplasmosis whose condition was initially misdiagnosed, and the consequential inadequate treatment led to his death.

A 19-year-old non-diabetic, non-HIV male presented with eighteen months of fever, weight loss, skin rash and lymphadenopathy. He was treated with anti-tubercular medication for more than twelve months in multiple institutions based on repeated biopsy reports of lymph nodes showing granuloma suggestive of tuberculosis. Before he was diagnosed at Bangabandhu Sheikh Mujib Medical University (BSMMU) with disseminated histoplasmosis at eighteen months of his disease, he already lost twenty kg weight, developed multiple small joint pain, back pain, and cough along with previously mentioned symptoms. Extensive investigations at BSMMU revealed biopsy material from multiple sites showed noncaseating granulomas with Periodic acid-Schiff (PAS) stain positive for budding oval yeast cells, and fungal culture revealed growth of dimorphic fungus suggestive of Histoplasma after three weeks. After treatment with intravenous liposomal amphotericin B with continuous itraconazole, the patient's fever completely subsided, his well-being improved, joint pain reduced, started to gain weight, and skin lesions started to heal. This case serves as a significant reminder that it is imperative to consider alternative diagnoses in patients who fail to show improvement with conventional antitubercular treatment.

Lei Qiang,1 Xianghui Deng,1 Yong Yang,1 Zhigan Wang,2 Wei Gai3 1Department of Critical Care Medicine, The Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China, Changsha, People’s Republic of China; 2Department of Pathology, The Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China, Changsha, People’s Republic of China; 3WillingMed Technology (Beijing) Co., Ltd, Beijing, People’s Republic of ChinaCorrespondence: Xianghui Deng, Department of Critical Care Medicine, The Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China, Changsha, People’s Republic of China, Email dengxianghui1@zsszxyy2.wecom.workAbstract: Histoplasmosis is an endemic disease caused by Histoplasma capsulatum. This systemic disease can affect various organs beyond the lungs, such as the liver, spleen, adrenal gland, and lymph nodes. The clinical symptoms can range from asymptomatic to severe, life-threatening conditions, depending on the state of the patient’s immune system. This report describes a 40-year-old male who presented with reports of weight loss, low back pain, and progressively worsening movement disorder of the bilateral lower extremities for months. Computed tomography (CT) examination showed multiple lytic lesions of vertebral bodies, bilateral ribs, and pelvic bone, histopathological examination and tumor-related serum markers exclude tumors. mNGS was employed to identify H. capsulatum var. capsulatum as the etiological agent of the lesions in the bone biopsy. Through phylogenetic tree analysis, Histoplasma capsulatum var. Capsulatum (Hcc) was the main responsible pathogen, rarely reported in bone lesions. The patient underwent spinal surgery and was successfully treated with liposomal amphotericin B and itraconazole. Based on the diagnosis and treatment of this case, we discuss the epidemiologic status, clinical presentations, diagnostic criteria, and treatment guidelines of histoplasmosis to provide additional information about this disease. mNGS is utilized in this case, and it appears to be a reliable method for early and accurate diagnosis of this disease.Keywords: metagenomic next generation sequencing, disseminated histoplasmosis, multifocal osteolytic lesions, diagnosis, Histoplasma capsulatum var. capsulatum

Abstract Histoplasmosis is a fungal infection most frequently seen in immunocompromised patients. It is endemic in Central and South America and in Africa. The infection is usually asymptomatic in a healthy individual. Extrapulmonary dissemination can be seen in immunocompromised hosts. Gastrointestinal manifestations frequently involve the terminal ileum and cecum, mimicking Crohn’s disease or malignancy. We describe the case of a 36-year-old healthy man from Cameroon, living in Switzerland for 13 years and without any medical nor surgical history, who presented peritonitis not responding to antibiotics. CT-scan showed bowel obstruction and signs of peritonitis. We opted for an explorative laparoscopy, which was converted to laparotomy with extensive adhesiolysis. Diagnostic of histoplasmosis was confirmed by histology and PCR analysis on biopsy. To our knowledge, this is the first described case of peritonitis as main outcome of a disseminated histoplasmosis involving the peritoneum in an immunocompetent patient.

Background: Histoplasmosis is a fungus disease caused by a dimorphic organism called Histoplasma capsulatum, it is endemic in United States, Asia, and Africa. Inoculation is through inhalation of infectious spores. Histoplasmosis is missed in diagnosis because it mimics tuberculosis in clinical presentations and not all patients suffering from tuberculosis are tuberculosis patients. The aim is to determine the prevalence of disseminated histoplasmosis among patients with pulmonary infections. Method: This is cross sectional and hospital based. Samples were collected from patients and questionnaires were administered. Three hundred and twenty-two (322) urine samples were aseptically collected in urine tubes and analyzed by enzyme linked immunosorbent assay to detect the presence of galactomannan in the urine samples. Results: Out of 322 samples analyzed, 12 (3.74 %) were positive for the presence of galactomannan while 310 (96.27 %) were negative. Participants of the geriatric age group had the highest prevalence of 12.5 %. Male 8.07 % were more prone to histoplasmosis disease than their female 3.10 % counterpart. The married displayed a high prevalence value of 6.25 % than singles 2.25 % and the divorced 3.57 % and framer were demonstrated a high value of 7.69 % prevalence. Among the risk factors trader had an odd ratio of 3.800 and chest discomfort 1.037 % is a disease symptom associated with histoplasmosis. Conclusion: Disseminated histoplasmosis occur among the study participants through low in prevalence, awareness of its presence should be known to the general public and clinician, diagnosis of histoplasmosis is be done along that of Tuberculosis because it can be co-infection with Tuberculosis for proper treatment regime.

Histoplasmosis is a fungal infection most frequently seen in immunocompromised patients. It is endemic in Central and South America and in Africa. The infection is usually asymptomatic in a healthy individual. Extrapulmonary dissemination can be seen in immunocompromised hosts. Gastrointestinal manifestations frequently involve the terminal ileum and cecum, mimicking Crohn's disease or malignancy. We describe the case of a 36-year-old healthy man from Cameroon, living in Switzerland for 13 years and without any medical nor surgical history, who presented peritonitis not responding to antibiotics. CT-scan showed bowel obstruction and signs of peritonitis. We opted for an explorative laparoscopy, which was converted to laparotomy with extensive adhesiolysis. Diagnostic of histoplasmosis was confirmed by histology and PCR analysis on biopsy. To our knowledge, this is the first described case of peritonitis as main outcome of a disseminated histoplasmosis involving the peritoneum in an immunocompetent patient. [ABSTRACT FROM AUTHOR]

Background: Histoplasmosis is a fungus disease caused by a dimorphic organism called Histoplasma capsulatum, it is endemic in United States, Asia, and Africa. Inoculation is through inhalation of infectious spores. Histoplasmosis is missed in diagnosis because it mimics tuberculosis in clinical presentations and not all patients suffering from tuberculosis are tuberculosis patients. The aim is to determine the prevalence of disseminated histoplasmosis among patients with pulmonary infections. Method: This is cross sectional and hospital based. Samples were collected from patients and questionnaires were administered. Three hundred and twenty-two (322) urine samples were aseptically collected in urine tubes and analyzed by enzyme linked immunosorbent assay to detect the presence of galactomannan in the urine samples. Results: Out of 322 samples analyzed, 12 (3.74 %) were positive for the presence of galactomannan while 310 (96.27 %) were negative. Participants of the geriatric age group had the highest prevalence of 12.5 %. Male 8.07 % were more prone to histoplasmosis disease than their female 3.10 % counterpart. The married displayed a high prevalence value of 6.25 % than singles 2.25 % and the divorced 3.57 % and framer were demonstrated a high value of 7.69 % prevalence. Among the risk factors trader had an odd ratio of 3.800 and chest discomfort 1.037 % is a disease symptom associated with histoplasmosis. Conclusion: Disseminated histoplasmosis occur among the study participants through low in prevalence, awareness of its presence should be known to the general public and clinician, diagnosis of histoplasmosis is be done along that of Tuberculosis because it can be co-infection with Tuberculosis for proper treatment regime. [ABSTRACT FROM AUTHOR]

Histoplasmosis is a granulomatous infection caused by dimorphic fungus-Histoplasma capsulatum. Ocular involvement is mainly in the form of retinal or choroidal involvement as presumed ocular histoplasmosis mostly in immunocompromised patients. Conjunctival, scleral, and adnexal involvement is rarely reported. We report a case of disseminated histoplasmosis with conjunctival lesion as the initial clinical manifestation clinching the diagnosis. [ABSTRACT FROM AUTHOR]

Background: Patients with advanced HIV can present with multiple life-threatening pathologies. Disseminated histoplasmosis is an underdiagnosed infection in advanced HIV which can lead to haemophagocytic lymphohistiocytosis (HLH). Case report: A 36-year-old woman originally from Nigeria was admitted with a two-month history of weight loss, fevers and a papular rash. She was diagnosed with advanced HIV with a CD4 count of 5 cells/mm3 and was pancytopaenic. She spiked fevers despite broad-spectrum antimicrobial therapy. Elevated ferritin and triglycerides levels with haemophagocytosis on bone marrow biopsy indicated HLH; she was treated with immunosuppressive therapy. Mycobacterial blood cultures grew Mycobacterium avium-intracellulare (MAI). She also had an Abiotrophia defectiva bacteraemia, Staphylococcus epidermidis line infection and cytomegalovirus viraemia. Despite treatment of her conditions, the patient deteriorated requiring ICU admission. Blood cultures eventually grew Histoplasma capsulatum. Biopsy of the rash showed fungal elements. She was treated for disseminated histoplasmosis (DH) with antifungals and improved. Discussion: Management of patients with advanced HIV who have multiple pathologies and numerous drug therapies relies on effective multi-disciplinary team involvement. Despite early diagnosis of advanced HIV and early consideration for HLH, there was a significant delay in diagnosis of DH, a condition with a high mortality. This delay was due to factors including the initial attribution of pancytopaenia and fever to HLH and MAI infection instead of DH, as well as the slow growth of H. capsulatum in cultures and lack of alternative diagnostics. Conclusion: Awareness of DH as a cause of HLH in the context of advanced HIV is crucial. Early diagnosis and treatment of both HLH and DH in the context of advanced HIV is associated with improved survival.

Haemophagocytic lymphohistiocytosis secondary to Histoplasma infection is rare and almost always occurs in immunocompromised hosts. We report a 32-year-old immunocompetent man presenting with a nonspecific febrile illness found to have disseminated histoplasmosis and associated haemophagocytic lymphohistiocytosis. The diagnosis was confirmed on histopathological examination and PCR of liver and bone marrow biopsies. He was successfully treated with steroids, intravenous immunoglobulin and itraconazole.

Histoplasmosis is the most common endemic fungal infection in the USA. The majority of cases are asymptomatic and have clear exposure to endemic regions. In contrast, we present an adolescent immunocompromised patient with systemic and relatively non-specific symptoms including abdominal pain, weight loss, lower extremity edema, and scabbing skin lesions, without known exposure to endemic areas for histoplasmosis. Histologic analysis of gastrointestinal and skin biopsies eventually revealed a diagnosis of disseminated histoplasmosis; the patient was successfully treated with amphotericin B followed by itraconazole maintenance therapy. Ultimately, a high bar of suspicion for fungal disease must be maintained in immunosuppressed individuals even without apparent exposure history to endemic areas. This case report serves as a valuable reference for practitioners evaluating differential diagnosis of infections in immunocompromised patients.

Harsimrandeep Bhatti, Enkhbileg Batbileg, Srijisnu De, Glen Friedman, Suresh Antony Department of Internal Medicine, Las Palmas Del Sol Medical Center, El Paso, TX, USACorrespondence: Harsimrandeep Bhatti, Department of Internal Medicine, Las Palmas Del Sol Medical Center, 10175 Gateway W. Suite 100, El Paso, TX, 79925, USA, Tel +1 915-539-4346, Email Harsimrandeep.Bhatti@hcahealthcare.comAbstract: Histoplasma capsulatum is an opportunistic pathogen which can lead to a wide variety of clinical presentations in the immunocompromised host. Post-transplant histoplasmosis in hematopoietic cell transplant recipients is exceedingly rare, with an incidence of < 1%. We present a case of acute caecal perforation resulting from disseminated histoplasmosis in a patient who had undergone autologous bone marrow transplant for plasma cell dyscrasia. This is a 71-year-old patient who initially presented due to progressive weakness associated with shortness of breath.Keywords: infectious disease, bone marrow transplant, pancytopenia, disseminated histoplasmosis, colonic perforation, surgery

Histoplasma vascular graft infection (VGI) is rarely reported, with only a handful of instances documented in the existing literature. Reporting Histoplasma VGI cases is important as they demonstrate previous treatment strategies and their outcomes. In this paper, we report a case of disseminated histoplasmosis with ascending aortic graft infection. Conservative therapy was attempted initially but failed, and our patient eventually required surgical graft explantation. Our case demonstrates the challenges in diagnosing and managing VGI caused by Histoplasma capsulatum.

Abstract Disseminated histoplasmosis is a rare complication of infection due to Histoplasma capsulatum. Typically, histoplasmosis is self‐limiting and asymptomatic in infected individuals with immunocompetence. Disseminated disease, however, can arise in high‐risk populations with primary or acquired cellular immunodeficiency including HIV/AIDS, transplant recipients, and those undergoing immunosuppressive therapy. Here we describe a unique case of extrapulmonary gastrointestinal histoplasmosis by infiltrative Peyer's patch disease with bone marrow involvement in a transgender HIV‐infected woman.

Background Histoplasmosis is a major AIDS-defining illness in Latin America. Liposomal amphotericin B (L-AmB) is the drug of choice for treatment, but access is restricted due to the high drug and hospitalization costs of the conventional long regimens. Methods Prospective randomized multicenter open-label trial of 1- or 2-dose induction therapy with L-AmB versus control for disseminated histoplasmosis in AIDS, followed by oral itraconazole therapy. We randomized subjects to: (i) single dose 10 mg/kg of L-AmB; (ii) 10 mg/kg of L-AmB on D1, and 5 mg/kg of L-AmB on D3; (iii) 3 mg/kg of L-AmB daily for 2 weeks (control). The primary outcome was clinical response (resolution of fever and signs/symptoms attributable to histoplasmosis) at day 14. Results A total of 118 subjects were randomized, and median CD4+ counts, and clinical presentations were similar between arms. Infusion-related toxicity, kidney toxicity at multiple time-points, and frequency of anemia, hypokalemia, hypomagnesemia, and liver toxicity were similar. Day 14 clinical response was 84% for single-dose L-AmB, 69% 2-dose L-AmB, and 74% for control arm (P =.69). Overall survival on D14 was 89.0% (34/38) for single-dose L-AmB, 78.0% (29/37) for 2-dose L-AmB, and 92.1% (35/38) for control arm (P =.82). Conclusions One day induction therapy with 10 mg/kg of L-AmB in AIDS-related histoplasmosis was safe. Although clinical response may be non-inferior to standard L-AmB therapy, a confirmatory phase III clinical trial is needed. A single induction dose would markedly reduce drug-acquisition costs (>4-fold) and markedly shorten and simplify treatment, which are key points in terms of increased access. [ABSTRACT FROM AUTHOR]

The globe has not yet recovered from Coronavirus disease 2019 (COVID-19). The infection with the virus and its treatment can lead to a state of immunological aberration predisposing to many infections. Here we present this patient who was treated with steroids during COVID but later developed mucocutaneous nodular lesions and arthritis. This was initially treated as an autoimmune disease which was eventually diagnosed to be systemic histoplasmosis. There are few case reports on post-COVID histoplasmosis in HIV patients. However, there is a paucity of literature on non-HIV patients. We report this case as the treating physician and rheumatologist must be cognizant of the atypical infections which can mimic an autoimmune disease. As management differs in both, awareness can avoid morbidity for the patient. [ABSTRACT FROM AUTHOR]

Histoplasmosis is caused by Histoplasma capsulatum and, although endemic in large parts of the world, is often underrecognized in many locations. In addition to underrecognition, inadequate availability of diagnostic tests is a major contributor to poor outcomes in disseminated disease in people with HIV. For those with advanced HIV and disseminated disease, antibody testing is less useful. Culture and histopathology can be useful in this situation, but each has limitations, including variable sensitivity by site and, in the case of culture, the need for a biosafety level three laboratory and a long period of growth. Antigen testing has proven useful for disseminated histoplasmosis due to the excellent sensitivity of urine. Yet, turnaround is slower than ideal due to use in a limited number of centers. The development of lateral flow assays has the potential to make for true rapid point-of-care assays for histoplasmosis, but in order to meet that promise, the tests must be widely available and affordable. [ABSTRACT FROM AUTHOR]

Disseminated histoplasmosis (DH) is the most severe clinical presentation of histoplasmosis, commonly associated with the advanced HIV disease (AHD) population. Our case report highlights the need for the deployment of point of care test kits for the diagnosis of histoplasmosis in resource limited settings including Africa and Nigeria in particular. Our case is a 56-year-old HIV positive (CD4 count of < 200 cells/microliter) Nigerian woman with complaints of cough, weight loss and easy fatigability all of several month’s duration, who had self-interrupted her care prior to the onset of presenting complaints. The anti-TB regimen was commenced based on chest CT and chest X-ray findings despite negative GeneXpert results while awaiting urine Histoplasma antigen assay results. A positive Histoplasma antigen assay was communicated to the attending clinician 2 weeks after patient’s demise. Delays in the diagnosis of disseminated histoplasmosis in our locality is a major factor contributing to fatal outcomes. The availability of point of care kits for the detection of Histoplasma in our facilities will aid in prompt diagnosis and invariably avert preventable deaths.

Disseminated histoplasmosis is a rare complication of infection due to Histoplasma capsulatum. Typically, histoplasmosis is self‐limiting and asymptomatic in infected individuals with immunocompetence. Disseminated disease, however, can arise in high‐risk populations with primary or acquired cellular immunodeficiency including HIV/AIDS, transplant recipients, and those undergoing immunosuppressive therapy. Here we describe a unique case of extrapulmonary gastrointestinal histoplasmosis by infiltrative Peyer's patch disease with bone marrow involvement in a transgender HIV‐infected woman. [ABSTRACT FROM AUTHOR]

Copyright of Revista Médica de Rosario is the property of Circulo Medico de Rosario and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The globe has not yet recovered from Coronavirus disease 2019 (COVID-19). The infection with the virus and its treatment can lead to a state of immunological aberration predisposing to many infections. Here we present this patient who was treated with steroids during COVID but later developed mucocutaneous nodular lesions and arthritis. This was initially treated as an autoimmune disease which was eventually diagnosed to be systemic histoplasmosis. There are few case reports on post-COVID histoplasmosis in HIV patients. However, there is a paucity of literature on non-HIV patients. We report this case as the treating physician and rheumatologist must be cognizant of the atypical infections which can mimic an autoimmune disease. As management differs in both, awareness can avoid morbidity for the patient.

Opportunistic infections, including progressive disseminated histoplasmosis (PDH), may have variable and surprising presentations in patients with AIDS. This can be either a primary infection or reactivation of a latent infection. Latent infections may occur due to being unmasked by the immune reconstitution inflammatory syndrome after the initiation of combined antiretroviral therapy. PDH can be difficult to diagnose in patients with AIDS due to its variable presentation and many overlapping symptoms with other opportunistic infections. Serum and urine antigen testing are highly sensitive and typically used as the initial diagnostic test to workup suspected PDH. However, negative antigen and antibody tests do not rule out Histoplasmosis capsulatum infection and suspicion should remain high for PDH in the right clinical context. A definitive diagnosis may require biopsy-proven narrow-based budding yeast. We present an interesting patient with AIDS who presented with worsening cognitive decline and was ultimately diagnosed with PDH based on biopsy histopathology in the setting of negative antigen and antibody testing.

A 66-year-old man presented with asymptomatic right testicular swelling. He was known to be infected with HIV and was non-adherent to treatment. He was recently treated for nasal leishmaniasis. Surgical drainage was performed and eventually, an orchiectomy was required. A post-mortem diagnosis was made of disseminated histoplasmosis. Testicular infection due to H. capsulatum is rare, with only a few cases being reported. Here we present a case of testicular histoplasmosis, followed by a literature review.

Neng Wang,&ast; Conglin Zhao,&ast; Congchen Tang, Lichun Wang Center of Infectious Diseases, West China Hospital, Sichuan University, Chengdu, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Lichun Wang, Center of Infectious Diseases, West China Hospital of Sichuan University, 37 Guoxue Lane, Chengdu, 610041, People’s Republic of China, Tel +86 288 542 2859, Fax +86 288 542 3052, Email mindywang0218@163.comBackground: Histoplasmosis is a deep fungal infection caused by Histoplasma capsulatum and can be classified as pulmonary, disseminated or central. Disseminated histoplasmosis is the most dangerous of all clinical types and is characterized by rapid onset, rapid progression, high mortality, and difficulty in diagnosis and treatment.Case Presentation: This report describes a 31-year-old female who presented with fever, with a maximum temperature of 39.8 °C. There were no concomitant symptoms, such as cough, sputum, abdominal pain and diarrhoea, before the onset of fever, and the illness lasted for more than 20 days. On examination, the liver and spleen were enlarged, and laboratory tests showed a significant decrease in CD4 cell count, suggesting immune deficiency. Broad-spectrum antibiotic treatment was ineffective, and specific infectious diseases and haematological neoplasms were considered likely. She was finally diagnosed with disseminated histoplasmosis after undergoing bone marrow aspiration and metagenomic next-generation sequencing (mNGS) and was treated with amphotericin B, fluorouracil and itraconazole, with good results.Conclusion: This case demonstrates that disseminated histoplasmosis infection can present with unexplained fever and that mNGS can be an important complement to bone marrow aspiration for the diagnosis of this disease.Keywords: disseminated histoplasmosis, immune deficiency, metagenomic next-generation sequencing, amphotericin B, case report

Background: Since 2020 the World Health Organization (WHO) recommends Histoplasma antigen detection for the diagnosis of disseminated histoplasmosis (DH) in people living with HIV (PLHIV). Objective: Here we aimed to optimise the IMMY's Clarus® Histoplasma GM enzyme immunoassay (EIA), evaluating the best cut‐off in the semi‐quantitative (SQ‐HGM EIA), also known as 'calibrator cut‐off procedure'. Methods: The optimization was done using the quantitative standard procedure (Q‐HGM EIA), also known as 'standard curve procedure', as reference test. A retrospective study from an endemic area of DH in southern Brazil was carried out including 264 patients investigated for DH using the test. Receiver Operator Characteristic curve was plotted, and sensitivity and specificity of the SQ‐HGM EIA were calculated. Results: The study included 24 positive (values ≥ 0.20 ng/ml) and 240 negative patients by the Q‐HGM EIA. According to the manufacturer SQ‐HGM EIA protocol, the new SQ‐HGM EIA cut‐off of 0.8 EIA units was validated, resulting in sensitivity and specificity of 88% and 98.7%, respectively. Conclusion: Our study pioneers and brings important data about the optimization of the Histoplasma antigen testing for the diagnosis of DH in a population from Southern Brazil. This optimization also reduced the amount of reagents used, lowering the cost associated with testing. [ABSTRACT FROM AUTHOR]

Copyright of Revista Foco (Interdisciplinary Studies Journal) is the property of Revista Foco and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Purpose of Review: The diagnosis of disseminated histoplasmosis remains a challenge particularly in developing countries chiefly due to the low number of required skilled personnel and poor accessibility to diagnostic tools. While culture remains the gold standard in the diagnosis of disseminated histoplasmosis, it requires a period of 1 to 6 weeks of incubation to achieve growth, thus delaying the initiation of treatment. Histoplasma antigen detection is an alternative diagnostic method but has not gained routine utility in resource-limited settings probably due to high cost. Molecular techniques have also been shown to have high sensitivity in the diagnosis of disseminated histoplasmosis but they are very expensive and not easily affordable. Besides the above techniques, Histoplasma can also be detected on peripheral blood film but this is not routinely utilized in the diagnosis of disseminated histoplasmosis. The purpose of this review is to demonstrate the use of peripheral blood film or blood smear as a diagnostic tool for disseminated histoplasmosis in resource-limited settings where classical diagnostic methods are not readily available. Recent Findings: We highlight fifty-eight case reports of disseminated histoplasmosis diagnosed on peripheral blood film. Of the 58, 53 (91.4%) were confirmed by classical diagnostic methods, 62.3% (33/53) by culture, 56.6% (30/53) by histopathology, 32.1% (17/53) by serology, 13.2% (7/53) by molecular detection and 3.8% (2/53) by cytology. Summary: Blood smears should be done in every patient being evaluated for disseminated histoplasmosis. It is yet an important tool for the diagnosis of disseminated histoplasmosis and is affordable. Comparative studies elucidating the performance of peripheral blood film in the diagnosis of disseminated histoplasmosis against a culture standard should be carried out. [ABSTRACT FROM AUTHOR]

Abstract The Ohio and Mississippi River Valleys are endemic to histoplasmosis. It is usually self‐limiting in immunocompetent people, but it can cause morbidity and mortality if not detected early in people with an underlying autoimmune disease. Disseminated Histoplasmosis induced hemophagocytic lymphohistiocytosis (HLH) mimicking the flare of an underlying autoimmune disease, is uncommon in the published literature. Disseminated histoplasmosis (DH) can cause multiorgan involvement, especially in a patient with an underlying autoimmune disease. We present the case of a 24‐year‐old female with HLH who was initially treated as a flare of autoimmune disease but later etiology was confirmed as disseminated histoplasmosis on bone marrow histopathological examination.

Hemophagocytic lymphohistiocytosis is usually considered a rapidly progressive fatal illness with poor outcomes. It is of two types: primary or familial and secondary. In patients with HIV, opportunistic infections are the secondary triggers of HLH. First line of management of infection associated HLH is treatment of the underlying infection. Here, we present a case of HLH in HIV infection due to disseminated histoplasmosis managed with liposomal amphotericin B, who required immunosuppressive therapy with intravenous immunoglobulin and dexamethasone due to nonresponse to primary therapy.

Histoplasmosis is a systemic mycosis caused by the dimorphic fungus Histoplasma capsulatum, with disseminated histoplasmosis (HD) being one of its clinical forms. As a consequence of the HIV-AIDS pandemic, HD has become prevalent not only in regions that are recognized as endemic but also in areas not considered endemic, such as Europe and Asia. Its clinical manifestations are varied and mimic several infectious diseases, mainly tuberculosis. In endemic areas, it is the first manifestation of AIDS in 50 to 70% of patients. The diagnosis of histoplasmosis is difficult and HD can lead to death if not diagnosed early and if proper treatment is not instituted. The present report presents a patient with a recent diagnosis of HIV-AIDS, in treatment for miliary tuberculosis, who was diagnosed with disseminated histoplasmosis because of his dermatological manifestations.

A 54 year-old man with lymphopenia secondary to lymphatic filariasis was admitted with dry cough, fever and wasting syndrome. He was diagnosed with sarcoidosis and therapy with corticosteroid was initiated. The patient evolved with worsening of the symptoms. Histoplasma species was recovered in lung biopsy tissue, lung tissue culture, and bone marrow aspirate. The authors describe the first case of disseminated histoplasmosis secondary to lymphatic filariasis, followed by a literature review. 2012 Elsevier Ltd. All rights reserved.

Disseminated histoplasmosis is the form of a mycosis caused by the fungus Histoplasma capsulatum that mainly occurs in immunosuppressed hosts, usually with non-specific symptoms. In non-endemic areas, where the disease is rarely involved in the differential diagnosis, a delay in treatment may lead to severe medical complications. Due to the rising prevalence of disseminated histoplasmosis in these areas, a thorough medical history is regarded as the decisive factor in prompt diagnosis of the disease. We, herein, report the case of an immunocompetent Greek farmer with disseminated histoplasmosis whose condition was initially misdiagnosed, and the consequential inadequate treatment led to his death. [ABSTRACT FROM AUTHOR]

A 19-year-old non-diabetic, non-HIV male presented with eighteen months of fever, weight loss, skin rash and lymphadenopathy. He was treated with anti-tubercular medication for more than twelve months in multiple institutions based on repeated biopsy reports of lymph nodes showing granuloma suggestive of tuberculosis. Before he was diagnosed at Bangabandhu Sheikh Mujib Medical University (BSMMU) with disseminated histoplasmosis at eighteen months of his disease, he already lost twenty kg weight, developed multiple small joint pain, back pain, and cough along with previously mentioned symptoms. Extensive investigations at BSMMU revealed biopsy material from multiple sites showed noncaseating granulomas with Periodic acid-Schiff (PAS) stain positive for budding oval yeast cells, and fungal culture revealed growth of dimorphic fungus suggestive of Histoplasma after three weeks. After treatment with intravenous liposomal amphotericin B with continuous itraconazole, the patient's fever completely subsided, his well-being improved, joint pain reduced, started to gain weight, and skin lesions started to heal. This case serves as a significant reminder that it is imperative to consider alternative diagnoses in patients who fail to show improvement with conventional antitubercular treatment. [ABSTRACT FROM AUTHOR]

Introduction: HIV-positive patients are at risk of developing various opportunistic infections, including disseminated histoplasmosis, the incidence of which is 29% in India. Diagnosis is usually delayed as the clinical manifestations are diverse and mimic other common diseases endemic to this region such as tuberculosis and visceral leishmaniasis. This leads to preventable morbidity and mortality. Materials and Methods: We carried out a retrospective data analysis of 1280 HIV positive patients' who were on treatment at our centre between 2016 and 2020., of which 8 cases of confirmed histoplasmosis were identified. The clinicopathological spectrum and outcomes of these patients were analyzed and presented as a case series. Results: The median age of patients was 39.5 years. In six out of eight patients, disseminated histoplasmosis was the initial presentation of HIV. Fever, weight loss, macular-papular skin lesions, bicytopenia, and respiratory system involvement were the most common clinical manifestations. Pulmonary lesions included patchy areas of consolidation, miliary nodules, and pleural effusion. Gastrointestinal symptoms were uncommon. In six out of eight patients, CD4 count was

Histoplasmosis is the most common endemic fungal infection in the USA. The majority of cases are asymptomatic and have clear exposure to endemic regions. In contrast, we present an adolescent immunocompromised patient with systemic and relatively non-specific symptoms including abdominal pain, weight loss, lower extremity edema, and scabbing skin lesions, without known exposure to endemic areas for histoplasmosis. Histologic analysis of gastrointestinal and skin biopsies eventually revealed a diagnosis of disseminated histoplasmosis; the patient was successfully treated with amphotericin B followed by itraconazole maintenance therapy. Ultimately, a high bar of suspicion for fungal disease must be maintained in immunosuppressed individuals even without apparent exposure history to endemic areas. This case report serves as a valuable reference for practitioners evaluating differential diagnosis of infections in immunocompromised patients.

Hemophagocytic lymphohistiocytosis is usually considered a rapidly progressive fatal illness with poor outcomes. It is of two types: primary or familial and secondary. In patients with HIV, opportunistic infections are the secondary triggers of HLH. First line of management of infection associated HLH is treatment of the underlying infection. Here, we present a case of HLH in HIV infection due to disseminated histoplasmosis managed with liposomal amphotericin B, who required immunosuppressive therapy with intravenous immunoglobulin and dexamethasone due to nonresponse to primary therapy. [ABSTRACT FROM AUTHOR]

The Ohio and Mississippi River Valleys are endemic to histoplasmosis. It is usually self‐limiting in immunocompetent people, but it can cause morbidity and mortality if not detected early in people with an underlying autoimmune disease. Disseminated Histoplasmosis induced hemophagocytic lymphohistiocytosis (HLH) mimicking the flare of an underlying autoimmune disease, is uncommon in the published literature. Disseminated histoplasmosis (DH) can cause multiorgan involvement, especially in a patient with an underlying autoimmune disease. We present the case of a 24‐year‐old female with HLH who was initially treated as a flare of autoimmune disease but later etiology was confirmed as disseminated histoplasmosis on bone marrow histopathological examination. [ABSTRACT FROM AUTHOR]

A 66-year-old man presented with asymptomatic right testicular swelling. He was known to be infected with HIV and was non-adherent to treatment. He was recently treated for nasal leishmaniasis. Surgical drainage was performed and eventually, an orchiectomy was required. A post-mortem diagnosis was made of disseminated histoplasmosis. Testicular infection due to H. capsulatum is rare, with only a few cases being reported. Here we present a case of testicular histoplasmosis, followed by a literature review. [ABSTRACT FROM AUTHOR]

Histoplasmosis is the fungal infection caused by Histoplasma capsulatum fungus. It is commonly found in a few endemic areas in the United States, where there is a large number of birds or bats and can spread through their droppings. Disseminated histoplasmosis is a severe manifestation of the fungal infection which is commonly seen in individuals with underlying immunosuppression. Our case is an unusual case of disseminated histoplasmosis in a 60-year-old, immunocompetent male patient with a history of significant alcohol abuse, which led to end stage liver failure. While the patient showed some signs of improvement initially upon beginning the treatment, he ultimately continued to deteriorate despite treatment due to an overwhelming histoplasmosis infection. This case demonstrates the importance of keeping a high index of suspicion even amongst immunocompetent patients with no obvious exposure to risk factors. It also shows that timely diagnosis with a high index of suspicion is required with an integrated treatment approach.

Histoplasmosis is caused by Histoplasma capsulatum and, although endemic in large parts of the world, is often underrecognized in many locations. In addition to underrecognition, inadequate availability of diagnostic tests is a major contributor to poor outcomes in disseminated disease in people with HIV. For those with advanced HIV and disseminated disease, antibody testing is less useful. Culture and histopathology can be useful in this situation, but each has limitations, including variable sensitivity by site and, in the case of culture, the need for a biosafety level three laboratory and a long period of growth. Antigen testing has proven useful for disseminated histoplasmosis due to the excellent sensitivity of urine. Yet, turnaround is slower than ideal due to use in a limited number of centers. The development of lateral flow assays has the potential to make for true rapid point-of-care assays for histoplasmosis, but in order to meet that promise, the tests must be widely available and affordable.

• A biopsy that shows narrow-based budding yeast confirms the diagnosis of Histoplasmosis capsulatum. • Latent infections may trigger a strong immune response after starting combined antiretroviral therapy. • Immune reconstitution inflammatory syndrome is possible with latent H. capsulatum. • Altered mental status is an atypical presentation of disseminated histoplasmosis. Opportunistic infections, including progressive disseminated histoplasmosis (PDH), may have variable and surprising presentations in patients with AIDS. This can be either a primary infection or reactivation of a latent infection. Latent infections may occur due to being unmasked by the immune reconstitution inflammatory syndrome after the initiation of combined antiretroviral therapy. PDH can be difficult to diagnose in patients with AIDS due to its variable presentation and many overlapping symptoms with other opportunistic infections. Serum and urine antigen testing are highly sensitive and typically used as the initial diagnostic test to workup suspected PDH. However, negative antigen and antibody tests do not rule out Histoplasmosis capsulatum infection and suspicion should remain high for PDH in the right clinical context. A definitive diagnosis may require biopsy-proven narrow-based budding yeast. We present an interesting patient with AIDS who presented with worsening cognitive decline and was ultimately diagnosed with PDH based on biopsy histopathology in the setting of negative antigen and antibody testing. [ABSTRACT FROM AUTHOR]

A 54 year-old man with lymphopenia secondary to lymphatic filariasis was admitted with dry cough, fever and wasting syndrome. He was diagnosed with sarcoidosis and therapy with corticosteroid was initiated. The patient evolved with worsening of the symptoms. Histoplasma species was recovered in lung biopsy tissue, lung tissue culture, and bone marrow aspirate. The authors describe the first case of disseminated histoplasmosis secondary to lymphatic filariasis, followed by a literature review. 2012 Elsevier Ltd. All rights reserved. [ABSTRACT FROM AUTHOR]

Objectives: Disseminated histoplasmosis is a major killer of HIV‐infected persons in Latin America. Antigen detection, fungal culture and Polymerase Chain Reaction are often not available, but cytology and histology are present in most hospitals and may offer a diagnostic alternative. In this study, we review 34 years of clinical experience to describe the roles of cytology and histology in diagnosing disseminated histoplasmosis. Methods: Retrospective multicentric study of 349 patients between 1 January 1981 and 1 October 2014 with confirmed disseminated histoplasmosis. Results: Around 32/214 (14.9%) of samples were screened using cytopathology, as were 10/101 (9.9%) bronchoalveolar lavage samples and 5/61 (8.2%) of spinal fluid samples. The samples most commonly sent to pathology were liver biopsies, lower digestive tract and lymphnode biopsies; the greatest proportion of positive results were found in lower digestive tract (43/59 (72.9%) positives), lymph node (39/63 (66.1%)), and liver (38/75 (50.7%)) samples. Overall, 97.2% of bone marrow and 97% of bronchoalveolar lavage samples were directly examined by a mycologist. Positive direct examination was independently associated with death (aHR = 1.5 (95%CI = 1–2.2)). Conclusions: Opportunities for a rapid diagnosis were regularly missed, notably for bone marrow samples, which could have been examined using staining methods complementary to those of the mycologist. [ABSTRACT FROM AUTHOR]