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.
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