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Review of diagnostic methods and results for HIV-associated disseminated histoplasmosis: Pathologists are not sufficiently involved.
- Source :
-
Tropical medicine & international health : TM & IH [Trop Med Int Health] 2021 Nov; Vol. 26 (11), pp. 1462-1469. Date of Electronic Publication: 2021 Sep 02. - Publication Year :
- 2021
-
Abstract
- 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.<br />Methods: Retrospective multicentric study of 349 patients between 1 January 1981 and 1 October 2014 with confirmed disseminated histoplasmosis.<br />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)).<br />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.<br /> (© 2021 John Wiley & Sons Ltd.)
- Subjects :
- AIDS-Related Opportunistic Infections complications
AIDS-Related Opportunistic Infections diagnosis
Adult
Female
French Guiana epidemiology
Histoplasmosis complications
Histoplasmosis diagnosis
Humans
Male
Retrospective Studies
AIDS-Related Opportunistic Infections epidemiology
Delivery of Health Care
Histoplasmosis epidemiology
Pathologists
Subjects
Details
- Language :
- English
- ISSN :
- 1365-3156
- Volume :
- 26
- Issue :
- 11
- Database :
- MEDLINE
- Journal :
- Tropical medicine & international health : TM & IH
- Publication Type :
- Academic Journal
- Accession number :
- 34310800
- Full Text :
- https://doi.org/10.1111/tmi.13663