title: Prospective study of histoplasmosis in patients infected with human immunodeficiency virus: incidence, risk factors, and pathophysiology.
abstract: Histoplasmosis is a common opportunistic infection in patients with human immunodeficiency virus (HIV) infection who reside in areas where Histoplasma capsulatum is endemic. We undertook a prospective study of a cohort of 304 HIV-Infected patients in Kansas City from October 1990 through March 1993 to define the incidence-specific risk factors, and pathophysiology of histoplasmosis. The annual incidence of histoplasmosis was 4.7%; 74% of the patients with histoplasmosis were symptomatic (all of whom had disseminated disease). A history of exposure to chicken coops, a positive baseline serology for complement-fixing antibodies to Histoplasma mycelium antigen, and a baseline CD4+ lymphocyte count of < 150/microL were associated with an increased risk for histoplasmosis. Histoplasmin reactivity and the presence of pulmonary calcifications were not useful markers for patients at high risk. Symptomatic infection occurred in 9.9% of patients with evidence of prior exposure to H. capsulatum, in 4.0% of patients without documented prior exposure, and in 3.0% of patients who were anergic; these findings suggest that the pathophysiology of histoplasmosis in patients with AIDS involves reactivation of latent infection in some cases and dissemination of exogenously acquired infection in other cases.
authors.affiliation: Infectious Disease Associates of Kansas City, University of Missouri-Kansas City School of Medicine, St. Luke's Hospital, USA.
authors.forename: D S
authors.initials: DS
authors.lastname: McKinsey
authors.forename: R A
authors.initials: RA
authors.lastname: Spiegel
authors.forename: L
authors.initials: L
authors.lastname: Hutwagner
authors.forename: J
authors.initials: J
authors.lastname: Stanford
authors.forename: M R
authors.initials: MR
authors.lastname: Driks
authors.forename: J
authors.initials: J
authors.lastname: Brewer
authors.forename: M R
authors.initials: MR
authors.lastname: Gupta
authors.forename: D L
authors.initials: DL
authors.lastname: Smith
authors.forename: M C
authors.initials: MC
authors.lastname: O'Connor
authors.forename: L
authors.initials: L
authors.lastname: Dall
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000188:drug therapy / Q000453:epidemiology / Q000209:etiology*; D018791:CD4 Lymphocyte Count; D005260:Female; D006660:Histoplasmosis / Q000188:drug therapy / Q000453:epidemiology / Q000209:etiology*; D006801:Humans; D015994:Incidence; D008297:Male; D011446:Prospective Studies; D012307:Risk Factors