title: Histoplasmosis among human immunodeficiency virus-infected people in Europe: report of 4 cases and review of the literature.
abstract: We reviewed the clinical, microbiologic, and outcome characteristics of 72 patients with human immunodeficiency virus (HIV)-associated histoplasmosis (4 newly described) reported in Europe over 20 years (1984-2004). Seven cases (9.7%) were acquired in Europe (autochthonous), whereas the majority involved a history of travel or arrival from endemic areas. The diagnosis of progressive disseminated histoplasmosis (PDH) was made during life in 63 patients (87.5%) and was the acquired immunodeficiency syndrome (AIDS)-presenting illness in 44 (61.1%). Disease was widespread in 66 patients (91.7%) and localized in 6 (8.3%), with the skin being the most frequent site of localized infection. Overall skin involvement was reported in 47.2% of the patients regardless of whether histoplasmosis was acquired in Africa or South America. Reticulonodular or diffuse interstial infiltrates occurred in 52.8%. The diagnosis was made during life by histopathology plus culture in 44 patients (69.8%), histopathology alone in 18 (28.5%), and culture alone in 1 (1.5%). During the induction phase amphotericin B and itraconazole (74.6%) were the single most frequently used drugs. Both drugs were also used either in combination (10.2%) or in sequential therapy (11.8%). Cumulative mortality rate during the induction phase of treatment was 15.2%. Overall, 37 patients died (57.8%); death occurred early in the course in 18 (28.1%). Seven of 40 patients (17.5%) who responded to therapy subsequently relapsed. Autopsy data in 13 patients confirmed the widespread disseminated nature of histoplasmosis (85%) among AIDS patients with a median of 4.5 organs involved. The results of the present report highlight the need to consider the diagnosis of PDH among patients with AIDS in Europe presenting with a febrile illness who have traveled to or who originated from an endemic area.
authors.affiliation: From Department of Clinical Sciences, Section of Infectious and Tropical Diseases (SA, MC, SS, LG, ALR), University of Milan, Milan; Institute of Pathology (MN, CP), and I Infectious Diseases Unit (CM), Luigi Sacco Hospital, Milan, Italy; and MiraVista Diagnostics (LJW), Indianapolis, Indiana, United States.
authors.forename: Spinello
authors.initials: S
authors.lastname: Antinori
authors.forename: Carlo
authors.initials: C
authors.lastname: Magni
authors.forename: Manuela
authors.initials: M
authors.lastname: Nebuloni
authors.forename: Carlo
authors.initials: C
authors.lastname: Parravicini
authors.forename: Mario
authors.initials: M
authors.lastname: Corbellino
authors.forename: Salvatore
authors.initials: S
authors.lastname: Sollima
authors.forename: Laura
authors.initials: L
authors.lastname: Galimberti
authors.forename: Anna Lisa
authors.initials: AL
authors.lastname: Ridolfo
authors.forename: L Joseph
authors.initials: LJ
authors.lastname: Wheat
mesh_terms: D000328:Adult; D000935:Antifungal Agents / Q000627:therapeutic use; D003937:Diagnosis, Differential; D005060:Europe; D017809:Fatal Outcome; D005260:Female; D015658:HIV Infections / Q000150:complications*; D006660:Histoplasmosis / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology* / Q000473:pathology* / Q000821:virology; D006801:Humans; D008297:Male; D011379:Prognosis
chemical_list: D000935:Antifungal Agents