AIDS-related Histoplasma capsulatum var. capsulatum infection: 25 years experience of French Guiana.
OBJECTIVE
Histoplasma capsulatum var. capsulatum infection is a major AIDS-defining illness in French Guiana. Although it affects South and Central American countries, the number of published cases is low. We present the largest series of AIDS-related histoplasmosis. The aim of this work is to describe clinical features and to help optimize investigations in settings where antigen detection methods are not available.


METHODS
Two hundred cases of AIDS-related histoplasmosis, diagnosed in the hospitals of French Guiana, were included retrospectively between 1982 and 2007.


RESULTS
At the time of diagnosis, 92% of patients did not receive highly active antiretroviral therapy. CD4 cell count was less than 100 cells/microl for 80% of them. Most patients had fever, lymphadenopathies, and pulmonary and digestive symptoms. Neurological signs and skin/mucosal locations were less common. Other opportunistic infections were associated in 36.6% of cases (mostly tuberculosis). In most of the patients, lactic dehydrogenase was at least four times the normal value, and there was a moderate increase of aspartate aminotransaminase but not alanine aminotransaminase levels. Bone marrow aspirations were useful, but cultures of liver and lymphadenopathy specimens were the most contributive. Following treatment initiation, 17.5% died within a month. Presumptive treatment was started before diagnostic confirmation in 14.3% of the cases.


CONCLUSIONS
In high prevalence settings, histoplasmosis often revealed AIDS in severely immunodeficient and poorly followed patients. In the absence of a quick sensitive technique, skin smear and fungal tissue cultures are contributive. Nevertheless, given the diagnostic delays and the poor prognosis, presumptive treatment with amphotericin B-containing regimens should be recommended when clinical and epidemiological contexts are evocative.
Dermatology Unit, Centre Hospitalier André Rosemon, Avenue des Flamboyants, BP 6006, 97306 Cayenne, French Guiana. flottehuber@yahoo.fr
Florence
F
Huber
Matthieu
M
Nacher
Christine
C
Aznar
Magalie
M
Pierre-Demar
Myriam
M
El Guedj
Tania
T
Vaz
Vincent
V
Vantilcke
Abba
A
Mahamat
Christian
C
Magnien
Elodie
E
Chauvet
Bernard
B
Carme
Pierre
P
Couppié
D017088:AIDS-Related Opportunistic Infections / Q000175:diagnosis* / Q000453:epidemiology; D000328:Adult; D015415:Biomarkers / Q000032:analysis; D005260:Female; D005616:French Guiana / Q000453:epidemiology; D015658:HIV Infections / Q000175:diagnosis* / Q000453:epidemiology; D006658:Histoplasma / Q000302:isolation & purification; D006660:Histoplasmosis / Q000175:diagnosis* / Q000453:epidemiology; D006801:Humans; D008297:Male; D012189:Retrospective Studies
D015415:Biomarkers