title: Tuberculosis and histoplasmosis among human immunodeficiency virus-infected patients: a comparative study.
abstract: In disease-endemic areas, histoplasmosis is the main differential diagnosis for tuberculosis among human immunodeficiency virus (HIV)-infected patients. However, no study has compared the two diseases. Thus, the objective of this study was to compare tuberculosis and histoplasmosis in HIV-infected patients. A population of 205 HIV-infected patients (99 with tuberculosis and 106 with histoplasmosis) hospitalized in Cayenne, French Guiana during January 1, 1997-December 31, 2008 were selected retrospectively from the French Hospital Database on HIV. Multivariate analysis showed that tuberculosis was associated with cough (adjusted odds ratio [AOR] = 0.20, 95% confidence interval [CI] = 0.05-0.73) and a C-reactive protein level > 70 mg/L (AOR = 0.98, 95% CI = 0.97-0.99). Variables associated with disseminated histoplasmosis were a γ-glutamyl transferase level > 72 IU/L (AOR = 4.99, 95% CI = 1.31-18.99), origin from French Guiana (AOR = 5.20, 95% CI = 1.30-20.73), disseminated localization (AOR = 6.40, 95% CI = 1.44-28.45), a concomitant opportunistic infection (AOR = 6.71, 95% CI = 1.50-29.96), a neutrophil count < 2,750 cells/mm(3) (AOR = 10.54, 95% CI = 2.83-39.24), a CD4 cell count < 60 cells/mm(3) (AOR = 11.62, 95% CI = 2.30-58.63), and a platelet count < 150,000/mm(3) (AOR = 19.20, 95% CI = 3.35-110.14). Tuberculosis and histoplasmosis have similarities, but some factors show a greater association with one of these diseases. Thus, adapted therapeutic choices can be made by using simple clinical and paraclinical criteria.
authors.affiliation: Centre d'Investigation Clinique Epidémiologie Clinique Antilles-Guyane, Service de Dermatologie Vénérologie, et Laboratoire Hospitalo-Universitaire de Parasitologie-Mycologie, Inserm CIE 802, Centre Hospitalier de Cayenne, Cayenne, French Guiana; Equipe EA3593, Epidémiologie des Parasitoses et des Mycoses Tropicales, Université des Antilles et de la Guyane, Cayenne, French Guiana.
authors.forename: Antoine
authors.initials: A
authors.lastname: Adenis
authors.forename: Mathieu
authors.initials: M
authors.lastname: Nacher
authors.forename: Matthieu
authors.initials: M
authors.lastname: Hanf
authors.forename: Célia
authors.initials: C
authors.lastname: Basurko
authors.forename: Julie
authors.initials: J
authors.lastname: Dufour
authors.forename: Florence
authors.initials: F
authors.lastname: Huber
authors.forename: Christine
authors.initials: C
authors.lastname: Aznar
authors.forename: Bernard
authors.initials: B
authors.lastname: Carme
authors.forename: Pierre
authors.initials: P
authors.lastname: Couppie
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology*; D000328:Adult; D002097:C-Reactive Protein; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology*; D006660:Histoplasmosis / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D012189:Retrospective Studies; D014376:Tuberculosis / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology*
chemical_list: D002097:C-Reactive Protein