Abstract
Disseminated histoplasmosis is a common differential diagnosis of tuberculosis in disease-endemic areas. We aimed to find a predictive score to orient clinicians towards disseminated histoplasmosis or tuberculosis when facing a non-specific infectious syndrome in patients with advanced HIV disease. We reanalyzed data from a retrospective study in Cayenne Hospital between January 1997–December 2008 comparing disseminated histoplasmosis and tuberculosis: 100 confirmed disseminated histoplasmosis cases and 88 confirmed tuberculosis cases were included. A simple logit regression model was constructed to predict whether a case was tuberculosis or disseminated histoplasmosis. From this model, a score may be obtained, where the natural logarithm of the probability of disseminated histoplasmosis/tuberculosis = +3.917962 × WHO performance score (1 if >2, 0 if ≤2) −1.624642 × Pulmonary presentation (1 yes, 0 no) +2.245819 × Adenopathies > 2 cm (1 yes, 0 no) −0.015898 × CD4 count − 0.001851 × ASAT − 0.000871 × Neutrophil count − 0.000018 × Platelet count + 6.053793. The area under the curve was 98.55%. The sensitivity of the model to distinguish between disseminated histoplasmosis and tuberculosis was 95% (95% CI = 88.7–98.3%), and the specificity was 93% (95% CI = 85.7.3–97.4%). In conclusion, we here present a clinical-biological predictive score, using simple variables available on admission, that seemed to perform very well to discriminate disseminated histoplasmosis from tuberculosis in French Guiana in well characterized patients.
Highlights
With an HIV prevalence greater than 1% for over 3 decades, French Guiana is the French territory where the human immunodeficiency virus (HIV) epidemic is most preoccupying [1]
A score may be obtained, where the natural logarithm of the probability of histoplasmosis compared to tuberculosis = +3.917962 × WHO performance score (1 if >2, 0 if ≤2) −1.624642 × pulmonary presentation (1 yes, 0 no) +2.245819 ×
Sensitivity of the model to distinguish between disseminated histoplasmosis and tuberculosis was 95%, and the specificity was 93%
Summary
With an HIV prevalence greater than 1% for over 3 decades, French Guiana is the French territory where the human immunodeficiency virus (HIV) epidemic is most preoccupying [1]. During HIV infection, both histoplasmosis and tuberculosis are often disseminated infections. In persons with advanced HIV, in the absence of treatment, the dissemination of the pathogen may cause a rapid and potentially fatal evolution, often in a context of hemophagocytic lymphohistiocytosis [4,5]. In the absence of rapid diagnostic tests, invasive diagnostic methods are often necessary and presumptive treatment is often given guided by both knowledge of the local epidemiology—the respective incidences of disseminated histoplasmosis and tuberculosis—and clinical judgement [6]. The non-specific nature of the clinical and paraclinical findings for both diseases makes the differential diagnosis between disseminated histoplasmosis and tuberculosis difficult in disease-endemic areas [14]. We have recently mapped estimates for histoplasmosis and tuberculosis incidence and case fatality for Latin America showing that, for a median scenario of
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