Abstract
Introduction: Histoplasmosis is the main opportunistic infection and cause of death in HIV-infected persons living with HIV in French Guiana and probably in most of Latin America. The objective of the present study was to compare cutaneomucous histoplasmosis to non-cutaneomucous histoplasmosis in French Guiana. Methods: Between 1981 and 2014 AIDS-related disseminated histoplasmosis patients followed in the three hospitals of French Guiana were retrospectively studied. Only proven incident cases of histoplasmosis, either by pathology and/or mycological analysis, were considered. Mucocutaneous histoplasmosis was ascertained by a positive mucosal or cutaneous biopsy. Results: Thirty-one patients had mucocutaneous lesions, and 318 had no mucocutaneous lesions. Patients with cutaneomucous lesions were more likely to have had prior opportunistic infections (35.5%) than those who did not have cutaneomucous lesions (19.5%). They were more likely to be very severely immunocompromised (CD4 count < 50) (90.3% versus 62.8%) and less likely to have digestive signs (32.3% versus 74.1%) and superficial adenopathies (29% versus 50.2%) than those without cutaneomucous lesions. In terms of simple biological examinations, patients with cutaneomucous lesions had fewer signs of cholestasis. The diagnosis was significantly more likely to be performed by direct examination and pathology in those with cutaneomucous lesions than in those without such lesions. On the contrary, patients with cutaneomucous lesions were less likely to be diagnosed by fungal culture than those without cutaneomucous lesions. There was a greater but non-significant risk of early death in those with cutaneomucous lesions relative to those without (OR = 2.28 (95%CI = 0.83–5.7), p = 0.056. Conclusions: Mucocutaneous forms were associated with more profound immunosuppression and perhaps risk of early death. They are easily accessible for diagnosis.
Highlights
Histoplasmosis is the main opportunistic infection and cause of death in HIV-infected persons living with HIV in French Guiana [1,2]
Of the 31 cases of cutaneo-mucous histoplasmosis observed during the study period, 15 were skin lesions, 13 were mucosal lesions and three simultaneously had cutaneous and mucous lesions
The present study shows the differences between patients with disseminated histoplasmosis with and without cutaneomucous lesions
Summary
Histoplasmosis is the main opportunistic infection and cause of death in HIV-infected persons living with HIV in French Guiana [1,2]. This situation is presumably a reflection of what occurs in most of Latin America, where the disease is often undiagnosed and untreated largely because awareness and diagnostic tools are lacking [3]. Multiple or isolated lesions can be observed [6–8] Such polymorphism makes them non-specific clinical signs in AIDS patients [7]. They represent a very accessible site for minimally invasive biopsies, allowing a rapid diagnosis for a frequent cause of death among patients with advanced HIV [5]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
