Abstract
Histoplasmosis in Africa has markedly increased since the advent of the HIV/AIDS epidemic but is under-recognised. Pulmonary histoplasmosis may be misdiagnosed as tuberculosis (TB). In the last six decades (1952–2017), 470 cases of histoplasmosis have been reported. HIV-infected patients accounted for 38% (178) of the cases. West Africa had the highest number of recorded cases with 179; the majority (162 cases) were caused by Histoplasma capsulatum var. dubuosii (Hcd). From the Southern African region, 150 cases have been reported, and the majority (119) were caused by H. capsulatum var. capsulatum (Hcc). There have been 12 histoplasmin skin test surveys with rates of 0% to 35% positivity. Most cases of Hcd presented as localised lesions in immunocompetent persons; however, it was disseminated in AIDS patients. Rapid diagnosis of histoplasmosis in Africa is only currently possible using microscopy; antigen testing and PCR are not available in most of Africa. Treatment requires amphotericin B and itraconazole, both of which are not licensed or available in several parts of Africa.
Highlights
Inhalation of conidia of H. capsulatum leads to histoplasmosis in some people
H. capsulatum var. capsulatum (Hcc) is patchily distributed around the world, whereas Histoplasma capsulatum var. dubuosii (Hcd) is essentially restricted to Africa [1]
Histoplasmosis was first described by Darling in the Canal Zone in Panama in 1906; patients were described as presenting with features suggestive of disseminated TB [2]
Summary
University of California San Diego School of Medicine, UNITED STATES. The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript
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