Histoplasmosis in Children; HIV/AIDS Not a Major Driver.

Bassey E Ekeng,Ikechukwu Amamilo,Kevin Edem,Zachary Panos,David W Denning,Rita O Oladele

doi:10.3390/jof7070530

Abstract

The classification of histoplasmosis as an AIDS-defining illness has largely attributed its occurrence in people to the presence of HIV/AIDS especially in Africa. Prior to the advent of the HIV/AIDS epidemic, many cases of histoplasmosis were documented both in the pediatric and adult population. Our review revealed 1461 reported cases of pediatric histoplasmosis globally in the last eight decades (1939–2021). North America (n = 1231) had the highest number of cases, followed by South America (n = 135), Africa (n = 65), Asia (n = 26) and Europe (n = 4). Histoplasmosis was much more common in the non-HIV pediatric population (n = 1418, 97.1%) compared to the HIV population. The non-HIV factors implicated were, childhood malignancies (n = 207), such as leukemias and lymphomas as well as their treatment, lung diseases (n = 7), environmental exposures and toxins (n = 224), autoimmune diseases (n = 12), organ transplants (n = 12), long-term steroid therapy (n = 3), the use of immunosuppressive drugs such as TNF-alpha inhibitors (n = 7) malnutrition (n = 12), histiocytosis (n = 3), hyperimmunoglobulin M and E syndromes (n = 15, 1.2%), pancytopaenias (n = 26), diabetes mellitus (n = 1) and T-cell deficiency (n = 21). Paediatricians should always consider or rule out a diagnosis of histoplasmosis in children presenting with symptoms suggestive of the above clinical conditions.

Highlights

Histoplasmosis is a systemic fungal infection occurring globally
Amongst risk factors associated with disseminated histoplasmosis (DH), HIV infection has been attributed as the greatest factor predisposing patients to DH in the adult population [4]
The purpose of this review is to identify factors other than HIV infection predisposing children to histoplasmosis and to raise awareness on pediatric histoplasmosis in the non-HIV population

Summary

Introduction

Histoplasmosis is a systemic fungal infection occurring globally. It is endemic in theOhio and Mississippi river valleys of the United States of America, India and SoutheastAsia [1,2]. Histoplasmosis is a systemic fungal infection occurring globally. Ohio and Mississippi river valleys of the United States of America, India and Southeast. Asia [1,2]. Amongst risk factors associated with disseminated histoplasmosis (DH), HIV infection has been attributed as the greatest factor predisposing patients to DH in the adult population [4]. Before the advent of HIV/AIDS, several cases of DH had been reported [5]. A review on the documented cases of histoplasmosis in Africa, from 1952–2017 by Oladele et al revealed 37 cases of histoplasmosis in the pediatric age group, of which 33 (89.2%) were non-HIV patients [4]

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