Abstract
The Republic of Congo (RoC) is one of the African countries with the most histoplasmosis cases reported. This review summarizes the current status regarding epidemiology, diagnostic tools, and treatment of histoplasmosis in the RoC. A computerized search was performed from online databases Medline, PubMed, HINARI, and Google Scholar to collect literature on histoplasmosis in the RoC. We found 57 cases of histoplasmosis diagnosed between 1954 and 2019, corresponding to an incidence rate of 1–3 cases each year without significant impact of the AIDS epidemic in the country. Of the 57 cases, 54 (94.7%) were cases of Histoplasma capsulatum var. duboisii (Hcd) infection, African histoplasmosis. Three cases (5.3%) of Histoplasma capsulatum var. capsulatum infection were recorded, but all were acquired outside in the RoC. The patients’ ages ranged between 13 months to 60 years. An equal number of cases were observed in adults in the third or fourth decades (n = 14; 24.6%) and in children aged ≤15 years. Skin lesions (46.3%), lymph nodes (37%), and bone lesions (26%) were the most frequent clinical presentations. Most diagnoses were based on histopathology and distinctive large yeast forms seen in tissue. Amphotericin B (AmB) was first line therapy in 65% of the cases and itraconazole (25%) for maintenance therapy. The occurrence of African histoplasmosis in apparently normal children raises the possibility that African histoplasmosis is linked to environmental fungal exposure.
Highlights
Histoplasmosis is an endemic mycosis due to a dimorphic fungus named Histoplasma capsulatum [1]
Its distribution is worldwide [2,3], but Africa is unique in regard to this infection [4] as 2 clinical entities coexist due to Histoplasma capsulatum var. capsulatum (Hcc) and Histoplasma capsulatum var. duboisii (Hcd), the cause of “African Histoplasmosis.”
Our exhaustive literature search revealed a total of 57 diagnosed cases of histoplasmosis, including 54 cases (94.7%) of Hcd infection and 3 Hcc, were reported in the Republic of Congo (RoC) between 1954 and 2019 (Tables 1 and 2)
Summary
Histoplasmosis is an endemic mycosis due to a dimorphic fungus named Histoplasma capsulatum [1]. Its distribution is worldwide [2,3], but Africa is unique in regard to this infection [4] as 2 clinical entities coexist due to Histoplasma capsulatum var. While the HIV/AIDS pandemic and the increased use of immunosuppressive agents clearly demonstrated the opportunistic behavior of Hcc. there were reports of cases in previously ‘‘non-endemic areas” revealing the global distribution of histoplasmosis in Africa [5] and throughout the world [2,3,6,7]. In countries where patients have limited access to diagnostic testing and antiretroviral therapies (ARTs), histoplasmosis is probably an important cause of mortality in persons living with HIV/AIDS. Histoplasmosis, Hcd, has not been adopted by the World Health Organisation as a neglected tropical disease (NTD) (https:// www.who.int/neglected_diseases/diseases/en/) despite early consideration [8] and was rejected by G-Finder, despite a formal application (Global action fund for fungal infections, 2016)
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