Abstract
ObjectivesDisseminated histoplasmosis is an AIDS-defining illness. Histoplasmosis is commonly misdiagnosed as tuberculosis. Nigeria has the second highest number of people living with HIV/AIDS in Africa. The present study was carried out to investigate the prevalence of skin sensitivity amongst Nigerians to histoplasmin.DesignA cross-sectional study was conducted in six centres across five geopolitical zones of Nigeria.MethodsWe recruited both healthy non-HIV and HIV-positive adults with CD4 count ≥ 350 cells/mm3 regardless of their ART status from March to May 2017. Skin tests were performed intradermally; induration ≥5 mm were considered to be histoplasmin positive.Results750 participants were recruited from Lagos (n = 52), Yola (n = 156), Ilorin (n = 125), Calabar (n = 120), Ibadan (n = 202) and Benin (n = 95). 467 (62.3%) were HIV negative, 247 (32.9%) were HIV positive and 36 (4.8%) did not know their HIV status. A total of 32/735 (4.4%) participants had a positive skin test. Study centre (p<0.001), education (p = 0.002) and age (p = 0.005) appeared to be significantly associated with positive skin reactivity at the 0.5% significance level, while sex (p = 0.031) and occupation (p = 0.031) would have been significant at the 5% significance level. Males had a higher rate of reactivity than females (p = 0.031, 7% vs 3%). The highest positive rates were recorded from Benin City (13/86 (15%)) and Calabar (7/120 (6%)) and no positives were recorded in Lagos (p<0.001). HIV status was not statistically significant (p = 0.70).ConclusionHistoplasmosis diagnostics should be included in the Nigerian HIV guidelines. Epidemiological vigilance of progressive disseminated histoplasmosis should be considered by local health authorities.
Highlights
Histoplasmosis is considered a disease of worldwide distribution, with hyperendemic areas
750 participants were recruited from Lagos (n = 52), Yola (n = 156), Ilorin (n = 125), Calabar (n = 120), Ibadan (n = 202) and Benin (n = 95). 467 (62.3%) were human immunodeficiency virus (HIV) negative, 247 (32.9%) were HIV positive and 36 (4.8%) did not know their HIV status
Histoplasmosis diagnostics should be included in the Nigerian HIV guidelines
Summary
Histoplasmosis is considered a disease of worldwide distribution, with hyperendemic areas. The presence of the pathogen and clinical disease are described in large geographical areas, including most of Asia and Africa [1]. In Nigeria, a higher prevalence of skin test reactivity (%35%) was found in a rural population, especially among farmers, local traders, and cave guides [3]and this was prior to the outbreak of the HIV epidemic. In Africa, surveys of histoplasmin skin sensitivity have demonstrated positivity rates ranging from 0.0% to 28%, [4,5,6,7,8,9,10,11,12] and cross reactivity has been demonstrated between Histoplasma capsulatum var capsulatum (Hcc) and Histoplasma capsulatum var duboisii (Hcd) in Nigeria [7]
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