Abstract
BackgroundDisseminated histoplasmosis is a major killer of patients with advanced HIV. It is proteiform and often hard to diagnose in the absence of diagnostic tests. We aimed to describe disseminated histoplasmosis with lymphadenopathies in French Guiana and to compare survival and severity of those patients to patients without lymphadenopathies.MethodsA retrospective cohort study was performed on data records collected between January 1, 1981 and October 1, 2014.ResultsAmong 349 cases of disseminated histoplasmosis 168 (48.3%) had superficial lymphadenopathies and 133(38.1%) had deep lymphadenopathies. The median LDH concentration, ferritin concentration, TGO concentration, and WHO performance status were lower among patients with deep lymphadenopathies than those without deep lymphadenopathies. There was a significant decrease in the risk of early death (<1 month) among those with deep lymphadenopathies relative to those without (OR=0.26 (95%CI=0.10–0.60), P=0.0006) and in the overall risk of death (OR=0.33 (95%CI=0.20-0.55), P<0.0001). These associations remained strongly significant after adjusting for time period, CD4 counts, age, delay between beginning of symptoms and hospital admission, antifungal and antiretroviral treatment.ConclusionsThe present data show that in patients with advanced HIV and disseminated histoplasmosis, the presence of deep lymphadenopathies is associated with fewer markers of severity and a lower risk of death. To our knowledge it is the first study to show this. The presence of deep lymphadenopathies is hypothesized to reflect the patient’s partially effective defense against H. capsulatum.
Highlights
Histoplasma capsulatum is a dimorphic ascomycete that grows in soil and bird and bat guano
Antigen presenting cells migrate to the nearest lymph node where the antigen they express along with MHCII molecules can be presented to a variety of circulating naïve lymphocytes that can eventually become activated and proliferate
Ever since the beginning of the HIV epidemic, lymph node pathology has been known to be an important consequence of human immunodeficiency virus (HIV) infection
Summary
Histoplasma capsulatum is a dimorphic ascomycete that grows in soil and bird and bat guano. The recognition of H. capsulatum by dendritic cells and macrophages promotes the differentiation and recruitment of Th1 cells. This process fails in immunocompromised individuals who are at risk for disseminated infection. Lymph nodes have a central role in the development of adaptive immunity against pathogens. During infections, they may become enlarged and palpable. Before being called HIV, the virus responsible for AIDS was called Lymphadenopathy Associated Virus. Another infecting pathogen that can cause lymphadenopathies is Histoplasma capsulatum. We aimed to describe disseminated histoplasmosis with lymphadenopathies in French Guiana and to compare survival and severity of those patients to patients without lymphadenopathies
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