Abstract
Histoplasmosis is the most frequent opportunistic infection and the first cause of mortality in HIV-infected patients in French Guiana and presumably in much of Latin America. Mucocutaneous lesions of histoplasmosis are considered as rare and late manifestations of the disease. It has been debated whether the greater proportion of cutaneo-mucous presentations in South America relative to the USA was the reflection of Histoplasma strains with increased dermotropism or simply delayed diagnosis and advanced immunosuppression. The objective of this study was to describe the clinical presentation, frequency, prognosis and temporal trends of cutaneomucous histoplasmosis in French Guiana. A retrospective study of patients with AIDS-related disseminated histoplasmosis followed in the three hospitals of French Guiana was performed between 1981 and 2014. Incident cases of histoplasmosis, proved by pathology and/or mycological examinations, were studied. Mucocutaneous histoplasmosis was confirmed by a positive cutaneous or mucosal biopsy. Mucocutaneous lesions were polymorphic. Ninety percent of patients were profoundly immunocompromised patients (CD4<50/mm3) and over 80% were not on antiretroviral treatment. The frequency of mucocutaneous forms and case fatality of disseminated histoplasmosis within one month of antifungal treatment significantly decreased over time (p<0,001). In this South American territory, diagnostic and therapeutic improvements have led to the quasi disappearance of cutaneous manifestations. There may be South American dermotropism in the laboratory but at the bedside early diagnosis seems to be the main parameter explaining the proportion of cutaneomucous presentations in South America relative to the USA.
Highlights
In French Guiana, histoplasmosis is the most common AIDS-defining infection and cause of death [1,2]
Mucocutaneous lesions of histoplasmosis are considered as rare and late manifestations of the disease. It has been debated whether the greater proportion of cutaneo-mucous presentations in South America relative to the USA was the reflection of Histoplasma strains with increased dermotropism or delayed diagnosis and advanced immunosuppression
A retrospective study of patients with AIDS-related disseminated histoplasmosis followed in the three hospitals of French Guiana was performed between 1981 and 2014
Summary
In French Guiana, histoplasmosis is the most common AIDS-defining infection and cause of death [1,2]. This situation is presumably similar in many parts of Latin America, where the diseases often goes undiagnosed -mostly mistaken for tuberculosis- and untreated for lack of diagnosis. [5] The clinical comparison between different countries is difficult because disentangling between-country differences in PLOS NEGLECTED TROPICAL DISEASES Evolution of cutaneomucous presentations of HIV-associated disseminated histoplasmosis access to care and diagnosis, and genetically-based phenotypic diversity of histoplasmosis is a challenge given the great diversity in health systems and the importance of genetic variation of Histoplasma isolates in Latin America.
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