Abstract
Histoplasmosis is a common but neglected AIDS-defining condition in endemic areas for Histoplasma capsulatum. At the advanced stage of HIV infection, the broad spectrum of clinical features may mimic other frequent opportunistic infections such as tuberculosis and makes it difficult for clinicians to diagnose histoplasmosis in a timely manner. Diagnosis of histoplasmosis is difficult and relies on a high index of clinical suspicion along with access to medical mycology facilities with the capacity to implement conventional diagnostic methods (direct examination and culture) in a biosafety level 3 laboratory as well as indirect diagnostic methods (molecular biology, antibody, and antigen detection tools in tissue and body fluids). Time to initiation of effective antifungals has an impact on the patient’s prognosis. The initiation of empirical antifungal treatment should be considered in endemic areas for Histoplasma capsulatum and HIV. Here, we report on 30 years of experience in managing HIV-associated histoplasmosis based on a synthesis of clinical findings in French Guiana with considerations regarding the difficulties in determining its differential diagnosis with other opportunistic infections.
Highlights
Fungal infections are a major cause of opportunistic infections at the advanced stage of HIV infection [1]
These situations require the urgent initiation of the lipid formulation of intravenous amphotericin B given its fungicidal activity on Histoplasma capsulatum [5,6,8]
We describe simple patterns for the two diseases to help clinicians distinguish between histoplasmosis and tuberculosis, regardless of the CD4 count level [13]
Summary
Fungal infections are a major cause of opportunistic infections at the advanced stage of HIV infection [1]. Histoplasma capsulatum is a thermally dimorphic fungus described worldwide with the Americas being the world hotspot according to current available data [2]. J. Fungi 2019, 5, 115; doi:10.3390/jof5040115 www.mdpi.com/journal/jof. J. Fungi 2019, 5, 115 disease evolutions [3]. Once the host is exposed to Histoplasma capsulatum, disease progression and prognosis are mainly driven by the level of the inhaled fungal burden and by innate or acquired defects in the host immune system. According to these parameters, histoplasmosis may be asymptomatic, self-limited, or invasive and life-threatening, notably in immunocompromised hosts [4]. HIV-associated histoplasmosis (HAH) is a common AIDS-defining condition in endemic areas for Histoplasma capsulatum, with the highest incidence among people living with HIV with a CD4 count
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