Epidemiology and clinical manifestations of histoplasmosis in HIV-infected patients
- John W Baddley, MD, MSPH
John W Baddley, MD, MSPH
- Professor of Medicine
- Birmingham VA Medical Center
- University of Alabama at Birmingham
Patients with acquired immunodeficiency syndrome (AIDS) are susceptible to both infection and to disseminated disease from the endemic fungi, which are localized to specific geographic regions. The endemic mycoses (ie, Histoplasma capsulatum, Coccidioides immitis, and Blastomyces dermatitidis) are a diverse group of fungi that occupy a specific niche in the environment and cause infections in healthy and immunocompromised hosts, particularly those with T-cell immune deficiencies.
Histoplasmosis is an important infectious disease among patients with advanced AIDS and continues to cause severe morbidity and mortality in endemic areas, particularly in resource-limited settings . Histoplasmosis may be the AIDS-defining illness in greater than 50 percent of affected patients [2-8]. In resource-rich settings, disseminated disease usually occurs in patients who are not taking antiretroviral therapy at the time of diagnosis .
The epidemiology and clinical manifestations of histoplasmosis will be reviewed here. The diagnosis and treatment of histoplasmosis in HIV-infected patients, as well as topic reviews that discuss histoplasmosis in HIV-uninfected patients are found elsewhere. (See "Diagnosis and treatment of histoplasmosis in HIV-infected patients" and "Diagnosis and treatment of pulmonary histoplasmosis" and "Diagnosis and treatment of disseminated histoplasmosis in HIV-uninfected patients" and "Pathogenesis and clinical features of pulmonary histoplasmosis" and "Pathogenesis and clinical manifestations of disseminated histoplasmosis".)
Histoplasmosis is found in temperate zones worldwide; specific endemic areas include the Mississippi, Ohio and St. Lawrence River valleys, the Caribbean, southern Mexico, certain parts of Central and South America, Africa, and Asia. In these regions, the fungus is found in high concentrations in soil contaminated with bird or bat excreta . Transmission occurs via inhalation of H. capsulatum spores from the soil. Thus, infection may be acquired through a multitude of activities (eg, construction, spelunking, bird handling), which can lead to inhalation of the pathogen through contaminated soil [15,16]. (See "Pathogenesis and clinical features of pulmonary histoplasmosis", section on 'Epidemiology'.)
- Mora DJ, dos Santos CT, Silva-Vergara ML. Disseminated histoplasmosis in acquired immunodeficiency syndrome patients in Uberaba, MG, Brazil. Mycoses 2008; 51:136.
- Nightingale SD, Parks JM, Pounders SM, et al. Disseminated histoplasmosis in patients with AIDS. South Med J 1990; 83:624.
- Sarosi GA, Johnson PC. Disseminated histoplasmosis in patients infected with human immunodeficiency virus. Clin Infect Dis 1992; 14 Suppl 1:S60.
- Johnson PC, Khardori N, Najjar AF, et al. Progressive disseminated histoplasmosis in patients with acquired immunodeficiency syndrome. Am J Med 1988; 85:152.
- Baddley JW, Sankara IR, Rodriquez JM, et al. Histoplasmosis in HIV-infected patients in a southern regional medical center: poor prognosis in the era of highly active antiretroviral therapy. Diagn Microbiol Infect Dis 2008; 62:151.
- Couppié P, Aznar C, Carme B, Nacher M. American histoplasmosis in developing countries with a special focus on patients with HIV: diagnosis, treatment, and prognosis. Curr Opin Infect Dis 2006; 19:443.
- Antinori S, Magni C, Nebuloni M, et al. Histoplasmosis among human immunodeficiency virus-infected people in Europe: report of 4 cases and review of the literature. Medicine (Baltimore) 2006; 85:22.
- Adenis A, Nacher M, Hanf M, et al. HIV-associated histoplasmosis early mortality and incidence trends: from neglect to priority. PLoS Negl Trop Dis 2014; 8:e3100.
- Wheat LJ, Chetchotisakd P, Williams B, et al. Factors associated with severe manifestations of histoplasmosis in AIDS. Clin Infect Dis 2000; 30:877.
- Hage CA, Wheat LJ, Loyd J, et al. Pulmonary histoplasmosis. Semin Respir Crit Care Med 2008; 29:151.
- Putot A, Perrin S, Jolivet A, Vantilcke V. HIV-associated disseminated histoplasmosis in western French Guiana, 2002-2012. Mycoses 2015; 58:160.
- Hajjeh RA, Pappas PG, Henderson H, et al. Multicenter case-control study of risk factors for histoplasmosis in human immunodeficiency virus-infected persons. Clin Infect Dis 2001; 32:1215.
- de Oliveira RB, Atobe JH, Souza SA, de Castro Lima Santos DW. Epidemiology of invasive fungal infections in patients with acquired immunodeficiency syndrome at a reference hospital for infectious diseases in Brazil. Mycopathologia 2014; 178:71.
- Murray JF, Mills J. Pulmonary infectious complications of human immunodeficiency virus infection. Part II. Am Rev Respir Dis 1990; 141:1582.
- Wheat LJ, Connolly-Stringfield PA, Baker RL, et al. Disseminated histoplasmosis in the acquired immune deficiency syndrome: clinical findings, diagnosis and treatment, and review of the literature. Medicine (Baltimore) 1990; 69:361.
- Hajjeh RA. Disseminated histoplasmosis in persons infected with human immunodeficiency virus. Clin Infect Dis 1995; 21 Suppl 1:S108.
- Bahr NC, Antinori S, Wheat LJ, Sarosi GA. Histoplasmosis infections worldwide: thinking outside of the Ohio River valley. Curr Trop Med Rep 2015; 2:70.
- Benedict K, Thompson GR 3rd, Deresinski S, Chiller T. Mycotic Infections Acquired outside Areas of Known Endemicity, United States. Emerg Infect Dis 2015; 21:1935.
- Vail GM, Mocherla S, Wheat LJ, et al. Cellular immune response in HIV-infected patients with histoplasmosis. J Acquir Immune Defic Syndr 2002; 29:49.
- Wheat LJ, Slama TG, Zeckel ML. Histoplasmosis in the acquired immune deficiency syndrome. Am J Med 1985; 78:203.
- Panel on Opportunistic Infections in HIV-Infected Adults and Adolescents. Guidelines for the prevention and treatment of opportunistic infections in HIV-infected adults and adolescents: recommendations from the Centers for Disease Control and Prevention, the National Institutes of Health, and the HIV Medicine Association of the Infectious Diseases Society of America. Available at http://aidsinfo.nih.gov/contentfiles/lvguidelines/adult_oi.pdf. (Accessed on August 17, 2016).
- Karimi K, Wheat LJ, Connolly P, et al. Differences in histoplasmosis in patients with acquired immunodeficiency syndrome in the United States and Brazil. J Infect Dis 2002; 186:1655.