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'.)
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