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. 2018 May 9;13(5):e0196224.
doi: 10.1371/journal.pone.0196224. eCollection 2018.

Prior subclinical histoplasmosis revealed in Nigeria using histoplasmin skin testing

Rita O Oladele  1   2   3 , Conchita Toriello  4 , Folasade T Ogunsola  1 , Olusola O Ayanlowo  5 , Philip Foden  6 , Adetona S Fayemiwo  7 , Iriagbonse I Osaigbovo  8 , Anthony A Iwuafor  9 , Shuwaram Shettima  10 , Halimat A Ekundayo  11 , Malcolm D Richardson  2   3   12 , David W Denning  2   3   13
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Prior subclinical histoplasmosis revealed in Nigeria using histoplasmin skin testing

Rita O Oladele et al. PLoS One. .

Abstract

Objectives: Disseminated histoplasmosis is an AIDS-defining illness. Histoplasmosis is commonly misdiagnosed as tuberculosis. Nigeria has the second highest number of people living with HIV/AIDS in Africa. The present study was carried out to investigate the prevalence of skin sensitivity amongst Nigerians to histoplasmin.

Design: A cross-sectional study was conducted in six centres across five geopolitical zones of Nigeria.

Methods: We recruited both healthy non-HIV and HIV-positive adults with CD4 count ≥ 350 cells/mm3 regardless of their ART status from March to May 2017. Skin tests were performed intradermally; induration ≥5 mm were considered to be histoplasmin positive.

Results: 750 participants were recruited from Lagos (n = 52), Yola (n = 156), Ilorin (n = 125), Calabar (n = 120), Ibadan (n = 202) and Benin (n = 95). 467 (62.3%) were HIV negative, 247 (32.9%) were HIV positive and 36 (4.8%) did not know their HIV status. A total of 32/735 (4.4%) participants had a positive skin test. Study centre (p<0.001), education (p = 0.002) and age (p = 0.005) appeared to be significantly associated with positive skin reactivity at the 0.5% significance level, while sex (p = 0.031) and occupation (p = 0.031) would have been significant at the 5% significance level. Males had a higher rate of reactivity than females (p = 0.031, 7% vs 3%). The highest positive rates were recorded from Benin City (13/86 (15%)) and Calabar (7/120 (6%)) and no positives were recorded in Lagos (p<0.001). HIV status was not statistically significant (p = 0.70).

Conclusion: Histoplasmosis diagnostics should be included in the Nigerian HIV guidelines. Epidemiological vigilance of progressive disseminated histoplasmosis should be considered by local health authorities.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Distribution of reported cases of histoplasmosis in Nigeria in relation to vegetation (A) and soil types (B).
See this image and copyright information in PMC

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