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Review
. 2021 Nov;26(11):1462-1469.
doi: 10.1111/tmi.13663. Epub 2021 Sep 2.

Review of diagnostic methods and results for HIV-associated disseminated histoplasmosis: Pathologists are not sufficiently involved

Mathieu Nacher  1   2 , Audrey Valdes  3 , Antoine Adenis  1   2 , Romain Blaizot  2   4 , Françoise Ugo  5 , Philippe Abboud  5 , Magalie Demar  6   7 , Félix Djossou  5 , Loïc Epelboin  5 , Caroline Misslin  8 , Denis Blanchet  6   7 , Pierre Couppié  2   4 , Kinan Drak Alsibai  9
Affiliations
Free article
Review

Review of diagnostic methods and results for HIV-associated disseminated histoplasmosis: Pathologists are not sufficiently involved

Mathieu Nacher et al. Trop Med Int Health. 2021 Nov.
Free article

Abstract

Objectives: Disseminated histoplasmosis is a major killer of HIV-infected persons in Latin America. Antigen detection, fungal culture and Polymerase Chain Reaction are often not available, but cytology and histology are present in most hospitals and may offer a diagnostic alternative. In this study, we review 34 years of clinical experience to describe the roles of cytology and histology in diagnosing disseminated histoplasmosis.

Methods: Retrospective multicentric study of 349 patients between 1 January 1981 and 1 October 2014 with confirmed disseminated histoplasmosis.

Results: Around 32/214 (14.9%) of samples were screened using cytopathology, as were 10/101 (9.9%) bronchoalveolar lavage samples and 5/61 (8.2%) of spinal fluid samples. The samples most commonly sent to pathology were liver biopsies, lower digestive tract and lymphnode biopsies; the greatest proportion of positive results were found in lower digestive tract (43/59 (72.9%) positives), lymph node (39/63 (66.1%)), and liver (38/75 (50.7%)) samples. Overall, 97.2% of bone marrow and 97% of bronchoalveolar lavage samples were directly examined by a mycologist. Positive direct examination was independently associated with death (aHR = 1.5 (95%CI = 1-2.2)).

Conclusions: Opportunities for a rapid diagnosis were regularly missed, notably for bone marrow samples, which could have been examined using staining methods complementary to those of the mycologist.

Keywords: French Guiana; HIV; diagnostic methods; disseminated histoplasmosis; retrospective study.

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References

REFERENCES

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    1. Nacher M, Adenis A, Mc Donald S, Do Socorro Mendonca Gomes M, Singh S, Lopes Lima I, et al. Disseminated histoplasmosis in HIV-infected patients in south America: a neglected killer continues on its rampage. PLoS Neglected Tropical Dis. 2013;7(11):e2319.
    1. Adenis AA, Valdes A, Cropet C, McCotter OZ, Derado G, Couppie P, et al. Burden of HIV-associated histoplasmosis compared with tuberculosis in Latin America: a modelling study. Lancet Infect Dis. 2018;18(10):1150-9.
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