Histoplasmosis in Non-HIV Infected Patients: Another Neglected Infection in French Guiana

Abstract

(1) Background: Only a few studies on histoplasmosis in immunocompetent patients have been reported in French Guiana. Therefore, we conducted a detailed clinical description of hospitalized patients suffering with histoplasmosis among non-HIV patients. (2) Methods: This is a single-center, retrospective study conducted at Cayenne Hospital Center between 2008 and 2022. (3) Results: Our cohort was composed of 31 (91%) adults (>18 years of age) and 3 (9%) children, with a sex ratio, M:F, of 1:2. The median age was higher among the women than among the men (70 versus 54 years). The collection of respiratory samples constituted the majority of the performed examinations (38%). Fever (>37 °C) was found in 56% of patients. Surprisingly, the histoplasmosis was disseminated in 82% of patients with an overall case fatality rate of 14.7%. However, immunosuppressive conditions were found in 52% (16/31) of the adult patients, including lymphoid hemopathies, diabetes and immunosuppressive drugs. Conclusions: This disease, though rare and usually considered a mostly benign disease in non-HIV patients, presented a relatively high mortality rate in our cohort. Thus, histoplasmosis should be suspected, screened and investigated as a first line of defense in highly endemic areas, even in immunocompetent and non-HIV patients, especially those with fever or chronic respiratory symptoms.

Keywords: French Guiana; histoplasmosis; neglected infectious disease; non-HIV.

Figure 1

Chest CT scan, miliary histoplasmosis in 91-year-old woman occurring after cleaning droppings, particularly those of bats, in a confined place without protection. She unfortunately died despite treatment. Scale bar: 25%.

Figure 2

Digestive endoscopy: inflammatory stenosis at the tip of the duodenal bulb in a 70-year-old patient (A) suffering from epigastric pain, anorexia and weight loss. Diagnosis of histoplasmosis via biopsy with favorable evolution under antifungal treatment (B). Scale bar: 100%.

Figure 3

Package of right supraclavicular adenopathy (red asterisk) in a 51-year-old woman, a housemaid with no previous history (A). (B) Histological section of lymph node shows numerous granulomas with epithelioid cells associated with multinucleated giant cells, centered by caseous necrosis mimicking tuberculoid granuloma (Hematoxylin–Eosin–Safran, “HES,” Stain, ×200). (C) Numerous extracellular and intra-histiocytic yeasts of Histoplasma capsulatum (Gömöri–Grocott stain, orange arrows, ×100).