[African histoplasmosis due to Histoplasma capsulatum var. duboisii: relationship with AIDS in recent Congolese cases]

Abstract

Six new cases are described for African histoplasmosis, Histoplasma capsulatum var. duboisii, from Congo. The first was an HIV sero-negative child who has been monitored for the last three years. While under treatment with ketoconazole, amphotericin B, and finally itraconazole, the development of the infection was accompanied by purulent lesions, mainly cutaneous, but also superficial and deep lymphadenopathies. As a last option, itraconazole gave very satisfactory results both during the acute phase and during long-term treatment. However, eight months after treatment had ceased, there was a relapse and the long-term treatment had to be restarted. The other cases concerned HIV sero-positive patients with disseminated infections that had all been mistaken for tuberculosis. After diagnosis of the infection in two cases, the following two years of treatment could not prevent death. A fourth case, diagnosed in December 1994, is currently undergoing treatment. The fifth subject was lost after diagnosis during follow-up, but inquires made after the discovery of the patient's death strongly indicated acquired immunodeficiency as the cause. The last of these six cases, determined as HIV sero-negative, showed large bony lesions of the spinal column associated with a sore on the thorax. Thus, in a short period of time, three or four cases of African histoplasmosis occurred which were associated with HIV infection. Only seven identical observations have previously been reported in the literature. Therefore, we believe that this mycosis should now be included in the criteria for the diagnosis and definition of AIDS in the tropics.

PIP: In Congo, the parasitology-mycology laboratory in Brazzaville diagnosed six new cases of African histoplasmosis (Histoplasma capsulatum var. duboisii) in a 3-year period. Three cases had AIDS. Another case was strongly suspected of being HIV seropositive. The first case was a 4-year-old child from Brazzaville who had been monitored for more than 3 years. Health providers treated him first with ketoconazole, then amphotericin B, and finally itraconazole. The child's African histoplasmosis was characterized by purulent lesions, particularly cutaneous, but also superficial and deep lymphadenopathies. Itraconazole adequately treated the child's condition both during the acute phase and during long-term treatment. Eight months after the end of itraconazole treatment, the child suffered a relapse, resulting in re-administration of longterm treatment. The remaining African histoplasmosis cases had disseminated infections, which were initially suspected to be tuberculosis. After diagnosis, two cases died despite two years of treatment. The fourth case was diagnosed in December 1994 and is still receiving treatment. After diagnosis, the fifth case was lost to follow-up. Health providers later learned that AIDS was probably responsible for the patient's death. The sixth case did not have HIV infection. The 32-year-old man, a nurse in the central army hospital in Brazzaville, had large bony lesions of the spinal column associated with a sore on the thorax. The literature shows only seven other African histoplasmosis cases infected with HIV. These HIV-infected African histoplasmosis cases along with the seven cases in the literature suggest that African histoplasmosis should be included in the criteria for the diagnosis and definition of AIDS in tropical countries.