Series of cases of disseminated histoplasmosis in people living with the human immunodeficiency virus: A neglected endemic in Latin America and the Caribbean.

Abstract

Background: Disseminated histoplasmosis is a common infection in people living with human immunodeficiency virus (HIV) in Latin America and the Caribbean.

Aims: To examine the clinical characteristics and outcomes of disseminated histoplasmosis in people living with HIV focusing on delayed diagnoses.

Methods: A descriptive study in a public hospital in Santa Fe (Argentina) was conducted between 2017 and 2023. Disseminated histoplasmosis was diagnosed through direct examination and/or culture of blood, respiratory secretions, bone marrow, or skin samples.

Results: Twenty-one patients were included (median age: 34 years; 61.9% male). Ten (47.6%) patients were under antiretroviral therapy, but were non-adherent. The median CD4+ count was 10cells/mm³. Fever was the prevailing symptom (19, 90.5%), with a median duration of 30 days. Visceromegalies were observed in 11 patients (52.4%), lymphadenopathy in 10 (47.6%), and skin lesions in 11 (52.4%). All patients had anemia, and 13 (61.9%) had liver function abnormalities. Diagnosis was made through the scraping of mucocutaneous lesions in 11 patients (52.4%). Eight patients (38.1%) were admitted to the Intensive Care Unit, and six (28.6%) died. Five patients (23.8%) had delayed diagnoses.

Conclusions: Disseminated histoplasmosis may be underdiagnosed due to its subacute course and nonspecific clinical presentation. A high index of suspicion is essential, particularly in people living with the HIV.