Histoplasmosis in Immunocompromised and Immunocompetent Patients in Guadeloupe.

IF 4.2 2区 生物学 Q2 MICROBIOLOGY
Constance Lahuna, Tanguy Dequidt, Pierre Postel-Vinay, Sandrine Peugny, Marwan Haboub, Samuel Markowicz, Muriel Nicolas
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Abstract

Background:Histoplasma capsulatum is an environmentally acquired dimorphic fungus. Infection results in histoplasmosis, a clinical syndrome often underdiagnosed and that may progress to life-threatening disseminated infection not only in immunocompromised individuals but also, following high-level exposure, in immunocompetent hosts. Epidemiological data from Caribbean regions, and particularly from Guadeloupe, remain limited. Methods: We performed a retrospective cohort study of all microbiologically confirmed histoplasmosis cases managed at the University Hospital of Guadeloupe between January 2014 and October 2024. Demographic, clinical, diagnostic, therapeutic, and outcome data were retrieved from medical records and analyzed using descriptive statistics. Results: Forty-two patients met the inclusion criteria, corresponding to an estimated annual incidence rate of 1 per 100,000 inhabitants. The median age was 52 years, and the male-to-female ratio was 4:1. An underlying immunocompromising condition was present in 85% of cases, most commonly HIV infection (48%). Common clinical features included weight loss (97%), fever (89%), and pulmonary manifestations (81%). The mean time to diagnosis from hospital admission was 3.5 ± 10.3 days. Direct microscopy was positive in 67% of cases, and culture was positive in 88% of cases. Intravenous liposomal amphotericin B constituted the initial therapy in 71% of patients. Overall, the in-hospital mortality was 29%, rising to 40% among HIV-positive individuals. The 30-day survival rate was 71%. Conclusions: Histoplasmosis in Guadeloupe is under-recognized and associated with appreciable morbidity and mortality in both immunocompromised and immunocompetent patients. The wider availability of rapid diagnostics and heightened clinical vigilance are essential to shorten diagnostic delays and improve outcomes in this Caribbean population.

瓜德罗普岛免疫功能低下和免疫功能正常患者的组织浆菌病。
背景:荚膜组织浆菌是一种环境获得的二态真菌。感染导致组织胞浆菌病,这是一种经常被误诊的临床综合征,不仅在免疫功能低下的个体中,而且在高水平暴露后,在免疫功能正常的宿主中,可能发展为危及生命的播散性感染。来自加勒比地区,特别是瓜德罗普岛的流行病学数据仍然有限。方法:我们对2014年1月至2024年10月在瓜德罗普大学医院管理的所有微生物学证实的组织胞浆菌病病例进行了回顾性队列研究。从医疗记录中检索人口统计学、临床、诊断、治疗和结果数据,并使用描述性统计进行分析。结果:42例患者符合纳入标准,相当于每10万居民中估计的年发病率为1例。年龄中位数为52岁,男女比例为4:1。85%的病例存在潜在的免疫损害状况,最常见的是HIV感染(48%)。常见的临床特征包括体重减轻(97%)、发烧(89%)和肺部表现(81%)。从入院到诊断的平均时间为3.5±10.3天。直接镜检阳性占67%,培养阳性占88%。静脉注射两性霉素B脂质体是71%患者的初始治疗方法。总体而言,住院死亡率为29%,在艾滋病毒阳性个体中上升至40%。30天存活率为71%。结论:瓜德罗普岛的组织胞浆菌病未被充分认识,并且在免疫功能低下和免疫功能正常的患者中都有明显的发病率和死亡率。更广泛地提供快速诊断和提高临床警惕性对于缩短诊断延误和改善加勒比人口的结果至关重要。
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来源期刊
Journal of Fungi
Journal of Fungi Medicine-Microbiology (medical)
CiteScore
6.70
自引率
14.90%
发文量
1151
审稿时长
11 weeks
期刊介绍: Journal of Fungi (ISSN 2309-608X) is an international, peer-reviewed scientific open access journal that provides an advanced forum for studies related to pathogenic fungi, fungal biology, and all other aspects of fungal research. The journal publishes reviews, regular research papers, and communications in quarterly issues. Our aim is to encourage scientists to publish their experimental and theoretical results in as much detail as possible. Therefore, there is no restriction on paper length. Full experimental details must be provided so that the results can be reproduced.
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