Morote Sophie, Nacher Mathieu, Blaizot Romain, Ntab Balthazar, Blanchet Denis, Drak Alsibai Kinan, Demar Magalie, Djossou Félix, Couppié Pierre, Adenis Antoine
Service de Dermatologie-Vénéréologie, Centre Hospitalier de Cayenne, 97300 Cayenne, French Guiana, France.
Centre d'Investigation Clinique Antilles Guyane, INSERM 1424, Centre Hospitalier de Cayenne, 97300 Cayenne, French Guiana, France.
J Fungi (Basel). 2020 Aug 12;6(3):133. doi: 10.3390/jof6030133.
: Histoplasmosis is the main opportunistic infection and cause of death in HIV-infected persons living with HIV in French Guiana and probably in most of Latin America. The objective of the present study was to compare cutaneomucous histoplasmosis to non-cutaneomucous histoplasmosis in French Guiana. : Between 1981 and 2014 AIDS-related disseminated histoplasmosis patients followed in the three hospitals of French Guiana were retrospectively studied. Only proven incident cases of histoplasmosis, either by pathology and/or mycological analysis, were considered. Mucocutaneous histoplasmosis was ascertained by a positive mucosal or cutaneous biopsy. : Thirty-one patients had mucocutaneous lesions, and 318 had no mucocutaneous lesions. Patients with cutaneomucous lesions were more likely to have had prior opportunistic infections (35.5%) than those who did not have cutaneomucous lesions (19.5%). They were more likely to be very severely immunocompromised (CD4 count < 50) (90.3% versus 62.8%) and less likely to have digestive signs (32.3% versus 74.1%) and superficial adenopathies (29% versus 50.2%) than those without cutaneomucous lesions. In terms of simple biological examinations, patients with cutaneomucous lesions had fewer signs of cholestasis. The diagnosis was significantly more likely to be performed by direct examination and pathology in those with cutaneomucous lesions than in those without such lesions. On the contrary, patients with cutaneomucous lesions were less likely to be diagnosed by fungal culture than those without cutaneomucous lesions. There was a greater but non-significant risk of early death in those with cutaneomucous lesions relative to those without (OR = 2.28 (95%CI = 0.83-5.7), = 0.056. : Mucocutaneous forms were associated with more profound immunosuppression and perhaps risk of early death. They are easily accessible for diagnosis.
在法属圭亚那以及可能在拉丁美洲大部分地区，组织胞浆菌病是艾滋病毒感染者主要的机会性感染及死亡原因。本研究的目的是比较法属圭亚那皮肤黏膜型组织胞浆菌病与非皮肤黏膜型组织胞浆菌病。1981年至2014年期间，对法属圭亚那三家医院收治的艾滋病相关播散性组织胞浆菌病患者进行了回顾性研究。仅纳入经病理学和/或真菌学分析确诊的组织胞浆菌病新发病例。皮肤黏膜型组织胞浆菌病通过黏膜或皮肤活检阳性确诊。31例患者有皮肤黏膜病变，318例无皮肤黏膜病变。有皮肤黏膜病变的患者比无皮肤黏膜病变的患者更易有既往机会性感染（35.5%对19.5%）。与无皮肤黏膜病变的患者相比，他们更易出现严重免疫抑制（CD4细胞计数<50）（90.3%对62.8%），且出现消化系统症状（32.3%对74.1%）和浅表淋巴结肿大（29%对50.2%）的可能性更小。就简单的生物学检查而言，有皮肤黏膜病变的患者胆汁淤积迹象较少。有皮肤黏膜病变的患者通过直接检查和病理学诊断的可能性显著高于无此类病变的患者。相反，有皮肤黏膜病变的患者通过真菌培养诊断的可能性低于无皮肤黏膜病变的患者。有皮肤黏膜病变的患者相对于无病变患者有更高但无显著差异的早期死亡风险（比值比=2.28（95%置信区间=0.83 - 5.7），P = 0.056）。皮肤黏膜型与更严重的免疫抑制以及可能的早期死亡风险相关。它们易于诊断。
