Assistance Publique-Hôpitaux de Paris, Hôpital St Antoine, Service de Parasitologie-Mycologie, Paris, France.
Faculty of Health Sciences, Marien Ngouabi University, Brazzaville, Republic of Congo.
Clin Infect Dis. 2021 Aug 2;73(3):e543-e549. doi: 10.1093/cid/ciaa1304.
Histoplasmosis caused by Histoplasma capsulatum var. duboisii (Hcd) is a rare, but probably underestimated, endemic infection described in intertropical Africa. Therefore, the epidemiology of the infection remains unclear, and there is no consensus on therapeutic management.
Using a comprehensive search on different Internet databases, we collected case reports of Hcd infection published from 1993 to 2019. Epidemiological and clinical charts and therapeutic strategies were analyzed.
We found 94 well-documented cases of Hcd infection, and 30.1% of the patients were under 18 years old. Symptoms occurred in some patients several decades after leaving the endemic area. Cutaneous/subcutaneous lesions, bone infections, and lymphadenopathies, both isolated and combined, were the most frequent presentations. The human immunodeficiency virus (HIV) coinfection rate was at 20.8%, with fever, lymphadenopathies, and an absence of bone infection being the differentiating elements from patients living without HIV. The rate of disseminated forms (60.6% in our review) significantly increased as compared to studies published before 1993, but without correlation with HIV infection. The global mortality rate was at 23.4% by the end of follow-up. The outcome was not correlated with the antifungal drug prescribed, nor with HIV serologic status, but was correlated with the initiation of an antifungal therapy.
Hcd histoplasmosis is a severe fungal infection for which the precise mode of acquisition remains to be determined. There is a need for affordable and more specific diagnostic tools. Itraconazole and amphotericin B are the best therapeutic alternatives and should be available in all low-income countries of the endemic area.
由杜波伊斯荚膜组织胞浆菌（Hcd）引起的组织胞浆菌病是一种罕见的，但可能被低估的地方性感染，在热带非洲有报道。因此，该感染的流行病学仍不清楚，治疗管理也没有共识。
我们使用不同互联网数据库的全面搜索，收集了 1993 年至 2019 年发表的 Hcd 感染病例报告。分析了流行病学和临床图表以及治疗策略。
我们发现了 94 例有明确记录的 Hcd 感染病例，其中 30.1%的患者年龄在 18 岁以下。一些患者在离开流行地区几十年后出现症状。皮肤/皮下病变、骨感染和淋巴结病，单独或联合存在，是最常见的表现。人类免疫缺陷病毒（HIV）合并感染率为 20.8%，发热、淋巴结病和无骨感染是与未感染 HIV 的患者相区别的因素。与 1993 年前发表的研究相比，播散性形式（在我们的综述中为 60.6%）的发生率显著增加，但与 HIV 感染无关。在随访结束时，全球死亡率为 23.4%。结局与所开抗真菌药物无关，也与 HIV 血清学状态无关，而是与抗真菌治疗的开始有关。
Hcd 组织胞浆菌病是一种严重的真菌感染，其确切的感染方式仍有待确定。需要经济实惠且更具特异性的诊断工具。伊曲康唑和两性霉素 B 是最佳的治疗选择，应在流行地区的所有低收入国家都有供应。
