Franklin Alexander D, Larson Lindsey, Rauseo Adriana M, Rutjanawech Sasinuch, Hendrix Michael Joshua, Powderly William G, Spec Andrej
Department of Medicine, Washington University School of Medicine, St Louis, MO, USA.
Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St Louis, MO, USA.
Med Mycol. 2021 Jan 13. doi: 10.1093/mmy/myaa112.
Few large cohorts have examined histoplasmosis in both immunocompromised and immunocompetent patients. We describe the differences in presentations and outcomes of histoplasmosis by immune and dissemination status. We assembled a retrospective cohort of adult patients diagnosed with histoplasmosis from 2002 to 2017. Patients were grouped by immune status: people living with HIV (PLWH), patients who were HIV negative but had other-immunocompromise (OIC), and immunocompetent patients. Patients were further classified into asymptomatic lung nodule (ALN), localized and disseminated disease groups, and outcomes were compared across patients by these immune status categories We identified 261 patients with histoplasmosis: 54 (21%) PLWH, 98 (38%) OIC, and 109 (42%) immunocompetent. Disseminated disease was more common among PLWH than among other groups (P < .001). In localized disease, median time from symptom onset to diagnosis was longer in immunocompetent patients than in other groups (P = .012), and was not significant in disseminated disease. The 90-day mortality was higher in PLWH (25%) and OIC (26%) with localized disease compared to the immunocompetent group (4%) (P = .009), but this difference was not seen in disseminated disease. Patients with localized disease had lower 90-day mortality (14%) compared to those with disseminated disease (21%) (P = .034). We conclude that immunocompetent individuals present with fewer typical symptoms, laboratory findings, and radiographic features of Histoplasma infection, leading to potential delays in diagnosis in this group. Despite this, immunocompetent patients have lower 90-day mortality in localized disease, and do not experience increased 90-day mortality in disseminated disease.
This article examines how the signs and symptoms of histoplasmosis vary by immune status and dissemination status. Immunocompetent patients with localized disease present with fewer typical signs and symptoms, are diagnosed later, but despite this have lower 90-day mortality.
很少有大型队列研究过免疫功能低下和免疫功能正常患者的组织胞浆菌病。我们描述了免疫状态和播散状态下组织胞浆菌病的临床表现和结局差异。我们收集了2002年至2017年被诊断为组织胞浆菌病的成年患者的回顾性队列。患者按免疫状态分组：艾滋病毒感染者（PLWH）、艾滋病毒阴性但有其他免疫功能低下的患者（OIC）和免疫功能正常的患者。患者进一步分为无症状肺结节（ALN）、局限性和播散性疾病组，并根据这些免疫状态类别比较患者的结局。我们确定了261例组织胞浆菌病患者：54例（21%）PLWH，98例（38%）OIC，109例（42%）免疫功能正常。播散性疾病在PLWH中比在其他组中更常见（P < .001）。在局限性疾病中，免疫功能正常患者从症状出现到诊断的中位时间比其他组更长（P = .012），而在播散性疾病中不显著。局限性疾病患者中，PLWH（25%）和OIC（26%）的90天死亡率高于免疫功能正常组（4%）（P = .009），但在播散性疾病中未观察到这种差异。局限性疾病患者的90天死亡率（14%）低于播散性疾病患者（21%）（P = .034）。我们得出结论，免疫功能正常的个体出现的组织胞浆菌感染的典型症状、实验室检查结果和影像学特征较少，导致该组诊断可能延迟。尽管如此，免疫功能正常的患者在局限性疾病中的90天死亡率较低，在播散性疾病中90天死亡率没有增加。
本文研究了组织胞浆菌病的体征和症状如何因免疫状态和播散状态而异。局限性疾病的免疫功能正常患者出现的典型体征和症状较少，诊断较晚，但尽管如此，其90天死亡率较低。
