Kuate Marius Paulin Ngouanom, Ekeng Bassey Ewa, Kwizera Richard, Mandengue Christine, Bongomin Felix
Department of Microbiology and Parasitology, Faculty of Science, University of Buea, Buea, Cameroon.
Department of Medical Microbiology & Parasitology, University of Calabar Teaching Hospital, Calabar, Nigeria.
Ther Adv Infect Dis. 2021 Apr 9;8:20499361211008675. doi: 10.1177/20499361211008675. eCollection 2021 Jan-Dec.
Histoplasmosis, tuberculosis and HIV are all highly prevalent in sub-Saharan Africa (SSA). Co-occurrence of two or more of these infections has been reported in several populations of patients, especially those with advanced HIV infection where these opportunistic infections contribute to a significant morbidity and mortality. With a high burden of pulmonary tuberculosis (PTB) secondary to HIV in SSA, histoplasmosis is commonly misdiagnosed as smear-negative PTB in HIV patients due to similar clinical and radiological presentations. This is also partly the result of the lack of trained clinical and laboratory personnel to make a definite diagnosis of histoplasmosis. There is a low index of clinical suspicion for histoplasmosis, and cases are mostly discovered accidently and documented through case reports and case series. Similarly, the high cost and lack of fungal diagnostics in most SSA countries makes it difficult to make a diagnosis. There is a need to build local capacity for mycology so that patients are managed to improve on the index of clinical suspicion and diagnostic capabilities. Moreover, simple accurate point-of-care diagnostic tests and first-line antifungal treatment for histoplasmosis are not available in many SSA countries. This review describes the existence of co-infections of histoplasmosis, tuberculosis and HIV in SSA, highlighting the challenges and research priorities.
组织胞浆菌病、结核病和艾滋病毒在撒哈拉以南非洲（SSA）都非常普遍。在一些患者群体中，尤其是那些晚期艾滋病毒感染者中，已报告存在两种或更多种这些感染的合并感染情况，这些机会性感染会导致显著的发病率和死亡率。由于SSA地区继发于艾滋病毒的肺结核（PTB）负担沉重，组织胞浆菌病在艾滋病毒患者中常因临床和影像学表现相似而被误诊为涂片阴性的PTB。这也部分是由于缺乏训练有素的临床和实验室人员来明确诊断组织胞浆菌病。对组织胞浆菌病的临床怀疑指数较低，病例大多是偶然发现的，并通过病例报告和病例系列记录下来。同样，大多数SSA国家真菌诊断的高成本和缺乏使得诊断变得困难。有必要建设当地的真菌学能力，以便对患者进行管理，从而提高临床怀疑指数和诊断能力。此外，许多SSA国家没有简单准确的即时护理诊断测试和针对组织胞浆菌病的一线抗真菌治疗。本综述描述了SSA地区组织胞浆菌病、结核病和艾滋病毒合并感染的情况，强调了挑战和研究重点。
