1Infectious Diseases Department, Centre Hospitalier de Cayenne, Cayenne, French Guiana.
2CIC INSERM 1424, Centre Hospitalier de Cayenne, Cayenne, French Guiana.
Am J Trop Med Hyg. 2021 May 10;105(1):125-129. doi: 10.4269/ajtmh.20-1486.
Disseminated histoplasmosis is the most frequent acquired immunodeficiency syndrome-defining illness in French Guiana. Paradoxically, central nervous system (CNS) involvement has been scarcely described. We aimed to identify CNS histoplasmosis in our territory. We conducted an observational, multicentric, descriptive, and retrospective study including patients with proven or probable CNS histoplasmosis according to the European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group (EORTC/MGS). The study population consisted of patients admitted in one of the hospitals of French Guiana between January 1, 1990 and December 31, 2019. During the study period, 390 cases of HIV-associated histoplasmosis were recorded, in which six of them had CNS infections with Histoplasma capsulatum. The male to female sex ratio was 0.25, and the median age at diagnosis was 37.5 years. The median CD4 count was 42 cells/mm3 ([IQR: 29-60]). All patients had disseminated histoplasmosis. Usual signs of meningitis were observed in three patients and focal signs in four patients. One patient had no neurological signs. The median time between the first cerebral symptoms and diagnosis was 22.4 days (IQR 9.5-36.2). Two patients died within a month after diagnosis. In conclusion, few proven CNS localizations of histoplasmosis were observed on 30-year study in French Guiana. This low proportion suggests that the documentation of CNS involvement is often not ascertained for lack of awareness of this particular presentation, and for lack of rapid and sensitive diagnostic tools.
播散性组织胞浆菌病是法属圭亚那最常见的获得性免疫缺陷综合征定义性疾病。矛盾的是，中枢神经系统（CNS）受累的描述却很少见。我们旨在确定我们地区的中枢神经系统组织胞浆菌病。我们进行了一项观察性、多中心、描述性和回顾性研究，包括根据欧洲癌症研究和治疗组织/侵袭性真菌感染合作组和美国国家过敏和传染病研究所真菌病研究组（EORTC/MGS）确诊或疑似中枢神经系统组织胞浆菌病的患者。研究人群包括 1990 年 1 月 1 日至 2019 年 12 月 31 日期间在法属圭亚那一家医院住院的患者。在研究期间，记录了 390 例与 HIV 相关的组织胞浆菌病病例，其中 6 例有中枢神经系统感染组织胞浆菌。男女比例为 0.25，诊断时的中位年龄为 37.5 岁。中位 CD4 计数为 42 个细胞/mm3（[IQR：29-60]）。所有患者均患有播散性组织胞浆菌病。3 例患者出现脑膜炎常见体征，4 例患者出现局灶性体征。1 例患者无神经系统体征。从首次出现脑部症状到诊断的中位时间为 22.4 天（IQR 9.5-36.2）。2 例患者在诊断后 1 个月内死亡。总之，在法属圭亚那进行的 30 年研究中，观察到的中枢神经系统组织胞浆菌病的确诊病例很少。这种低比例表明，由于对这种特殊表现缺乏认识，以及缺乏快速和敏感的诊断工具，中枢神经系统受累的记录往往没有得到证实。
