Department of Anatomical Pathology, National Health Laboratory Service & School of Laboratory Medicine and Medical Sciences, University of KwaZulu-Natal, Durban, South Africa.
Department of Anatomical Pathology, Mayville, South Africa.
J Cutan Pathol. 2022 Feb;49(2):139-146. doi: 10.1111/cup.14118. Epub 2021 Aug 25.
Histoplasma capsulatum var. duboisii (H. duboisii) causes potentially fatal disease in the immunocompromised patient, and the literature on these cases is limited. The study was undertaken to describe the cases of H. duboisii seen in a resource-limited setting.
A 5-year retrospective, laboratory-based histopathologic review of all H. duboisii cases.
A total of 24 patients were diagnosed with cutaneous H. duboisii infection. The male-to-female ratio was 1.4. All the patients were human immunodeficiency virus (HIV) positive, and 70.83% (17 of 24 patients) were on antiretroviral therapy. The clinically identified lesions were as follows: plaques, nodular plaques, papules, papulo-pustules, and umbilicated papules. Histopathological appraisal revealed organisms typical of H. duboisii. The commonest epidermal alterations were interface change, parakeratosis, spongiosis, ulceration, acanthosis, hyperkeratosis, transepidermal elimination, and exocytosis in decreasing order. The dermal changes included histiocytic pattern (n = 14), neutrophil-rich (n = 13), non-necrotizing granulomatous inflammation (n = 9), and karyorrhexis (n = 6). Histoplasma was confirmed in 53% (8 of 15 samples) of the tissue samples submitted for routine fungal culture.
This study showed the demographics, clinical and histopathology features of H. duboisii infection in a resource-limited setting. Further research on histopathological features of this rare infection is essential to expand on the knowledge base and support findings in this study.
荚膜组织胞浆菌变种杜波依斯菌（H. duboisii）可在免疫功能低下的患者中引起潜在致命的疾病，而关于这些病例的文献有限。本研究旨在描述在资源有限的环境中观察到的荚膜组织胞浆菌变种杜波依斯菌病例。
对所有荚膜组织胞浆菌变种杜波依斯菌病例进行了为期 5 年的回顾性、基于实验室的组织病理学回顾。
共诊断出 24 例皮肤荚膜组织胞浆菌变种杜波依斯菌感染患者。男女比例为 1.4。所有患者均为人免疫缺陷病毒（HIV）阳性，70.83%（24 例患者中的 17 例）正在接受抗逆转录病毒治疗。临床上识别出的病变如下：斑块、结节性斑块、丘疹、丘疹脓疱和脐状丘疹。组织病理学评估显示出荚膜组织胞浆菌变种杜波依斯菌的典型生物体。最常见的表皮改变依次为界面变化、角化不全、海绵状变性、溃疡、棘皮症、角化过度、经表皮消除和胞吐。真皮变化包括组织细胞模式（n=14）、富含中性粒细胞（n=13）、非坏死性肉芽肿性炎症（n=9）和核碎裂（n=6）。在提交进行常规真菌培养的 15 个组织样本中，有 53%（8 个样本）确认了荚膜组织胞浆菌。
本研究显示了资源有限环境中荚膜组织胞浆菌变种杜波依斯菌感染的人口统计学、临床和组织病理学特征。进一步研究这种罕见感染的组织病理学特征对于扩大知识库和支持本研究中的发现至关重要。
