Kontogiannis Dimitra, Di Lorenzo Andrea, Zaçe Drieda, Benvenuto Domenico, Moccione Martina, Muratore Gianmarco, Giacalone Maria L, Montagnari Giulia, Carnevale Laura, Mulas Tiziana, Coppola Luigi, Campogiani Laura, Sarmati Loredana, Iannetta Marco
Department of Systems Medicine, Infectious Disease Clinic, Tor Vergata University, Rome, Italy.
Infectious Disease Clinic, Policlinico Tor Vergata, Rome, Italy.
Front Microbiol. 2024 Jun 27;15:1418530. doi: 10.3389/fmicb.2024.1418530. eCollection 2024.
var. , is a dimorphic fungus that causes histoplasmosis. It usually affects people coming from endemic areas, causing a variety of clinical manifestations up to progressive disseminated histoplasmosis (PDH), especially among people living with HIV (PLWH). We conducted a systematic review to assess histoplasmosis burden of PLWH in Europe. The review follows PRISMA guidelines, with protocol registered in PROSPERO (CRD42023429779). Seventy-eight articles were selected, including 109 patients (32 women). On overall, median age was 37 years. Forty-six patients were Americans, 39 Africans, 17 Europeans, 5 Asians, in 2 cases nationality was not specified. Cases were mainly diagnosed in Italy (28.4%), France (17.3%) and Spain (17.4%), with a north-south gradient. Six cases lacked epidemiologic links with endemic areas. Concerning CDC HIV staging at diagnosis, the information was available for 60 PLWH (55%) and all subjects were at stage C3 except for two subjects at stage B3. PDH was the AIDS-presenting illness in 39 patients. Most patients had a PDH (80.7%); other common extrapulmonary forms were isolated cutaneous histoplasmosis (7.3%), or lymphatic localization (2.7%). In 30 cases, the diagnosis was made by analyzing only one sample. For the remaining 79 cases, multiple samples were collected from each patient. Regarding the biological sample more frequently used for the diagnosis of histoplasmosis, bronchoalveolar lavage sample was taken from 39 patients, and tested positive in 51.3% of cases; 36 patients underwent a skin biopsy which was positive in 86.1% of cases and 28 patients performed bone-marrow biopsy, which led to the diagnosis of histoplasmosis in 92.9% of cases. The identification of was available in 97 PLWH through examination of different samples: and were identified in 89 and 8 PLWH, respectively. Concerning therapies, 67.9% were treated with liposomal amphotericin B, 18.3% with itraconazole, 10 died pre-treatment. The overall mortality rate was 23.6%. Non-survivors exhibited more frequently gastrointestinal symptoms ( = 0.017), while cutaneous signs correlated with better survival ( = 0.05). Untreated patients faced higher mortality ( < 0.001). Histoplasmosis should be considered amongst opportunistic infection in PLWH, even in Europe, especially if patients originate from or have travelled to endemic areas. The registration number is CRD42023429779.
荚膜组织胞浆菌变种是一种双相真菌，可引起组织胞浆菌病。它通常影响来自疫区的人群，可导致多种临床表现，直至进展性播散性组织胞浆菌病（PDH），尤其是在艾滋病毒感染者（PLWH）中。我们进行了一项系统评价，以评估欧洲PLWH的组织胞浆菌病负担。该评价遵循PRISMA指南，方案已在PROSPERO（CRD42023429779）注册。共筛选出78篇文章，包括109例患者（32名女性）。总体而言，中位年龄为37岁。46例患者为美国人，39例为非洲人，17例为欧洲人，5例为亚洲人，2例未注明国籍。病例主要在意大利（28.4%）、法国（17.3%）和西班牙（17.4%）诊断，呈南北梯度分布。6例与疫区无流行病学关联。关于诊断时的美国疾病控制与预防中心（CDC）艾滋病毒分期，60例PLWH（55%）有相关信息，除2例处于B3期外，所有受试者均处于C3期。39例患者的艾滋病首发疾病为PDH。大多数患者患有PDH（80.7%）；其他常见的肺外形式为孤立性皮肤组织胞浆菌病（7.3%）或淋巴定位（2.7%）。30例病例仅通过分析一个样本做出诊断。其余79例病例中，从每位患者采集了多个样本。关于最常用于诊断组织胞浆菌病的生物样本，39例患者采集了支气管肺泡灌洗样本，其中51.3%检测呈阳性；36例患者进行了皮肤活检，86.1%呈阳性，28例患者进行了骨髓活检，92.9%确诊为组织胞浆菌病。通过对不同样本的检查，97例PLWH中鉴定出了荚膜组织胞浆菌：89例和8例PLWH中分别鉴定出荚膜组织胞浆菌和杜波组织胞浆菌。关于治疗，6
