Ekeng Bassey E, Elem David E, Kokelu Anthony N, Onukak Asukwo, Egbara Walter O, Benjamin Ofonime O, Ogar Aje N, Chukwuma Stella T, Okafor Love E, Essien Kingsley A, Ekpenyong Deborah U, Bongomin Felix
Department of Medical microbiology and parasitology, University of Calabar Teaching Hospital, Calabar, Nigeria.
Department of Internal Medicine, University of Calabar Teaching Hospital, Calabar, Nigeria.
Infection. 2025 Apr;53(2):513-522. doi: 10.1007/s15010-024-02431-6. Epub 2025 Jan 2.
Pancytopenia in the setting of disseminated histoplasmosis is sparsely described in the literature. We investigated the underlying mechanisms of pancytopenia in disseminated histoplasmosis and highlighted clinical outcomes.
We conducted a scoping review of cases and series on disseminated histoplasmosis presenting with pancytopenia published between 2001 and 2024. PubMed database was used for the search. The search terms were (disseminated histoplasmosis) AND (pancytopenia OR haemophagocytic syndrome OR lymphohistiocytosis).
We identified 72 cases. Forty-four (61.1%) cases were from the Americas, 18 (25.5%) from Asia, 8 (11.1%) from Europe, and 1(1.4%) each from Africa and Australia. Of the 72 cases, five cases (6.9%) were reported in children. The mean age was 41.9 ± 16.7 years with a range of 3 months to 78 years. Seven cases (9.7%) were immunocompetent, 27 (37.5%) had an underlying HIV infection and 45 (62.5%) were complicated with haemophagocytic lymphohistiocytosis syndrome. Histoplasma antigen assay (n = 29, 40.2%) was the major diagnostic method followed by bone marrow biopsy (n = 28, 38.9%). Fifty-three cases (73.6%) recovered, 15 (20.8%) died and outcomes were not stated in 4 cases (5.65%). The relationship between haemophagocytic lymphohistiocytosis and fatal outcomes was not statistically significant (P = 0.5). Likewise, HIV infection was not significantly associated with fatal outcomes (P = 0.6). Fatal outcomes were predominantly due to difficulty or delayed diagnosis of disseminated histoplasmosis and/or haemophagocytic lymphohistiocytosis (n = 5, 6.9%), multiple organ failure (n = 4, 5.6%) and late presentation (n = 2, 2.8%).
Pancytopenia in disseminated histoplasmosis is associated with poor outcomes. Such a hematologic finding should arouse the index of suspicion in the attending clinician for an invasive mycosis like disseminated histoplasmosis to avert fatal outcomes. Besides haemophagocytic lymphohistiocytosis, other factors associated with pancytopenia in disseminated histoplasmosis were the cooccurrence of viral and bacterial infections.
文献中对播散性组织胞浆菌病伴全血细胞减少的描述较少。我们研究了播散性组织胞浆菌病中全血细胞减少的潜在机制，并强调了临床结局。
我们对2001年至2024年间发表的有关播散性组织胞浆菌病伴全血细胞减少的病例和系列进行了范围综述。使用PubMed数据库进行检索。检索词为（播散性组织胞浆菌病）AND（全血细胞减少或噬血细胞综合征或淋巴细胞组织细胞增生症）。
我们确定了72例病例。44例（61.1%）来自美洲，18例（25.5%）来自亚洲，8例（11.1%）来自欧洲，非洲和澳大利亚各1例（1.4%）。在这72例病例中，5例（6.9%）为儿童。平均年龄为41.9±16.7岁，范围为3个月至78岁。7例（9.7%）免疫功能正常，27例（37.5%）有潜在的HIV感染，45例（62.5%）并发噬血细胞性淋巴组织细胞增生综合征。组织胞浆菌抗原检测（n = 29，40.2%）是主要诊断方法，其次是骨髓活检（n = 28，38.9%）。53例（73.6%）康复，15例（20.8%）死亡，4例（5.65%）未说明结局。噬血细胞性淋巴组织细胞增生症与致命结局之间的关系无统计学意义（P = 0.5）。同样，HIV感染与致命结局也无显著相关性（P = 0.6）。致命结局主要归因于播散性组织胞浆菌病和/或噬血细胞性淋巴组织细胞增生症诊断困难或延迟（n = 5，6.9%）、多器官功能衰竭（n = 4，5.6%）和就诊延迟（n = 2，2.8%）。
播散性组织胞浆菌病中的全血细胞减少与不良结局相关。这种血液学表现应引起主治医生对播散性组织胞浆菌病等侵袭性真菌病的怀疑指数，以避免致命结局。除噬血细胞性淋巴组织细胞增生症外，播散性组织胞浆菌病中与全血细胞减少相关的其他因素是病毒和细菌感染的同时发生。
