We reviewed the clinical, microbiologic, and outcome characteristics of 72 patients with human immunodeficiency virus (HIV)-associated histoplasmosis (4 newly described) reported in Europe over 20 years (1984-2004). Seven cases (9.7\%) were acquired in Europe (autochthonous), whereas the majority involved a history of travel or arrival from endemic areas. The diagnosis of progressive disseminated histoplasmosis (PDH) was made during life in 63 patients (87.5\%) and was the acquired immunodeficiency syndrome (AIDS)-presenting illness in 44 (61.1\%). Disease was widespread in 66 patients (91.7\%) and localized in 6 (8.3\%), with the skin being the most frequent site of localized infection. Overall skin involvement was reported in 47.2\% of the patients regardless of whether histoplasmosis was acquired in Africa or South America. Reticulonodular or diffuse interstial infiltrates occurred in 52.8\%. The diagnosis was made during life by histopathology plus culture in 44 patients (69.8\%), histopathology alone in 18 (28.5\%), and culture alone in 1 (1.5\%). During the induction phase amphotericin B and itraconazole (74.6\%) were the single most frequently used drugs. Both drugs were also used either in combination (10.2\%) or in sequential therapy (11.8\%). Cumulative mortality rate during the induction phase of treatment was 15.2\%. Overall, 37 patients died (57.8\%); death occurred early in the course in 18 (28.1\%). Seven of 40 patients (17.5\%) who responded to therapy subsequently relapsed. Autopsy data in 13 patients confirmed the widespread disseminated nature of histoplasmosis (85\%) among AIDS patients with a median of 4.5 organs involved. The results of the present report highlight the need to consider the diagnosis of PDH among patients with AIDS in Europe presenting with a febrile illness who have traveled to or who originated from an endemic area.
%0 Journal Article
%1 antinori_histoplasmosis_2006
%A Antinori, Spinello
%A Magni, Carlo
%A Nebuloni, Manuela
%A Parravicini, Carlo
%A Corbellino, Mario
%A Sollima, Salvatore
%A Galimberti, Laura
%A Ridolfo, Anna Lisa
%A Wheat, L Joseph
%D 2006
%J Medicine
%K Adult, Agents, Antifungal Diagnosis, Differential, Europe, Fatal Female, Histoplasmosis, Humans, Infections, Male, Outcome, Prognosis {HIV}
%N 1
%P 22--36
%R 10.1097/01.md.0000199934.38120.d4
%T Histoplasmosis among human immunodeficiency virus-infected people in Europe: report of 4 cases and review of the literature
%U http://www.ncbi.nlm.nih.gov/pubmed/16523050
%V 85
%X We reviewed the clinical, microbiologic, and outcome characteristics of 72 patients with human immunodeficiency virus (HIV)-associated histoplasmosis (4 newly described) reported in Europe over 20 years (1984-2004). Seven cases (9.7\%) were acquired in Europe (autochthonous), whereas the majority involved a history of travel or arrival from endemic areas. The diagnosis of progressive disseminated histoplasmosis (PDH) was made during life in 63 patients (87.5\%) and was the acquired immunodeficiency syndrome (AIDS)-presenting illness in 44 (61.1\%). Disease was widespread in 66 patients (91.7\%) and localized in 6 (8.3\%), with the skin being the most frequent site of localized infection. Overall skin involvement was reported in 47.2\% of the patients regardless of whether histoplasmosis was acquired in Africa or South America. Reticulonodular or diffuse interstial infiltrates occurred in 52.8\%. The diagnosis was made during life by histopathology plus culture in 44 patients (69.8\%), histopathology alone in 18 (28.5\%), and culture alone in 1 (1.5\%). During the induction phase amphotericin B and itraconazole (74.6\%) were the single most frequently used drugs. Both drugs were also used either in combination (10.2\%) or in sequential therapy (11.8\%). Cumulative mortality rate during the induction phase of treatment was 15.2\%. Overall, 37 patients died (57.8\%); death occurred early in the course in 18 (28.1\%). Seven of 40 patients (17.5\%) who responded to therapy subsequently relapsed. Autopsy data in 13 patients confirmed the widespread disseminated nature of histoplasmosis (85\%) among AIDS patients with a median of 4.5 organs involved. The results of the present report highlight the need to consider the diagnosis of PDH among patients with AIDS in Europe presenting with a febrile illness who have traveled to or who originated from an endemic area.
@article{antinori_histoplasmosis_2006,
abstract = {We reviewed the clinical, microbiologic, and outcome characteristics of 72 patients with human immunodeficiency virus {(HIV)-associated} histoplasmosis (4 newly described) reported in Europe over 20 years (1984-2004). Seven cases (9.7\%) were acquired in Europe (autochthonous), whereas the majority involved a history of travel or arrival from endemic areas. The diagnosis of progressive disseminated histoplasmosis {(PDH)} was made during life in 63 patients (87.5\%) and was the acquired immunodeficiency syndrome {(AIDS)-presenting} illness in 44 (61.1\%). Disease was widespread in 66 patients (91.7\%) and localized in 6 (8.3\%), with the skin being the most frequent site of localized infection. Overall skin involvement was reported in 47.2\% of the patients regardless of whether histoplasmosis was acquired in Africa or South America. Reticulonodular or diffuse interstial infiltrates occurred in 52.8\%. The diagnosis was made during life by histopathology plus culture in 44 patients (69.8\%), histopathology alone in 18 (28.5\%), and culture alone in 1 (1.5\%). During the induction phase amphotericin B and itraconazole (74.6\%) were the single most frequently used drugs. Both drugs were also used either in combination (10.2\%) or in sequential therapy (11.8\%). Cumulative mortality rate during the induction phase of treatment was 15.2\%. Overall, 37 patients died (57.8\%); death occurred early in the course in 18 (28.1\%). Seven of 40 patients (17.5\%) who responded to therapy subsequently relapsed. Autopsy data in 13 patients confirmed the widespread disseminated nature of histoplasmosis (85\%) among {AIDS} patients with a median of 4.5 organs involved. The results of the present report highlight the need to consider the diagnosis of {PDH} among patients with {AIDS} in Europe presenting with a febrile illness who have traveled to or who originated from an endemic area.},
added-at = {2011-03-11T10:05:34.000+0100},
author = {Antinori, Spinello and Magni, Carlo and Nebuloni, Manuela and Parravicini, Carlo and Corbellino, Mario and Sollima, Salvatore and Galimberti, Laura and Ridolfo, Anna Lisa and Wheat, L Joseph},
biburl = {https://www.bibsonomy.org/bibtex/24341cd09cda7ab86c2737b18adc98efc/jelias},
doi = {10.1097/01.md.0000199934.38120.d4},
interhash = {182e8609659df5739bea150fa757b76c},
intrahash = {4341cd09cda7ab86c2737b18adc98efc},
issn = {0025-7974},
journal = {Medicine},
keywords = {Adult, Agents, Antifungal Diagnosis, Differential, Europe, Fatal Female, Histoplasmosis, Humans, Infections, Male, Outcome, Prognosis {HIV}},
month = jan,
note = {{PMID:} 16523050},
number = 1,
pages = {22--36},
shorttitle = {Histoplasmosis among human immunodeficiency virus-infected people in Europe},
timestamp = {2011-03-11T10:06:23.000+0100},
title = {Histoplasmosis among human immunodeficiency virus-infected people in Europe: report of 4 cases and review of the literature},
url = {http://www.ncbi.nlm.nih.gov/pubmed/16523050},
volume = 85,
year = 2006
}