Seroprevalence of Histoplasmosis in Somali, Burmese, and Hmong Refugees Residing in Thailand and Kenya.

Histoplasmosis is known to be endemic to the Midwestern United States, but cases have been reported throughout much of the world. Somali, Hmong, and Burmese (ethnically Karen) persons make up some of the largest refugee populations coming the United States in recent years. Yet, information about risk of Histoplasma capsulatum infection amongst these populations is limited. This study used the CDC Migrant Serum Bank to test ~100 samples from each of Somali, Burmese, and Hmong U.S.-bound refugees. Samples were tested by enzyme immunoassay for Histoplasma capsulatum IgG. Overall 1% (2/299) of refugee serum samples were positive for H. capsulatum IgG. One of 99 samples obtained from Hmong refugees was positive, and the other positive sample came from among 100 Burmese refugee samples. H capsulatum IgG positivity was detected at low levels in Hmong and Burmese refugees. No IgG positivity was detected among 100 Somali refugees.

HIV-associated histoplasmosis in a nonendemic area of the United States during the HAART era: role of migration from endemic areas and lack of antiretroviral therapy.

Histoplasmosis is known to be an AIDS-associated infection, with scattered areas of endemicity throughout the world. Although the Atlanta, GA, metropolitan area is not a highly endemic area, a significant number of cases have been noted at our institution in recent years. Cases of histoplasmosis over a 4-year period were reviewed. All 27 patients (100%) were HIV infected. Thirty percent of patients with histoplasmosis were from Latin American countries. Patients from Latin America were younger than patients from the United States, tended to be more likely to have proven disease, and were exclusively male. Patients with proven disease had significantly higher urine histoplasma antigen levels, lower platelets counts, and lower neutrophil counts than patients with probable disease. The majority of patients survived after treatment with antifungals and initiation of antiretroviral therapy. Histoplasmosis is thus an important consideration in the workup of patients with advanced HIV in nonendemic areas of the United States.

Fever and high lactate dehydrogenase in HIV-positive patients from the Antilles and Surinam: histoplasmosis?

We describe four cases of HIV-positive patients, two from Surinam, one from the Dutch Antilles and one from Nigeria, who presented with a febrile illness and a high lactate dehydrogenase plasma level. In all four, the diagnosis of disseminated histoplasmosis was made, in three of them by liver biopsy. Two patients had retinal abnormalities compatible with a systemic fungal infection. Three patients were treated successfully with antifungal agents. One patient died. Between 2000 and 2006, only 14 patients with HIV have been found to have histoplasmosis in the Netherlands. Although histoplasmosis is not endemic in the Netherlands, physicians are more likely to see cases because of a growing number of HIV -positive immigrants from endemic regions.

Histoplasmosis in two aboriginal patients from Australia's tropical Northern Territory.

Endemic histoplasmosis occurs uncommonly in Australia and has not previously been reported in the tropical Northern Territory, nor in Aboriginal Australian patients. We report one suspected and one confirmed case of severe disseminated histoplasmosis in Aboriginal Australians from the Northern Territory. Underlying illness included chronic cardiac disease and Type 1 diabetes mellitus, respectively, and neither patient was infected with HIV. The clinical presentations resembled malignancy. Diagnosis of histoplasmosis was made on the basis of bowel histology in Case 1, demonstrating characteristic yeasts, and lymph node histology and culture in Case 2. Histoplasmosis should be considered in relevant clinical situations, even in HIV-negative patients who have not left Australia.

[Manifestations of histoplasmosis]. / Manifestaties van histoplasmose.

Two patients, a 34-year old man-to-woman transsexual and a 32-year-old man, with aids presented with pulmonary symptoms, fever, serious weight loss and an oral ulcer. A third patient, a 16-year-old boy, had signs of transverse myelitis and meningitis without immunodeficiency. All were South American citizens and had disseminated histoplasmosis. After antifungal treatment they recovered, although the third patient remained a wheelchair user. If pulmonary or miliary tuberculosis is suspected in a patient originating from South America, histoplasmosis should be considered. Oral ulcers and skin lesions can be diagnostic clues. Specific stainings of direct preparations and longer-lasting cultures of various materials, especially of biopsy samples, then provide the diagnosis.

[Disseminated Histoplasma capsulatum histoplasmosis in African AIDS patients (3 cases)]. / Histoplasmose disséminee à Histoplasma capsulatum et SIDA chez l' africain (à propos de 3 cas).

The authors describe three cases of Histoplasma capsulatum histoplasmosis that occurred in black AIDS patients living in France but originally from Guinea and Ivory Coast. In all three cases histoplasmosis was disseminated with fever. In two cases there were cutaneous manifestations. One patient had renal insufficiency and nephrotic syndrome and another presented ulcerative colitis with histoplasma in the chorion. The outcome was favorable in two patients. These three cases are in addition to the five previously reported cases in african AIDS patients. These cases stress the need for awareness of this opportunistic infection as a complication of AIDS in patients from Black Africa.

[HIV-associated histoplasmosis with pulmonary manifestation in Europe]. / HIV-assoziierte Histoplasmose in Europa mit pulmonaler Manifestation.

A 35-year-old man developed weight loss, lower abdominal pain, diarrhoea, cough, fever and general deterioration in his health. He had been born and resident in the USA until 1991, when he moved to Germany. Since 1991 he had known that he was HIV-positive. The chest radiograph showed bilateral diffuse spotty marking and a rounded cardiac silhouette, the latter echocardiographically due to pericardial effusion. Tuberculostatic drugs were started because miliary tuberculosis was suspected. But as his condition worsened and he was thought to have Pneumocystis pneumonia high doses of co-trimoxazole were administered. Perbronchial lung biopsy showed nonspecific chronic inflammatory changes. Periodide acid-Schiff reaction and Grocott staining demonstrated numerous histoplasma in alveolar macrophages and connective tissue. The organism was also cultured from bronchial secretions. Treatment was now changed to itraconazole (400 mg daily), 2 weeks later changed to liposomal amphotericin B (100 mg daily) because of renewed fever. After 6 weeks the patient became free of symptoms and the radiological changes had largely regressed. To prevent recurrence, treatment with itraconazole (400 mg daily) is being continued.

Paracoccidioidin and histoplasmin sensitivity in Tupí-Mondé Amerindian populations from Brazilian Amazonia.

A cross-sectional epidemiological survey for paracoccidioidomycosis and histoplasmosis, including skin tests with paracoccidioidin and histoplasmin, physical examinations and X-rays, was conducted among three Tupí-Mondé Amerindian populations from Brazilian Amazonia. The study followed the diagnosis of an increasing number of cases of paracoccidioidomycosis among the Suruí in recent years. Positivity rates to paracoccidioidin and histoplasmin (> or = 5 mm of intradermal induration 24-48 h post-injection) were 43.8% and 78.7% for the Suruí, 6.4% and 5.8% for the Gavião and 14.9% and 80.5% for the Zoró, respectively. There was no significant difference in the results for males and females but marked differences were noted across age groups. The results of the univariate analysis were confirmed after adjustment for confounding variables by multiple logistic regression analysis: paracoccidioidin positivity was relatively high in the Suruí and histoplasmin positivity was relatively high in the Suruí and Zoró. The Suruí's greater exposure to Paracoccidioides brasiliensis, the causative agent of paracoccidioidomycosis, is probably associated with their adoption of new subsistence practices. The epidemiology of this mycosis among the Tupí-Mondé appears to be related to the environmental and socio-economic changes taking place in Amazonia.

[Histoplasma duboisii osteitis as an imported disease]. / Histoplasma-duboisii-Osteitis als Importkrankheit.

A case of imported Histoplasma duboisii osteitis in a visitor from Africa to Switzerland is described. The diagnosis was by histology confirmed by culture. Infection of other organs was ruled out. Amphotericin B therapy and its side effects are discussed.