Disseminated Histoplasmosis; A Threat in Advanced HIV Disease Population in Sub-Saharan Africa?

Oladele, Rita O. and Ekeng, Bassey Ewa and Mandengue, Christine E. (2021) Disseminated Histoplasmosis; A Threat in Advanced HIV Disease Population in Sub-Saharan Africa? Journal of Advances in Medicine and Medical Research, 33 (3). pp. 115-144. ISSN 2456-8899

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Abstract

Background: Histoplasmosis is a neglected acquired immune deficiency syndrome (AIDS)-defining disease in sub-Saharan African countries, which is commonly misdiagnosed as tuberculosis (TB) due to similar imagery and clinical features; patients usually receive presumptive anti-TB treatment that is considered as anti-TB treatment failure. Patients with advanced human immunodeficiency virus (HIV) disease (AHD), CD4<200/mm3 or World Health Organisation clinical stage 3 or 4, develop disseminated histoplasmosis (DH) diagnosed at a late stage or at post-mortem, owing to poor clinical suspicion, lack of rapid diagnosis tools to offer rapid and accurate results, and non-availability and accessibility of appropriate antifungal medications. We report 31 cases of DH amongst patients with AHD in sub-Saharan African population from the literature, highlighting the challenging care issue in sub-Saharan Africa.

Results: Out of 31 reported cases 64.51% (20/31) were caused by Histoplasma capsulatum var capsulatum, 48.38% (15/31) being immigrants in Europe, Canada and Japan, with 41.93% (13/31) mortality, and 6 cases having no reported outcome. The poor index of suspicion on the part of clinicians; the lack of skilled laboratory personnel and rapid and accurate diagnosis tools of histoplasmosis for a proper detection of either classical or African histoplasmosis coexisting in many sub-Saharan African countries; and the non-availability and accessibility of appropriate antifungal medications were the most challenges in caring DH in advanced HIV disease population in sub-Saharan Africa.

Conclusion: there is a need for prompt and routine screening of advanced HIV disease patients in sub-Saharan Africa for histoplasmosis as an AIDS-defining illness.

Item Type: Article
Uncontrolled Keywords: Advanced HIV disease; AIDS; antifungal medications; disseminated histoplasmosis; histoplasma diagnosis tools; sub-Saharan Africa.
Subjects: Institute Archives > Medical Science
Depositing User: Managing Editor
Date Deposited: 12 Nov 2022 06:12
Last Modified: 01 Jan 2024 12:28
URI: http://eprint.subtopublish.com/id/eprint/112

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