Disseminated histoplasmosis: A comparative study of the clinical features and outcome among immunocompromised and immunocompetent patients.
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Date
2013-07
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Abstract
Background. Disseminated histoplasmosis is a chronic
granulomatous disease caused by the dimorphic fungus,
Histoplasma capsulatum. Clinical presentation can vary from
the acute pulmonary to the chronic disseminated form. In
India, disseminated histoplasmosis often presents with pyrexia
of unknown origin with a presentation similar to ‘disseminated
tuberculosis’ involving the adrenal glands and bone marrow.
Due to rarity of the disease, data are lacking regarding its
clinical presentation and outcome among immunocompromised
and immunocompetent patients.
Methods. During January 2000 to December 2010, we
identified 37 patients of disseminated histoplasmosis and
attempted to characterize the differences between immunocompromised
and immunocompetent patients. Demographic
characteristics, clinical presentation, risk factors, laboratory
findings, diagnostic yield, treatment received and prognosis
were noted and compared between the two groups.
Results. Eleven of 37 patients with disseminated histoplasmosis
were immunocompromised and 26 were immunocompetent.
Comparison of their clinical features showed a
higher frequency of skin lesions in the immunocompromised
compared to the immunocompetent group (54.5% v. 11.5%).
Pancytopenia and anaemia were more common among the
immunocompromised (81.8%) compared to the
immunocompetent (46.2%) group. In the immunocompromised
patients, the diagnosis was made most often by
bone marrow aspirate and culture (72.7%) compared to the
immunocompromised group where the diagnosis was most
often obtained by adrenal gland biopsy and fungal cultures (57.7%). The cure rate was significantly higher in the
immunocompetent group (73% v. 45%).
Conclusion. The clinical presentation and outcome of
patients with disseminated histoplasmosis differs among
immunocompromised and immunocompetent patients.
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DEODHAR D, FRENZEN F, RUPALI P, DAVID D, PROMILA M, RAMYA I, SESHADRI M S. Disseminated histoplasmosis: A comparative study of the clinical features and outcome among immunocompromised and immunocompetent patients. National Medical Journal of India. 2013 Jul-Aug ; 26 (4): 214-215.