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The Broad Clinical Spectrum of Disseminated Histoplasmosis in HIV-Infected Patients: A 30 Years’ Experience in French Guiana

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Service de Dermatologie-Vénérologie, Centre Hospitalier de Cayenne, Avenue des Flamboyants, BP 6006, 97300 Cayenne, France
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Equipe EA3593, Ecosystèmes Amazoniens et Pathologie Tropicale, Université de Guyane, 97300 Cayenne, France
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Service de Médecine B, Centre Hospitalier de Cayenne, 97300 Cayenne, France
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Laboratoire de Parasitologie-Mycologie, Centre Hospitalier de Cayenne, 97300 Cayenne, France
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Laboratoire d’Anatomie et Cytologie Pathologique, Centre Hospitalier de Cayenne, 97300 Cayenne, France
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Unité de Maladies Infectieuses et Tropicales, Centre Hospitalier de Cayenne, 97300 Cayenne, France
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Centre d’Investigation Clinique Antilles Guyane, Inserm CIC 1424, Centre Hospitalier de Cayenne, 97300 Cayenne, France
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Author to whom correspondence should be addressed.
J. Fungi 2019, 5(4), 115; https://doi.org/10.3390/jof5040115
Received: 18 July 2019 / Revised: 12 September 2019 / Accepted: 17 September 2019 / Published: 13 December 2019
(This article belongs to the Special Issue Histoplasma and Histoplasmosis)
Histoplasmosis is a common but neglected AIDS-defining condition in endemic areas for Histoplasma capsulatum. At the advanced stage of HIV infection, the broad spectrum of clinical features may mimic other frequent opportunistic infections such as tuberculosis and makes it difficult for clinicians to diagnose histoplasmosis in a timely manner. Diagnosis of histoplasmosis is difficult and relies on a high index of clinical suspicion along with access to medical mycology facilities with the capacity to implement conventional diagnostic methods (direct examination and culture) in a biosafety level 3 laboratory as well as indirect diagnostic methods (molecular biology, antibody, and antigen detection tools in tissue and body fluids). Time to initiation of effective antifungals has an impact on the patient’s prognosis. The initiation of empirical antifungal treatment should be considered in endemic areas for Histoplasma capsulatum and HIV. Here, we report on 30 years of experience in managing HIV-associated histoplasmosis based on a synthesis of clinical findings in French Guiana with considerations regarding the difficulties in determining its differential diagnosis with other opportunistic infections. View Full-Text
Keywords: HIV; histoplasmosis; histoplasma; French Guiana; South America HIV; histoplasmosis; histoplasma; French Guiana; South America
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Couppié, P.; Herceg, K.; Bourne-Watrin, M.; Thomas, V.; Blanchet, D.; Alsibai, K.D.; Louvel, D.; Djossou, F.; Demar, M.; Blaizot, R.; Adenis, A. The Broad Clinical Spectrum of Disseminated Histoplasmosis in HIV-Infected Patients: A 30 Years’ Experience in French Guiana. J. Fungi 2019, 5, 115.

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