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Clinical patterns of histoplasmosis in India

December 06 2017

Over 200 cases of disseminated histoplasmosis have been described in India since 2001, according to Ayush Gupta and colleagues from the All India Institute of Medical Sciences (AIIMS) in Delhi. First described in India in 1954, there has been an acceleration of reports and interest in histoplasmosis in India, even without the benefit of serological or molecular testing.  North and Northeast India seem to carry more cases, but no state had zero cases.

After identifying 204 cases in the literature and 10 at AIIMS, they summarized the similar and different clinical characteristics of both subacute and acute (progressive) disseminated histoplasmosis in non-immunocompromised and immune-compromised patients and found striking differences. Weight loss was common, but more common in subacute disease (60%), in contrast to lymphadenopathy which was distinctly uncommon in this group (14%).  Even more striking was the lack of adrenal involvement in immunocompromised patients (6%). Pulmonary involvement and skin lesions were more common immunocompromised infection (29% and 55%).

AIDS was the underlying diagnosis in 39 patients (72% of the immunocompromised cases). Both forms of disease occurred at all ages, but subacute disease in non-immunocompromised patients was more common in the 40-70 age group. Men were affected 6 times as frequently as women, a possibly explained by occupation and exposure. As expected, survival was also better in this group at 90% vs 73%. Responses to therapy with either itraconazole or amphotericin B were sub-optimal (<50%). This remarkable disparity with responses in prospective therapy studies needs addressing.

 

Read the full paper: Gupta et al (2017) A Twenty-First-Century Perspective of Disseminated Histoplasmosis in India: Literature Review and Retrospective Analysis of Published and Unpublished Cases at a Tertiary Care Hospital in North India. Mycopathologia 182:1077–1093