TY - JOUR
T1 - A comparison of presentations and outcomes of histoplasmosis across patients with varying immune status
AU - Franklin, Alexander D.
AU - Larson, Lindsey
AU - Rauseo, Adriana M.
AU - Rutjanawech, Sasinuch
AU - Hendrix, Michael Joshua
AU - Powderly, William G.
AU - Spec, Andrej
N1 - Funding Information:
Research reported in this publication was supported by the Washington University Institute of Clinical and Translational Sciences grant UL1TR002345 from the National Center for Advancing Translational Sciences (NCATS) of the National Institutes of Health (NIH). The content is solely the responsibility of the authors and does not necessarily represent the official view of the NIH.
Publisher Copyright:
© 2021 The Author(s) 2021. Published by Oxford University Press on behalf of The International Society for Human and Animal Mycology.
PY - 2021/6/1
Y1 - 2021/6/1
N2 - Few large cohorts have examined histoplasmosis in both immunocompromised and immunocompetent patients. We describe the differences in presentations and outcomes of histoplasmosis by immune and dissemination status. We assembled a retrospective cohort of adult patients diagnosed with histoplasmosis from 2002 to 2017. Patients were grouped by immune status: people living with HIV (PLWH), patients who were HIV negative but had other-immunocompromise (OIC), and immunocompetent patients. Patients were further classified into asymptomatic lung nodule (ALN), localized and disseminated disease groups, and outcomes were compared across patients by these immune status categories We identified 261 patients with histoplasmosis: 54 (21%) PLWH, 98 (38%) OIC, and 109 (42%) immunocompetent. Disseminated disease was more common among PLWH than among other groups (P <. 001). In localized disease, median time from symptom onset to diagnosis was longer in immunocompetent patients than in other groups (P =. 012), and was not significant in disseminated disease. The 90-day mortality was higher in PLWH (25%) and OIC (26%) with localized disease compared to the immunocompetent group (4%) (P =. 009), but this difference was not seen in disseminated disease. Patients with localized disease had lower 90-day mortality (14%) compared to those with disseminated disease (21%) (P =. 034). We conclude that immunocompetent individuals present with fewer typical symptoms, laboratory findings, and radiographic features of Histoplasma infection, leading to potential delays in diagnosis in this group. Despite this, immunocompetent patients have lower 90-day mortality in localized disease, and do not experience increased 90-day mortality in disseminated disease.
AB - Few large cohorts have examined histoplasmosis in both immunocompromised and immunocompetent patients. We describe the differences in presentations and outcomes of histoplasmosis by immune and dissemination status. We assembled a retrospective cohort of adult patients diagnosed with histoplasmosis from 2002 to 2017. Patients were grouped by immune status: people living with HIV (PLWH), patients who were HIV negative but had other-immunocompromise (OIC), and immunocompetent patients. Patients were further classified into asymptomatic lung nodule (ALN), localized and disseminated disease groups, and outcomes were compared across patients by these immune status categories We identified 261 patients with histoplasmosis: 54 (21%) PLWH, 98 (38%) OIC, and 109 (42%) immunocompetent. Disseminated disease was more common among PLWH than among other groups (P <. 001). In localized disease, median time from symptom onset to diagnosis was longer in immunocompetent patients than in other groups (P =. 012), and was not significant in disseminated disease. The 90-day mortality was higher in PLWH (25%) and OIC (26%) with localized disease compared to the immunocompetent group (4%) (P =. 009), but this difference was not seen in disseminated disease. Patients with localized disease had lower 90-day mortality (14%) compared to those with disseminated disease (21%) (P =. 034). We conclude that immunocompetent individuals present with fewer typical symptoms, laboratory findings, and radiographic features of Histoplasma infection, leading to potential delays in diagnosis in this group. Despite this, immunocompetent patients have lower 90-day mortality in localized disease, and do not experience increased 90-day mortality in disseminated disease.
KW - Histoplasma
KW - histoplasmosis
KW - immune status
KW - outcomes
UR - http://www.scopus.com/inward/record.url?scp=85106606132&partnerID=8YFLogxK
U2 - 10.1093/mmy/myaa112
DO - 10.1093/mmy/myaa112
M3 - Article
C2 - 33443574
AN - SCOPUS:85106606132
SN - 1369-3786
VL - 59
SP - 624
EP - 633
JO - Medical Mycology
JF - Medical Mycology
IS - 6
ER -