Tropical medicine & international health : TM & IH | 2021
Review of diagnostic methods and results for HIV-associated disseminated histoplasmosis: pathologists are not sufficiently involved.
Abstract
OBJECTIVE\nDisseminated histoplasmosis is a major killer of HIV-infected persons in Latin America. Antigen detection, fungal culture and Polymerase Chain Reaction are often not available, but cytology and histology are present in most hospitals and may offer a diagnostic alternative. In this study, we review 34 years of clinical experience to describe the roles of cytology and histology in diagnosing disseminated histoplasmosis.\n\n\nMETHODS\nRetrospective multicentric study of 349 patients between January 1st, 1981 and October 1st, 2014 with confirmed disseminated histoplasmosis.\n\n\nRESULTS\n32/214 (14.9%) of samples were screened using cytopathology, as were 10/101 (9.9%) bronchoalveolar lavage samples and 5/61 (8.2%) of spinal fluid samples. The samples most commony sent to pathology were liver biopsies, lower digestive tract and lymphnode biopsies; the greatest proportion of positive results were found in lower digestive tract (43/59 (72.9%) positives), lymph node (39/63(66.1%)), and liver (38/75 (50.7%)) samples. Overall, 97.2% of bone marrow and 97% of bronchoalveolar lavage samples were directly examined by a mycologist. Positive direct examination was independently associated with death (aHR=1.5 (95%CI=1-2.2).\n\n\nCONCLUSIONS\nOpportunities for a rapid diagnosis were regularly missed, notably for bone marrow samples, which could have been examined using staining methods complementary to those of the mycologist.