Mathieu Nacher1,2, Kinan Drak Alsibai3, Antoine Adenis1,2, Romain Blaizot2,4, Philippe Abboud5, Magalie Demar6,7, Félix Djossou5, Loïc Epelboin5, Caroline Misslin8, Balthazar Ntab9, Audrey Valdes10, Pierre Couppié2,4. 1. CIC INSERM 1424, Centre hospitalier Andree Rosemon Cayenne, Cayenne, French Guiana. 2. DFR Santé, Université de Guyane, Cayenne, French Guiana. 3. Department of Pathology, Centre hospitalier Andrée Rosemon, Cayenne, French Guiana. 4. Department of Dermatology, Centre hospitalier Andrée Rosemon, Cayenne, French Guiana. 5. Service des Maladies Infectieuses et Tropicales, Centre hospitalier Andrée Rosemon Cayenne, Cayenne, French Guiana. 6. Laboratory, Centre hospitalier Andrée Rosemon Cayenne, Cayenne, French Guiana. 7. UMR Tropical Biome and Immunopathology, Université de Guyane, Cayenne, French Guiana. 8. Service de Médecine, Centre hospitalier de l'Ouest Guyanais, Saint Laurent du Maroni, French Guiana. 9. Département d'Information Médicale, Centre hospitalier de l'Ouest Guyanais, Saint Laurent du Maroni, French Guiana. 10. Equipe Opérationnelle d'hygiène hospitalière, Centre hospitalier Andrée Rosemon Cayenne, Cayenne, French Guiana.
Abstract
Background: Disseminated histoplasmosis is a major killer of patients with advanced HIV. It is proteiform and often hard to diagnose in the absence of diagnostic tests. We aimed to describe disseminated histoplasmosis with lymphadenopathies in French Guiana and to compare survival and severity of those patients to patients without lymphadenopathies. Methods: A retrospective cohort study was performed on data records collected between January 1, 1981 and October 1, 2014. Results: Among 349 cases of disseminated histoplasmosis 168 (48.3%) had superficial lymphadenopathies and 133(38.1%) had deep lymphadenopathies. The median LDH concentration, ferritin concentration, TGO concentration, and WHO performance status were lower among patients with deep lymphadenopathies than those without deep lymphadenopathies. There was a significant decrease in the risk of early death (<1 month) among those with deep lymphadenopathies relative to those without (OR=0.26 (95%CI=0.10-0.60), P=0.0006) and in the overall risk of death (OR=0.33 (95%CI=0.20-0.55), P<0.0001). These associations remained strongly significant after adjusting for time period, CD4 counts, age, delay between beginning of symptoms and hospital admission, antifungal and antiretroviral treatment. Conclusions: The present data show that in patients with advanced HIV and disseminated histoplasmosis, the presence of deep lymphadenopathies is associated with fewer markers of severity and a lower risk of death. To our knowledge it is the first study to show this. The presence of deep lymphadenopathies is hypothesized to reflect the patient's partially effective defense against H. capsulatum.
Background: Disseminated histoplasmosis is a major killer of patients with advanced HIV. It is proteiform and often hard to diagnose in the absence of diagnostic tests. We aimed to describe disseminated histoplasmosis with lymphadenopathies in French Guiana and to compare survival and severity of those patients to patients without lymphadenopathies. Methods: A retrospective cohort study was performed on data records collected between January 1, 1981 and October 1, 2014. Results: Among 349 cases of disseminated histoplasmosis 168 (48.3%) had superficial lymphadenopathies and 133(38.1%) had deep lymphadenopathies. The median LDH concentration, ferritin concentration, TGO concentration, and WHO performance status were lower among patients with deep lymphadenopathies than those without deep lymphadenopathies. There was a significant decrease in the risk of early death (<1 month) among those with deep lymphadenopathies relative to those without (OR=0.26 (95%CI=0.10-0.60), P=0.0006) and in the overall risk of death (OR=0.33 (95%CI=0.20-0.55), P<0.0001). These associations remained strongly significant after adjusting for time period, CD4 counts, age, delay between beginning of symptoms and hospital admission, antifungal and antiretroviral treatment. Conclusions: The present data show that in patients with advanced HIV and disseminated histoplasmosis, the presence of deep lymphadenopathies is associated with fewer markers of severity and a lower risk of death. To our knowledge it is the first study to show this. The presence of deep lymphadenopathies is hypothesized to reflect the patient's partially effective defense against H. capsulatum.
Authors: Marcio Valle Cortez; Cintia Mara Costa de Oliveira; Rossicléia Lins Monte; José Ribamar de Araújo; Bruna Backsmann Braga; Débora Zotteli dos Reis; Luis Carlos de Lima Ferreira; Milton Ozório Moraes; Sinésio Talhari Journal: An Bras Dermatol Date: 2011 Sep-Oct Impact factor: 1.896