Table 1. Cases of histoplasmosis in/or from Bangladesh (N = 26).

Patient number/ Journal, Year/ Reference	Age/ Sex/ Occupation	Immune status	Clinical presentation	Physical signs	Important laboratory and imaging findings	Diagnostic test and form of histoplasmosis	Treatment and outcome
1/ BMRC Bull, 198216	69 years/ Male/ Not known	Not known	Nodular lesion in oral mucosa	Submandibular lymphadenopathy Hepatosplenomegaly	-	Histopathology from oral nodule. Disseminated histoplasmosis.	Amphotericin B. Anti-TB prescription. Cured with relapse at 16th month.
2/ JBCPS, 200535	41 years/ Male/ Businessman	Positive anti-HIV	Fever Weight loss Anorexia Sore throat Loose motion	Anemia Oral moniliasis Dehydration Cervical lymphadenopathy Hepatosplenomegaly	Hb = 7.7 gm/dL WBC = 3800/cmm Platelets = 150 000/cmm	Bone marrow study. Disseminated histoplasmosis.	Itraconazole. Expired in hospital due to septic shock.
3/ Transpl Infect Dis, 201017	60 years/ Male/ Builder	T2DM Renal transplant recipient	Fever Sore throat	Skin nodules	Hb = 11.1 gm/dL WBC = 3100/cmm LDH = 256 IU/L Abnormal chest imaging (nodules)	Biopsy and culture from skin nodule, broncho-alveolar lavage, and transbronchial biopsy. Epiglottic biopsy. Disseminated histoplasmosis.	Lipid amphotericin B. Itraconazole for an indefinite period. History of INH prophylaxis. Cured, no recurrence up to 2 years.
4/ BSMMUJ, 201018	45 years/ Male/ Fishing farm worker	HIV-negative	Fever Weight loss Abdominal pain	Anemia Generalized lymphadenopathy Growth in the oral cavity Ascites	Hb = 9.1 gm/dL ESR = 40 mm in first hour	Biopsy and histopathology from tongue growth and lymph node. Disseminated histoplasmosis.	Amphotericin B. Itraconazole (planned for one year). Improved up to six weeks.
5/ JHPN, 201019	32 years/ Male/ Storekeeper	Diagnosed AIDS	Fever Weight loss Anorexia	Cervical lymphadenopathy Splenomegaly Maculopapular rash	Hb = 9.6 gm/dL Esophageal candidiasis CD4 = 19/uL	Histopathology from lymph node. Disseminated histoplasmosis.	Amphotericin B (0.7 mg/kg/d for 21 days). Itraconazole (200 mg 12-h). Anti-TB Not known
6/ J Med, 201020	56 years/ Male/ Not known	HIV-negative	Fever Cough Shortness of breath Disorientation	Anemia	Hb = 9 gm/dL ESR = 60 mm in first hour Serum creatinine = 2.3 mg/dL Abnormal chest X-ray (infiltrates)	Bone marrow study. Disseminated histoplasmosis.	Amphotericin B. Anti-TB (presumptive). Expired due to aspiration pneumonia.
7/ J Med, 201021	57 years/ Male/ Farmer	Not known	Fever Back pain	Anemia Generalized lymphadenopathy Hepatomegaly Spastic paraparesis	Hb = 8.9 mg/dL ESR = 90 mm in first hour	Open biopsy from paravertebral tissue. Disseminated histoplasmosis.	Not known Not known
8/ Unpublished, 2010*	8 years/ Male/ Unknown	Not known	Fever Anorexia Weight loss Diarrhea	Anemia Generalized lymphadenopathy Hepatosplenomegaly	Hb = 8.3 gm/dL WBC = 5300/cmm Platelets = 132 000/cmm ESR = 89 mm in first hour	Lymph node culture. Disseminated histoplasmosis.	Anti-TB Expired
9/ J Med, 201122	65 years/ Male/ School teacher	HIV-negative	Fever Anorexia Weight loss Abdominal pain Cough Hemoptysis Vomiting Oral ulcer	Hepatomegaly Lung crepitation	ALT = 81.9 IU/L AST = 83.2 IU/L Abnormal chest X-ray (reticulonodular shadow). Bilateral adrenal masses.	FNAC from adrenal gland. Partial adrenal insufficiency. Disseminated histoplasmosis.	Anti-TB for eight months. Not known
10/ JBCPS, 201123	75 years/ Male/ Farmer	HIV-negative	Fever Anorexia Weight loss	Anemia Postural hypotension	ERS = 41 mm in first hour. Bilateral adrenal masses.	FNAC and culture from adrenal gland. Partial adrenal insufficiency. Disseminated histoplasmosis.	Amphotericin B (five doses) Itraconazole (one year). Cured, no recurrence up to 27 weeks of follow-up.
11/ J Med, 201224	60 years/ Male/ Not known	HIV-negative	Hoarseness of voice	Ulcerative growth in vocal cord	Abnormal chest X-ray (diffuse patchy opacity).	Histopathology from vocal cord specimen. Primary vocal cord histoplasmosis.	Amphotericin B (0.5 mg/kg EAD for 14 doses). Itraconazole (200 mg 12-h for 12 weeks). Anti-TB (two times) Improved and advised for follow-up.
12/ JAFMC, 201225	30 years/ Male/ Brick field worker	HIV positive	Fever Cough Bleeding from multiple sites Respiratory distress Loose stool Dis-orientation	Anemia Mucosal ulcers rash/plaques Abnormal chest auscultation	Pancytopenia ALT = 103 IU/L Alkaline phosphatase = 527 IU/L LDH = 1003 U/L Abnormal chest imaging (consolidation).	PBF and bone marrow study. Disseminated histoplasmosis.	Anti-TB for nine months (presumptive). Expired in hospital due to aspiration pneumonia.
13/ JBCPS, 201226	42 years/ Male/ Painter	HIV-negative	Oral ulcer Dysphagia Poor general health Diarrhea	Anemia Bilateral submandibular lymphadenopathy	-	Histopathology from oral ulcer. Localized to the oral cavity.	Itraconazole (200 mg 12-h for three weeks then maintenance dose). Cured, no recurance up to 2 months of follow-up.
14/ JBCPS, 201226	65 years/ Male/ Farmer	HIV-negative	Oral ulcer Poor general health	Anemia Bilateral submandibular lymphadenopathy	-	Histopathology from oral ulcer. Localized to oral cavity.	Itraconazole (200 mg BID for 4 weeks then maintenance dose). Cured, no recurance up to 2 months of follow-up.
15/ J Gen Pract, 201327	32 years/ Male/ Farmer	HIV-negative	Fever Weight loss Anorexia	Hepatosplenomegaly	ESR = 40 mm in first hour Bilateral adrenal masses	FNAC from adrenal gland. Disseminated histoplasmosis.	Anti-TB Not known
16/ Bang J Med. 201328	45 years/ Male/ Not known	T2DM HIV positive	Fever Cough Weight loss Orogenital ulcers	Anemia Rash Crepitation in lung Hepatomegaly	Hb = 8.2 gm/dL WBC = 3600/cmm Platelets = 103 000/cmm ESR = 115 mm in first hour ALT = 146 IU/L AST = 537 IU/L Alkaline phosphatase= 407 IU/L LDH = 826U/L CD4 = 4/uL	Bone marrow study. Disseminated histoplasmosis.	Amphotericin B Expired
17/ J Med, 201329	62 years/ Male/ Farmer	HIV-negative	Fever Back pain Paraplegia Bowel-bladder in-continence	Anemia Generalized lymphadenopathy Hepatosplenomegaly Spastic paraplegia	-	Lymph node biopsy CT-guided FNAC from paraspinal soft tissue. Disseminated histoplasmosis.	Amphotericin B Itraconazole Neurosurgical exploration. Improved (up to one month of follow-up).
18/ Mymensingh Med J, 201430	60 years/ Male/ Farmer	T2DM HIV-negative	Fever Cough Weight loss Sore throat Voice change	-	FBG = 12 mmol/L Patchy opacity in chest X-ray	Histopathology from vocal cord punch biopsy specimen (ulcer). Vocal cord histoplasmosis.	Amphotericin B (0.5 mg/kg/d for six weeks). Itraconazole (200 mg for 12 weeks). Anti-TB Improved up to three months of follow-up.
19/ Unpublished, 2014*	60 years/ Male/ Farmer	Not known	Weight loss Anorexia Weakness	Increased pigmentation	Hb = 10.9 gm/dl WBC = 10 800/cmm Platelets = 189 000/cmm ESR = 47 mm in first hour ALT = 41 IU/L ACTH stimulation test: partial adrenal insufficiency Bilateral adrenal enlargement	CT-guided FNAC from adrenal gland. Gum biopsy Anti-histoplasma antibody. Disseminated histoplasmosis.	Itraconazole Hydrocortisone Improved up to five months of follow-up.
20/ Unpublished, 2014*	42 years/ Male/ Farmer	Not known	Weight loss Anorexia Weakness	Increased pigmentation	Hb = 10.6 gm/dL WBC = 9700/cmm Platelets = 230 000/cmm ESR = 53 mm in first hour ALT = 65 IU/L ACTH stimulation test: partial adrenal insufficiency Bilateral adrenal enlargement	CT-guided FNAC from the adrenal gland. Anti-histoplasma antibody. Disseminated histoplasmosis.	Itraconazole Hydrocortisone Improved up to three months of follow-up.
21/ Unpublished, 2014*	59 years/ Male/ School teacher	T2DM HIV-negative	Fever Weight loss Anorexia	Anemia Jaundice Hepatoplenomegaly	Hb = 9.1 gm/dL WBC = 3900/cmm Platelets = 89 000/cmm ESR = 85 mm in first hour Bilateral adrenal enlargement	FNAC from the adrenal gland. Disseminated histoplasmosis.	Discharged against medical advice. Not known
22/ BSM Bull, 2015	40 years/ Male/ Not known	HIV-negative	Fever Weight loss Cough Anorexia Weakness	Anemia Pigmentation Hepatomegaly	Hb = 8.9 gm/dl Bilateral adrenal mass	USG guided FNAC from adrenal gland. Disseminated histoplasmosis.	Lipid formulation of amphotericin B (0.5 mg/kg/d for two weeks). Itraconazole (200 mg 12-h for 12 months). Anti-TB Not known
23/ Unpublished, 2015*	72 years/ Male/ Retired government employee	T2DM HIV-negative	Fever Weight loss Anorexia	Anemia	Hb = 9.6 gm/dl WBC = 6700/cmm Platelets = 165 000/cmm ESR= 67 mm in first hour HbA1c = 8.3% Bilateral adrenal enlargement	FNAC from the adrenal gland. Disseminated histoplasmosis.	Amphotericin B Itraconazole Improving
24/ Unpublished, 2015*	62 years/ Male/ Retired government employee	T2DM	Fever Anorexia Weight loss Cough Convulsion	Anemia	Hb = 8.7 gm/dl WBC = 4100/cmm Platelets = 153 000/cmm ESR = 45 mm in first hour HbA1c = 7.9% Bilateral adrenal enlargement	FNAC from the adrenal gland MRI of brain. Disseminated histoplasmosis.	Amphotericin B Itraconazole. Recurrence with CNS histoplasmosis (later expired).
25/ Unpublished, 2016*	42 years/ Male/ Service holder	HIV-negative	Fever Anorexia Weight loss	Hepatosplenomegaly	Hb = 12 gm/dl WBC = 5600/cmm Platelets = 222 000/cmm ESR = 78 mm in first hour Bilateral adrenal enlargement	FNAC from the adrenal gland. Disseminated histoplasmosis.	Itraconazole Anti-TB Not known
26/ BIRDEM Med J, 201831	42 years/ Male/ Not known	T2DM HIV-negative	Fever Anorexia Weight loss Pigmentation	-	Hb = 12.4 gm/dL WBC = 8300/cmm Platelets = 426 000/cmm ESR = 40 mm in first hour ALT = 91 IU/L AST = 82 IU/L HbA1c = 6.6% Bilateral adrenal enlargement	FNAC from the adrenal gland. ACTH stimulation test: no adrenal insufficiency. Disseminated histoplasmosis.	Amphotericin B (14 days). Itraconazole (planned for 18 months). Improved up to last (six month) visit.

Anti-TB: anti-tuberculosis; HIV: human immune deficiency virus; Hb: hemoglobin; WBC: white blood cells; T2DM: type 2 diabetes mellitus; LDH: lactate dehydrogenase; INH: isoniazid; ESR: erythrocyte sedimentation rate; AIDS: acquired immunodeficiency syndrome; CD: cluster of differentiation; ALT: alanine aminotransferase; AST: aspartate aminotransferase; FNAC: fine-needle aspiration cytology; EAD: every alternate day; PBF: peripheral blood film; FBG: fasting blood glucose; CT: computed tomography; ACTH: adrenocorticotropic hormone; USG: ultrasonography; HbA1c: glycated hemoglobin; MRI: magnetic resonance imaging; CNS: central nervous system; BID: twice a day.

*Note: Unpublished cases were recruited from three teaching hospitals, BIRDEM General Hospital (case 8, 21, 23 and 25), Bangabandhu Sheikh Mujib Medical University (cases 19 and 20) and Dhaka Medical College (Case 24), Dhaka, Bangladesh.

Missing data: physical signs (cases 18 and 26) and value/important laboratory and imaging findings (cases 1, 13, 14 and 17).