Table 1. HIV-associated disseminated histoplasmosis: comparison between patients with and without gastrointestinal symptoms and signs and positive identification of H. capsulatum in the digestive tract.
| Patient features | Disseminated histoplasmosis with a gastrointestinal presentation N = 65 | Disseminated histoplasmosis without a gastrointestinal presentation N = 103 | P |
|---|---|---|---|
| Sociodemographic | |||
| Mean age [SD] in years | 41.5 [9.2] | 40.9 [10.6] | 0.7 |
| Sex M F |
41 (38.3) 24 (39.3) |
66 (61.7) 37 (60.7) |
0.9 |
| Geographic origin N(%) | 0.001 | ||
| French Guiana | 19 (44.2) | 24 (55.8) | |
| Haiti | 5 (10.9) | 41 (89.1) | |
| Suriname | 14 (48.3) | 15 (50.7) | |
| Brazil | 20 (71.4) | 8 (28.6) | |
| Guyana | 2 (20) | 8 (80) | |
| Mainland France | 1 (16.7) | 5 (83.3) | |
| Other | 4 (66.6) | 2 (33.3) | |
| Median number of months in French Guiana [IQR] | 300 [96–432] | 228 [96–384] | P = 0.34 |
| Inclusion center N(%) | P = 0.11 | ||
| Cayenne | 39 (33.6) | 77 (66.4) | |
| Kourou | 8 (44.4) | 10 (55.6) | |
| Saint Laurent | 18 (52.9) | 16 (47.1) | |
| HIV infection data | |||
| Transmission mode | P = 0.4 | ||
| heterosexual | 62 (70.9) | 93 (29.1) | |
| Homosexual | 0 (57.1) | 3 (46.9) | |
| IV drug use | 0 (0) | 3 (100) | |
| Transfusion | 1 | 0 | |
| unknown | 2 (85.7) | 2 (14.3) | |
| HAART on admission Yes No |
11 (50) 55 (37.2) |
10 (50) 93 (62.8) |
P = 0.2 |
| Primary prophylaxis on admission Yes No |
12 (57.1) 53 (36) |
9 (42.9) 94 (64) |
0.06 |
| Histoplasmosis is AIDS-classifying event Yes No |
56 (43.7) 9 (22.5) |
72 (56.3) 31 (77.5) |
P = 0.01 |
| History of opportunistic infection Yes No |
11 (26.2) 31 (42.9) |
31 (73.8) 72 (57.1) |
P = 0.05 |
| Concomitant opportunistic infection Yes No |
25 (37.9) 40 (39.2) |
41 (62.1) 62 (60.8) |
P = 0.8 |
| Median CD4 count on admission [IQR] | |||
| Immunosuppression stage | P = 0.15 | ||
| CD4≥200 per mm3 | 4 (26.6) | 11 (73.4) | |
| CD4[50–200 [per mm3 | 25 (51) | 24 (49) | |
| CD4<50 per mm3 | 35 (34.3) | 67 (65.7) | |
| Clinical and paraclinical examination on admission | |||
| Impaired WHO general performance score (>2) Yes No |
24 (36.9) 41 (40) |
41 (63.1) 62 (60) |
P = 0.7 |
| Fever Yes No |
51 (36.4) 14 (50) |
89 (63.6) 14 (50) |
0.17 |
| Weight loss Yes No |
24 (39.3) 5 (50) |
37 (60.7) 5 (50) |
0.5 |
| Respiratory signs Yes No |
15 (21.4) 50 (51) |
55 (78.6) 48 (49) |
P<0.001 |
| Superficial adenopathies >2cm Yes No |
5 (14.7) 22 (46.8) |
29 (85.3) 25 (53.2) |
P = 0.002 |
| Cutaneous signs Yes No |
2 (15.4) 63 (40.6) |
11 (84.6) 92 (59.4) |
0.07 |
| Oral signs Yes No |
1 (7.1) 64 (41.6) |
13 (92.9) 90 (58.4) |
P = 0.01 |
| Neurological signs Yes No |
12 (40) 53 (384) |
18 (60) 85 (61.6) |
P = 0.8 |
| Abdominal ultrasound performed Yes No |
43 (39.1) 22 (37.9) |
67 (60.9) 36 (62.1) |
P = 0.8 |
| Endoscopy performed Yes No |
63 (76.8) 2 (2.3) |
19 (23.2) 84 (97.7) |
P<0.001 |
| Bone marrow aspiration Yes No |
13 (41.9) 52 (38) |
61 (58.1) 41 (62) |
P = 0.6 |
| Standard biological tests on admission | |||
| Hemoglobin Mean [SD] | 9.5 [2] | 9.3 [2.1] | P = 0.4 |
| Neutrophils (/mm3) Median [IQR] | 1550 [4–2650] | 1815 [1100–2790] | P = 0.07 |
| Platelets Median [IQR] | 154500 [353–269500] | 16500 [73000–249000] | P = 0.5 |
| Serum creatinine (μmol/L) Median [IQR] | 76 [60–97] | 79 [66–91] | P = 0.4 |
| Protein (g/L) Mean [SD] | 81.9 [14] | 80.6 [12.2] | P = 0.6 |
| Aspartate aminotransferase (IU/L) Median [IQR] | 40 [25–53] | 53 [32–95] | P = 0.004 |
| Alanine aminotransferase (IU/L) Median [IQR] | 22 [15–34] | 28 [17–52] | P = 0.07 |
| Gamma glutamyl transferase (IU/L) Median [IQR] | 74 [58–240] | 80 [43–195] | P = 0.4 |
| Alkaline phosphatase (IU/L) Median [IQR] | 125 [87–250] | 109 [71–228] | P = 0.22 |
| Lactico Deshydrogenase (LDH)(IU/L) Median [IQR] | 307 [227–407] | 482 [284–1308] | P = 0.0001 |
| CRP (mg/L) Median [IQR] | 43 [15–91] | 46 [13–87] | P = 0.8 |
| Ferritin (μg/L) Median [IQR] | 847 [272–1430] | 1057 [660–3080] | P = 0.03 |
| Prothrombin time Median [IQR] | 76 [68–85] | 86 [77–92] | P = 0.004 |
| Diagnosis and treatment of histoplasmosis | |||
| Delay between symptoms onset and diagnosis (days) Median[IQR] | 40 [20–133] | 78 [25–231] | P = 0.03 |
| Diagnostic method | |||
| Direct examination | 36/65 | 50/103 | P = 0.38 |
| Fungal culture | 45/65 | 60/103 | P = 0.15 |
| Pathology | 46/65 | 38/103 | P<0.001 |
| Initial treatment | |||
| Deoxycholate amphotericin B | 5/65 | 14/99 | P = 0.2 |
| Liposomal amphotericin B | 17.65 | 23/99 | P = 0.5 |
| Itraconazole | 55.65 | 49/69 | P = 0.2 |
| Death at 1 month after antifungal initiation Yes No |
3 (4.6) 62 (95.4) |
19 (18.5) 84 (81.5) |
P = 0.01 |