Table 5.

Co-occurrence of pediatric histoplasmosis with TB/pneumonia.

Sex/Age/Country	Clinical findings	HIV	Initial diagnosis	Diagnostic method/Final diagnosis	Treatment/outcome	References
M/12/ Guinea-Bissau	Multiple cervical nodules, axillary, and inguinal cutaneous fistulas. Painful supra pubic abdominal mass. CT scan: micro-nodules and hilar calcifications on the left lower lobe. Sputum culture for TB was positive.	N	Lymphoma/Pulmonary TB	Cervical nodular biopsy: Histoplasma duboisii, swab cultures of the exudates: Histoplasma duboisii	6 months course of anti-TB therapy but did not improve. Patient recovered with Posaconazole	Gonçalves et al. 32
M/12/ Tanzania	Productive cough and intermittent low-grade evening fevers for 1 year and shortness of breath of 1 week duration	N	TB/Recurrent TB	AFB; initially positive, then became negative after completion of anti-TB therapy. Post-mortem findings showed yeast cells suggestive of Histoplasma capsulatum	No improvement after commencement of anti TB therapy and repeated anti-TB therapy. Patient died	Kabangila et al. 24
F/8/ South Africa	Fever, malaise, and respiratory distress. Examination findings: pallor with generalized lymphadenopathy. Punched out painless ulcer on her left lower leg, ulcerative lesions on the tip of her tongue and the angle of her mouth; tender hepatomegaly. Chest radiograph: right upper lobe consolidation with cavitation. Direct immunofluorescence and culture of the oral lesions yielded herpes simplex type 1.	P	Herpesvirus infection, severe community-acquired pneumonia, Pneumocystis carinii infection	Bone marrow aspirate and trephine biopsy (revealed yeast forms of H. capsulatum /DH	Patient died before antifungal therapy could be commenced. Postmortem specimens from lung, liver, lower limb skin lesion and lymph node demonstrated histoplasmosis.	Pillay et al. 27

AFB, acid-fast bacilli; CT, computed tomography; DH, disseminated histoplasmosis; N, negative; P, positive; TB, tuberculosis.