Disseminated Histoplasmosis: Fighting a neglected killer of patients with advanced HIV disease in Latin America

About the Authors: Mathieu Nacher * E-mail: mathieu.nacher66@gmail.com Affiliation: CIC INSERM 1424, Centre Hospitalier de Cayenne, rue des Flamboyants, Cayenne French Guiana ORCID logo http://orcid.org/0000-0001-9397-3204 Pierre Couppié Affiliation: Dermatology Department, Centre Hospitalier de Cayenne, rue des Flamboyants, Cayenne French Guiana Loic Epelboin Affiliation: Infectious Diseases Department, Centre Hospitalier de Cayenne, rue des Flamboyants, Cayenne French Guiana Félix Djossou Affiliation: Infectious Diseases Department, Centre Hospitalier de Cayenne, rue des Flamboyants, Cayenne French Guiana Magalie Demar Affiliations Parasitology-Mycology laboratory, Centre Hospitalier de Cayenne, rue des Flamboyants, Cayenne French Guiana, UMR Tropical Biome and Immuno-pathophysiology, Université de Guyane, Cayenne French Guiana Antoine Adenis Affiliation: CIC INSERM 1424, Centre Hospitalier de Cayenne, rue des Flamboyants, Cayenne French Guiana ORCID logo http://orcid.org/0000-0003-4000-4981 Citation: Nacher M, Couppié P, Epelboin L, Djossou F, Demar M, Adenis A (2020) Disseminated Histoplasmosis: Fighting a neglected killer of patients with advanced HIV disease in Latin America. [...]in Panama, 7.6% of patients had culture-proven histoplasmosis [9]; in Venezuela, histoplasmosis was documented in 43 of 200 (21.3%) [10]; in Fortaleza, Brazil, of 378 consecutive hospitalized HIV patients, 164 (43.4%) had disseminated histoplasmosis [11]; A recent screening study in hospitalized HIV patients in Brazil found high Histoplasma antigen prevalence, ranging from 8.8% in Porto Alegre to 44.8% in Natal. [12] In French Guiana, with an overall incidence of 1.5 per 100 person years and 10 per 100 person years for patients with cluster of differentiation lymphocytes 4 (CD4) counts less than 50 per mm3, disseminated histoplasmosis has been the first AIDS-defining illness and the first cause of death in French Guiana; [13,14] among hospitalized HIV-infected patients with advanced HIV, 42% had disseminated histoplasmosis, among those with CD4 counts less than 50 per mm3, 85% had histoplasmosis. Increasing publication numbers helped the Global Action Fund for Fungal Infections (GAFFI) to make the case for the inclusion of itraconazole in the WHO essential drugs list (2017) and Histoplasma antigen detection tests in the WHO list of essential diagnostic tests (2019).