Differentiating proven progressive disseminated histoplasmosis from other diagnoses in hospitalized persons with HIV and suspected progressive disseminated histoplasmosis: Findings from a clinical and demographic study in Mexico

作者：María Dolores Niembro-Ortega, Areli Martínez‐Gamboa, Antonio Olivas‐Martínez, Brenda Crabtree‐Ramírez, Janeth Santiago-Cruz, Andrea Rangel‐Cordero, Pedro Torres‐González, Armando Gamboa‐Domínguez, Víctor Hugo Lozano, Víctor Hugo Ahumada-Topete, Pedro Martínez-Ayala, Marisol Manríquez-Reyes, Juan Pablo Ramírez-Hinojosa, Patricia Rodríguez‐Zulueta, Jesús Arturo Ruiz-Quiñones, Christian Hernández-León, Norma E. Rivera-Martínez, Alberto Chaparro-Sánchez, Jaime Andrade‐Villanueva, Luz Alicia González-Hernández, Sofia Cruz-Martínez, Oscar Flores-Barrientos, Jesús Gaytán‐Martínez, Axel Cervantes‐Sanchez, Nancy Guadalupe Velázquez-Zavala, María del Roció Reyes-Montes, Esperanza Duarte Escalante, María Guadalupe Frías‐De‐León, José Antonio Ramírez, Mária Lucía Taylor, José Sifuentes‐Osornio, Alfredo Ponce‐de‐León · 发表于：PLoS neglected tropical diseases · 年份：2025 · DOI：10.1371/journal.pntd.0013527 · 被引用次数：3 · 研究领域：Fungal Infections and Studies、Infectious Diseases and Tuberculosis、Diagnosis and treatment of tuberculosis

BACKGROUND: Progressive disseminated histoplasmosis (PDH) is a leading cause of morbidity and mortality among persons with HIV (PWH) in the Americas. Clinical presentation often overlaps with other opportunistic infections -especially tuberculosis (TB)- and sensitive diagnostics are frequently unavailable. In Mexico, epidemiological data on histoplasmosis in PWH are scarce. This study aims to describe the clinical and demographic characteristics along with final diagnosis of hospitalized PWH who had clinical suspicion of progressive disseminated histoplasmosis. METHODOLOGY/PRINCIPAL FINDINGS: We conducted a multicenter, prospective, cross-sectional study involving 415 hospitalized PWH and clinical suspicion of PDH across ten tertiary care hospitals in Mexico. Participants underwent comprehensive evaluation for Histoplasmosis infection, including cultures, histopathology, and urine antigen testing. Of the total cohort, 108 patients (26%) had proven PDH, 162 (39%) received an alternative diagnosis, and 145 (35%) had no definitive diagnosis. In univariate analyses, proven PDH was more frequently associated with skin lesions, thrombocytopenia, elevated AST and LDH levels (>2x ULN), and micronodular infiltrates on chest imaging. In contrast, lymphadenopathy, tree-in-bud patterns, pleural effusion, hepatomegaly, and splenomegaly in imaging were more commonly observed in patients without proven PDH. Among patients without proven PDH, 41 met the criteria for probable PDH. Compared wi...