Histoplasmosis remains a prevalent opportunistic infection in Brazil. Many services lack bedside laboratory methods for diagnosis, requiring early clinical suspicion and invasive procedures for specimen collection. Understanding prevalent symptoms is important to improve suspicion of cases. Disseminated histoplasmosis cases hospitalized in a tertiary hospital between 2009 and 2024 were evaluated. Analysis was based on epidemiologic data and the main signs and symptoms at admission. Eighty-eight cases were evaluated (75 male, 13 female), aged 19 to 72 years. Death occurred in 28 cases (ages 19 to 70 years; mean 39.5; median 36), with 85.71% male. Among those discharged alive, characteristics were similar (ages 19 to 72; mean 38.3; median 38), with 85% male. Mean symptom duration was similar in both groups (2.85 vs. 2.98 months). There was no statistical difference in weight loss (mean 18.8% in deaths vs. 14.34% in survivors) or in prevalence of mucocutaneous lesions (57.14% vs. 56.66%). Diarrhea was more prevalent among deaths (60.71% vs. 43.33%), as was hepato- and/or splenomegaly (85.71% vs. 58.33%). There was also a difference in hemorrhagic events at admission (35.71% vs. 13.33%). Specimen collection for investigation was performed within the first three days of hospitalization in both populations. Pneumocystosis was more prevalent among deaths (53.57% vs. 13.33%), while mycobacterial infection showed the opposite pattern (7.14% vs. 13.33%). There was no statistical difference in time to diagnosis between groups. Differences were observed only in hemorrhagic events and hepato- and/or splenomegaly, both more prevalent among deaths. Identifying the most prevalent clinical alterations, especially in severe cases, is important to enable more timely diagnosis.
Gastaldi et al. (Sun,) studied this question.