Histoplasmosis is a fungal infection still associated with high morbidity and mortality in immunosuppressed patients, especially those coinfected with HIV. Although laboratory methods that allow rapid diagnosis exist, they are not widely available due to high cost. Thus, diagnosis is still based on clinical suspicion and sterile specimen collection, often with invasive methods. It is therefore important to determine the main clinical findings associated with this infection. Deaths occurring in a tertiary hospital between 2009 and 2024 with histoplasmosis diagnosed during hospitalization (confirmed by fungal culture) were analyzed. Epidemiologic data and main presenting signs and symptoms were collected. Twenty-eight cases were evaluated (24 male, 4 female), aged 19 to 70 years (mean 39.5; median 36). In 10 cases, HIV diagnosis was made during hospitalization. 35.71% reported illicit drug use, smoking, and alcohol use; another 17.85% had at least one of these dependencies. Symptom duration ranged from 1 to 6 months (mean 2.85 months). The most commonly reported symptom was weight loss (96.42%), with mean loss of 18.8% of previous body weight. Other prevalent symptoms were fever (89.28%), diarrhea (60.71%), and cough and/or dyspnea (57.14%). On physical examination, hepato- and/or splenomegaly occurred in 85.71% and mucocutaneous lesions in 57.14%. Tachypnea was observed in 71.42%, more prevalent than respiratory complaints. The triad of hepato- and/or splenomegaly, diarrhea, and mucocutaneous lesions was recorded in 53.57%. All cases underwent investigation for mycobacterial infection (confirmed in only 2 cases), and bone marrow aspirate and/or skin biopsy sampling. In 4 patients, Cryptococcus neoformans was isolated in addition to Histoplasma. Pneumocystosis was diagnosed in 15 (53.57%) cases. Death occurred between 2 and 163 days of hospitalization (mean 21.5 days), on average 16.6 days after fungal infection diagnosis (3 were diagnosed post-mortem). The analyzed patients already had severe clinical compromise at admission. There are no specific symptoms in this infection, making early diagnosis and treatment essential.
Gastaldi et al. (Sun,) studied this question.