Volume 90, Issue 2
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645



In disease-endemic areas, histoplasmosis is the main differential diagnosis for tuberculosis among human immunodeficiency virus (HIV)–infected patients. However, no study has compared the two diseases. Thus, the objective of this study was to compare tuberculosis and histoplasmosis in HIV-infected patients. A population of 205 HIV-infected patients (99 with tuberculosis and 106 with histoplasmosis) hospitalized in Cayenne, French Guiana during January 1, 1997–December 31, 2008 were selected retrospectively from the French Hospital Database on HIV. Multivariate analysis showed that tuberculosis was associated with cough (adjusted odds ratio [AOR] = 0.20, 95% confidence interval [CI] = 0.05–0.73) and a C-reactive protein level > 70 mg/L (AOR = 0.98, 95% CI = 0.97–0.99). Variables associated with disseminated histoplasmosis were a γ-glutamyl transferase level > 72 IU/L (AOR = 4.99, 95% CI = 1.31–18.99), origin from French Guiana (AOR = 5.20, 95% CI = 1.30–20.73), disseminated localization (AOR = 6.40, 95% CI = 1.44–28.45), a concomitant opportunistic infection (AOR = 6.71, 95% CI = 1.50–29.96), a neutrophil count < 2,750 cells/mm (AOR = 10.54, 95% CI = 2.83–39.24), a CD4 cell count < 60 cells/mm (AOR = 11.62, 95% CI = 2.30–58.63), and a platelet count < 150,000/mm (AOR = 19.20, 95% CI = 3.35–110.14). Tuberculosis and histoplasmosis have similarities, but some factors show a greater association with one of these diseases. Thus, adapted therapeutic choices can be made by using simple clinical and paraclinical criteria.


Article metrics loading...

Loading full text...

Full text loading...



  1. Nacher M, El Guedj M, Vaz T, Nasser V, Randrianjohany A, Alvarez F, Sobesky M, Magnien C, Couppié P, , 2005. Risk factors for late HIV diagnosis in French Guiana. AIDS 19: 727729.[Crossref]
  2. Lewden C, Sobesky M, Cabié A, Couppié P, Boulard F, Bissuel F, May T, Morlat P, Chêne G, Lamaury I, Salmon D, Group d'Étude Mortalité 2000; , 2004. Causes of death among HIV infected adults in French Guyana and the French West Indies in the era of highly active antiretroviral therapy (HAART [in French]. Med Mal Infect 34: 286292.[Crossref]
  3. Nacher M, Aznar C, Blanchet D, Demar M, El Guedy M, Vaz T, Clyti E, Carme B, Couppié P, , 2006. AIDS-related disseminated histoplasmosis in the greater Caribbean: how frequent is it? AIDS 20: 951952.[Crossref]
  4. Wheat LJ, Connolly-Stringfield PA, Baker RL, Curfman MF, Eads ME, Israel KS, Norris SA, Webb DH, Zeckel ML, , 1990. Disseminated histoplasmosis in the acquired immune deficiency syndrome: clinical findings, diagnosis and treatment, and review of the literature. Medicine (Baltimore) 69: 361374.[Crossref]
  5. Jones BE, Young SM, Antoniskis D, Davidson PT, Kramer F, Barnes PF, , 1993. Relationship of the manifestations of tuberculosis to CD4 cell counts in patients with human immunodeficiency virus infection. Am Rev Respir Dis 148: 12921297.[Crossref]
  6. Couppié P, Aznar C, Carme B, Nacher M, , 2006. American histoplasmosis in developing countries with a special focus on patients with HIV: diagnosis, treatment, and prognosis. Curr Opin Infect Dis 19: 443449.[Crossref]
  7. Chan KS, Looi LM, Chan SP, , 1993. Disseminated histoplasmosis mimicking miliary tuberculosis: a case report. Malays J Pathol 15: 155158.
  8. Tong P, Tan WC, Pang M, , 1983. Sporadic disseminated histoplasmosis simulating miliary tuberculosis. Br Med J (Clin Res Ed) 287: 822823.[Crossref]
  9. Greene L, Peters B, Lucas SB, Pozniak AL, , 2000. Extrapulmonary tuberculosis masking disseminated histoplasmosis in AIDS. Sex Transm Infect 76: 5456.[Crossref]
  10. Bulmer AC, Bulmer GS, , 2001. Incidence of histoplasmin hypersensitivity in the Philippines. Mycopathologia 149: 6971.[Crossref]
  11. Rezende RE, Brunaldi MO, Girão MS, Zucoloto S, Garcia SB, Machado AA, Módena JL, , 2009. Case report: esophageal histoplasmosis associated with disseminated tuberculosis in acquired immunodeficiency syndrome. Am J Trop Med Hyg 80: 347350.
  12. Hay RJ, White HS, Fields PE, Quamina DB, Dan M, Jones TR, , 1981. Histoplasmosis in the eastern Caribbean: a preliminary survey of the incidence of the infection. J Trop Med Hyg 84: 912.
  13. Floch H, , 1953. Histoplasmosis in French Guiana [in French]. Ann Parasitol Hum Comp 28: 108125.
  14. Eza D, Cerrillo G, Moore DA, Castro C, Ticona E, Morales D, Cabanillas J, Barrantes F, Alfaro A, Benavides A, Rafael A, Valladares G, Arevalo F, Evans CA, Gilman RH, , 2006. Postmortem findings and opportunistic infections in HIV-positive patients from a public hospital in Peru. Pathol Res Pract 202: 767775.[Crossref]
  15. Souza SL, Feitoza PV, Araújo JR, Andrade RV, Ferreira LC, , 2008. Causes of death among patients with acquired immunodeficiency syndrome autopsied at the Tropical Medicine Foundation of Amazonas [in Portuguese]. Rev Soc Bras Med Trop 41: 247251.[Crossref]
  16. Huber F, Nacher M, Aznar C, Pierre-Damar M, El Guedj M, Vaz T, Vantilcke V, Mahamat A, Magnien C, Chauvet C, Carme A, Couppié P, , 2008. AIDS-related Histoplasma capsulatum var. capsulatum infection: 25 years experience of French Guiana. AIDS 22: 10471053.[Crossref]
  17. Darling ST, , 1906. A protozoon general infection producing pseudotubercles in the lungs and focal necrosis in the liver, spleen and lymph nodes. JAMA 46: 12831285.[Crossref]
  18. Oken MM, Creech RH, Tormey DC, Horton J, Davies TE, McFadden ET, Carbone RP, , 1982. Toxicity and response criteria of the Eastern Cooperative Oncology Group. Am J Clin Oncol 5: 649655.[Crossref]
  19. StataCorp, 2007. Stata Statistical Software: Release 10. College Station, TX: StataCorp LP.
  20. Hosmer DW, Jr Wang CY, Lin IC, Lemeshow S, , 1978. A computer program for stepwise logistic regression using maximum likelihood estimation. Comput Programs Biomed 8: 121134.[Crossref]
  21. Walls K, Furcolow ML, Lehan PH, , 1958. Histoplasmosis as a problem in tuberculosis sanatoriums throughout the United States. J Lab Clin Med 51: 266270.
  22. Furcolow ML, Brasher CA, , 1956. Chronic progressive (cavitary) histoplasmosis as a problem in tuberculosis sanatoriums. Am Rev Tuberc 73: 609619.
  23. Corcoran GR, Al-Abdely H, Flanders CD, Geimer J, Patterson TF, , 1997. Markedly elevated serum lactate dehydrogenase levels are a clue to the diagnosis of disseminated histoplasmosis in patients with AIDS. Clin Infect Dis 24: 942944.[Crossref]
  24. Dos Santos RP, Scheid KL, Goldani LZ, , 2008. Laboratory features for presumptive diagnosis of disseminated tuberculosis in HIV-infected patients. Int J Tuberc Lung Dis 12: 13401343.
  25. Guturu P, Sarria JC, , 2008. Extreme hyperferritenemia in an AIDS patient with disseminated histoplasmosis. J Infect 57: 356357.[Crossref]
  26. Couppié P, Sobesky M, Aznar C, Bichat S, Clyti E, Bissuel F, El Guedj M, Alvarez F, Demar M, Louvel D, Pradinaud R, Carme B, , 2004. Histoplasmosis and acquired immunodeficiency syndrome: a study of prognostic factors. Clin Infect Dis 38: 134138.[Crossref]

Data & Media loading...

  • Received : 12 Feb 2013
  • Accepted : 04 Sep 2013

Most Cited This Month

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error