How Many Have Died from Undiagnosed Human Immunodeficiency Virus–Associated Histoplasmosis, A Treatable Disease? Time to Act

Mathieu Nacher Centre d'Investigation Clinique Epidémiologie Clinique Antilles Guyane CIC-EC CIE 802, Cayenne General Hospital, Cayenne, French Guiana; Coordination Regionale de la Lutte Contre le VIH de Guyane, Laboratoire Hospitalo-Universitaire de Parasitologie Mycologie, Unité des Maladies Infectieuses et Tropicale, et Service de Dermatologie Vénéréologie, Centre Hospitalier de Cayenne, Cayenne, French Guiana; Equipe EPaT EA3593 Epidemiologie des Parasitoses et Mycoses Tropicales, Université Antilles Guyane, Cayenne, French Guiana

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Antoine Adenis Centre d'Investigation Clinique Epidémiologie Clinique Antilles Guyane CIC-EC CIE 802, Cayenne General Hospital, Cayenne, French Guiana; Coordination Regionale de la Lutte Contre le VIH de Guyane, Laboratoire Hospitalo-Universitaire de Parasitologie Mycologie, Unité des Maladies Infectieuses et Tropicale, et Service de Dermatologie Vénéréologie, Centre Hospitalier de Cayenne, Cayenne, French Guiana; Equipe EPaT EA3593 Epidemiologie des Parasitoses et Mycoses Tropicales, Université Antilles Guyane, Cayenne, French Guiana

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Christine Aznar Centre d'Investigation Clinique Epidémiologie Clinique Antilles Guyane CIC-EC CIE 802, Cayenne General Hospital, Cayenne, French Guiana; Coordination Regionale de la Lutte Contre le VIH de Guyane, Laboratoire Hospitalo-Universitaire de Parasitologie Mycologie, Unité des Maladies Infectieuses et Tropicale, et Service de Dermatologie Vénéréologie, Centre Hospitalier de Cayenne, Cayenne, French Guiana; Equipe EPaT EA3593 Epidemiologie des Parasitoses et Mycoses Tropicales, Université Antilles Guyane, Cayenne, French Guiana

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Denis Blanchet Centre d'Investigation Clinique Epidémiologie Clinique Antilles Guyane CIC-EC CIE 802, Cayenne General Hospital, Cayenne, French Guiana; Coordination Regionale de la Lutte Contre le VIH de Guyane, Laboratoire Hospitalo-Universitaire de Parasitologie Mycologie, Unité des Maladies Infectieuses et Tropicale, et Service de Dermatologie Vénéréologie, Centre Hospitalier de Cayenne, Cayenne, French Guiana; Equipe EPaT EA3593 Epidemiologie des Parasitoses et Mycoses Tropicales, Université Antilles Guyane, Cayenne, French Guiana

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Vincent Vantilcke Centre d'Investigation Clinique Epidémiologie Clinique Antilles Guyane CIC-EC CIE 802, Cayenne General Hospital, Cayenne, French Guiana; Coordination Regionale de la Lutte Contre le VIH de Guyane, Laboratoire Hospitalo-Universitaire de Parasitologie Mycologie, Unité des Maladies Infectieuses et Tropicale, et Service de Dermatologie Vénéréologie, Centre Hospitalier de Cayenne, Cayenne, French Guiana; Equipe EPaT EA3593 Epidemiologie des Parasitoses et Mycoses Tropicales, Université Antilles Guyane, Cayenne, French Guiana

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Magalie Demar Centre d'Investigation Clinique Epidémiologie Clinique Antilles Guyane CIC-EC CIE 802, Cayenne General Hospital, Cayenne, French Guiana; Coordination Regionale de la Lutte Contre le VIH de Guyane, Laboratoire Hospitalo-Universitaire de Parasitologie Mycologie, Unité des Maladies Infectieuses et Tropicale, et Service de Dermatologie Vénéréologie, Centre Hospitalier de Cayenne, Cayenne, French Guiana; Equipe EPaT EA3593 Epidemiologie des Parasitoses et Mycoses Tropicales, Université Antilles Guyane, Cayenne, French Guiana

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Bernard Carme Centre d'Investigation Clinique Epidémiologie Clinique Antilles Guyane CIC-EC CIE 802, Cayenne General Hospital, Cayenne, French Guiana; Coordination Regionale de la Lutte Contre le VIH de Guyane, Laboratoire Hospitalo-Universitaire de Parasitologie Mycologie, Unité des Maladies Infectieuses et Tropicale, et Service de Dermatologie Vénéréologie, Centre Hospitalier de Cayenne, Cayenne, French Guiana; Equipe EPaT EA3593 Epidemiologie des Parasitoses et Mycoses Tropicales, Université Antilles Guyane, Cayenne, French Guiana

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Pierre Couppié Centre d'Investigation Clinique Epidémiologie Clinique Antilles Guyane CIC-EC CIE 802, Cayenne General Hospital, Cayenne, French Guiana; Coordination Regionale de la Lutte Contre le VIH de Guyane, Laboratoire Hospitalo-Universitaire de Parasitologie Mycologie, Unité des Maladies Infectieuses et Tropicale, et Service de Dermatologie Vénéréologie, Centre Hospitalier de Cayenne, Cayenne, French Guiana; Equipe EPaT EA3593 Epidemiologie des Parasitoses et Mycoses Tropicales, Université Antilles Guyane, Cayenne, French Guiana

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Human immunodeficiency virus (HIV)–associated disseminated Histoplasma capsulatum capsulatum infection often mimics tuberculosis. This disease is well know in the United States but is dramatically underdiagnosed in Central and South America. In the Amazon region, given the available incidence data and the regional HIV prevalence, it is expected that, every year, 1,500 cases of histoplasmosis affect HIV patients in that region alone. Given the mortality in undiagnosed patients, at least 600 patients would be expected to die from an undiagnosed but treatable disease. The lack of a simple diagnostic tool and the lack of awareness by clinicians spiral in a vicious cycle and made a major problem invisible for 30 years. The HIV/acquired immunodeficiency syndrome community should tackle this problem now to prevent numerous avoidable deaths from HIV-associated histoplasmosis in the region and elsewhere.

Author Notes

* Address correspondence to Mathieu Nacher, Centre Hospitalier de Cayenne, Rue des Famboyants, Cayenne 97300, French Guiana. E-mail: mathieu.nacher@ch-cayenne.fr

Authors' addresses: Mathieu Nacher, Centre Hospitalier de Cayenne, Rue des Flamboyants, Cayenne 97300, French Guiana, E-mail: mathieu.nacher@ch-cayenne.fr. Antoine Adenis, Centre d'Investigation Clinique Epidémiologie Clinique Antilles Guyane, INSERM DGOS CIE 802, Cayenne General Hospital, Avenue des Flamboyants, Cayenne 97306, French Guiana, E-mail: antoine.adenis@ch-cayenne.fr. Christine Aznar, Service Hospitalo Universitaire de Parasitologie Mycologie, Centre Hospitalier de Cayenne, Cayenne, French Guiana, E-mail: christine.aznar@ch-cayenne.fr. Denis Blanchet, Laboratoire Hospitalo Universitaire de Parasitologie Mycologie, Centre Hospitalier de Cayenne, Cayenne, French Guiana, E-mail: denis.blanchet@ch-cayenne.fr. Vincent Vantilcke, Service de Médecine, Centre Hospitalier de l'Ouest Guyanais, Saint Laurent du Maroni, French Guiana, E-mail: v.vantilcke@ch-ouestguyane.fr. Magalie Demar, Department of Infectious and Tropical Disease, Centre Hospitalier Andrée Rosemon, Cayenne, French Guiana, E-mail: magalie.demar@ch-cayenne.fr. Bernard Carme, Centre d'Investigation Clinique Épidémiologie Clinique Antilles Guyane, CIE INSERM 802, Pole de Guyane, Centre Hospitalier de Cayenne, Cayenne, French Guiana, E-mail: bernard.carme@ch-cayenne.fr. Pierre Couppié, Equipe EA 3593, Epidemiologie des Parasitoses et Mycoses Tropicales, Universite des Antilles et de la Guyane, Cayenne, French Guiana, E-mail: couppie.pierre@voila.fr.

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