Tuberculosis and Histoplasmosis among Human Immunodeficiency Virus–Infected Patients: A Comparative Study

Antoine Adenis Centre d'Investigation Clinique Epidémiologie Clinique Antilles-Guyane, Service de Dermatologie Vénérologie, et Laboratoire Hospitalo-Universitaire de Parasitologie-Mycologie, Inserm CIE 802, Centre Hospitalier de Cayenne, Cayenne, French Guiana; Equipe EA3593, Epidémiologie des Parasitoses et des Mycoses Tropicales, Université des Antilles et de la Guyane, Cayenne, French Guiana

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Mathieu Nacher Centre d'Investigation Clinique Epidémiologie Clinique Antilles-Guyane, Service de Dermatologie Vénérologie, et Laboratoire Hospitalo-Universitaire de Parasitologie-Mycologie, Inserm CIE 802, Centre Hospitalier de Cayenne, Cayenne, French Guiana; Equipe EA3593, Epidémiologie des Parasitoses et des Mycoses Tropicales, Université des Antilles et de la Guyane, Cayenne, French Guiana

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Matthieu Hanf Centre d'Investigation Clinique Epidémiologie Clinique Antilles-Guyane, Service de Dermatologie Vénérologie, et Laboratoire Hospitalo-Universitaire de Parasitologie-Mycologie, Inserm CIE 802, Centre Hospitalier de Cayenne, Cayenne, French Guiana; Equipe EA3593, Epidémiologie des Parasitoses et des Mycoses Tropicales, Université des Antilles et de la Guyane, Cayenne, French Guiana

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Célia Basurko Centre d'Investigation Clinique Epidémiologie Clinique Antilles-Guyane, Service de Dermatologie Vénérologie, et Laboratoire Hospitalo-Universitaire de Parasitologie-Mycologie, Inserm CIE 802, Centre Hospitalier de Cayenne, Cayenne, French Guiana; Equipe EA3593, Epidémiologie des Parasitoses et des Mycoses Tropicales, Université des Antilles et de la Guyane, Cayenne, French Guiana

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Julie Dufour Centre d'Investigation Clinique Epidémiologie Clinique Antilles-Guyane, Service de Dermatologie Vénérologie, et Laboratoire Hospitalo-Universitaire de Parasitologie-Mycologie, Inserm CIE 802, Centre Hospitalier de Cayenne, Cayenne, French Guiana; Equipe EA3593, Epidémiologie des Parasitoses et des Mycoses Tropicales, Université des Antilles et de la Guyane, Cayenne, French Guiana

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Florence Huber Centre d'Investigation Clinique Epidémiologie Clinique Antilles-Guyane, Service de Dermatologie Vénérologie, et Laboratoire Hospitalo-Universitaire de Parasitologie-Mycologie, Inserm CIE 802, Centre Hospitalier de Cayenne, Cayenne, French Guiana; Equipe EA3593, Epidémiologie des Parasitoses et des Mycoses Tropicales, Université des Antilles et de la Guyane, Cayenne, French Guiana

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Christine Aznar Centre d'Investigation Clinique Epidémiologie Clinique Antilles-Guyane, Service de Dermatologie Vénérologie, et Laboratoire Hospitalo-Universitaire de Parasitologie-Mycologie, Inserm CIE 802, Centre Hospitalier de Cayenne, Cayenne, French Guiana; Equipe EA3593, Epidémiologie des Parasitoses et des Mycoses Tropicales, Université des Antilles et de la Guyane, Cayenne, French Guiana

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Bernard Carme Centre d'Investigation Clinique Epidémiologie Clinique Antilles-Guyane, Service de Dermatologie Vénérologie, et Laboratoire Hospitalo-Universitaire de Parasitologie-Mycologie, Inserm CIE 802, Centre Hospitalier de Cayenne, Cayenne, French Guiana; Equipe EA3593, Epidémiologie des Parasitoses et des Mycoses Tropicales, Université des Antilles et de la Guyane, Cayenne, French Guiana

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Pierre Couppie Centre d'Investigation Clinique Epidémiologie Clinique Antilles-Guyane, Service de Dermatologie Vénérologie, et Laboratoire Hospitalo-Universitaire de Parasitologie-Mycologie, Inserm CIE 802, Centre Hospitalier de Cayenne, Cayenne, French Guiana; Equipe EA3593, Epidémiologie des Parasitoses et des Mycoses Tropicales, Université des Antilles et de la Guyane, Cayenne, French Guiana

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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/mm3 (AOR = 10.54, 95% CI = 2.83–39.24), a CD4 cell count < 60 cells/mm3 (AOR = 11.62, 95% CI = 2.30–58.63), and a platelet count < 150,000/mm3 (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.

Author Notes

* Address correspondence to Antoine Adenis, Centre d'Investigation Clinique Epidémiologie Clinique Antilles-Guyane, INSERM CIE 8202, Centre Hospitalier de Cayenne, Avenue des Flamboyants, BP 6006, 97 300 Cayenne, French Guiana. E-mail: antoine.adenis@gmail.com

Financial support: This study was supported by the grant Investissement d'Avenir from the Agence Nationale de la Recherche (CEBA reference no. ANR-10-LABX-0025).

Authors' addresses: Antoine Adenis, Mathieu Nacher, Matthieu Hanf, and Célia Basurko, Centre d'Investigation Clinique Epidémiologie Clinique Antilles-Guyane, INSERM CIE 802, Centre Hospitalier de Cayenne, Cayenne, French Guiana, and Equipe EA3593, Epidémiologie des Parasitoses et des Mycoses Tropicales, Université des Antilles et de la Guyane, Cayenne, French Guiana, E-mails: antoine.adenis@gmail.com, mathieu.nacher@ch-cayenne.fr, matthieu.hanf@ch-cayenne.fr, and c.basurko@free.fr. Julie Dufour and Florence Huber, Equipe EA3593, Epidémiologie des Parasitoses et des Mycoses Tropicales, Université des Antilles et de la Guyane, Cayenne, French Guiana, and Service de Dermatologie Vénérologie, Centre Hospitalier de Cayenne, Cayenne, French Guiana, E-mails: dufour-julie@orange.fr and flottehuber@yahoo.fr. Christine Aznar, Equipe EA3593, Epidémiologie des Parasitoses et des Mycoses Tropicales, Université des Antilles et de la Guyane, Cayenne, French Guiana, and Laboratoire Hospitalo-Universitaire de Parasitologie-Mycologie, Centre Hospitalier de Cayenne, Cayenne, French Guiana, E-mail: christine.aznar1@wanadoo.fr. Bernard Carme, Centre d'Investigation Clinique Epidémiologie Clinique Antilles-Guyane, INSERM CIE 802, et Laboratoire Hospitalo-Universitaire de Parasitologie-Mycologie, Centre Hospitalier de Cayenne, Cayenne, French Guiana, and et Equipe EA3593, Epidémiologie des Parasitoses et des Mycoses Tropicales, Université des Antilles et de la Guyane, Cayenne, French Guiana, E-mail: bernard.carme@ch-cayenne.fr. Pierre Couppie, Equipe EA3593, Epidémiologie des Parasitoses et des Mycoses Tropicales, Université des Antilles et de la Guyane, Cayenne, French Guiana, and et Service de Dermatologie Vénérologie, Centre Hospitalier de Cayenne, Cayenne, French Guiana, E-mail: couppie.pierre@voila.fr.

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