Histoplasmosis of the Central Nervous System: A Case Series between 1990 and 2019 in French Guiana

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  • 1 Infectious Diseases Department, Centre Hospitalier de Cayenne, Cayenne, French Guiana;
  • 2 CIC INSERM 1424, Centre Hospitalier de Cayenne, Cayenne, French Guiana;
  • 3 Ecosystèmes Amazoniens et Pathologie Tropicale, EA3593, Université de Guyane, Cayenne, French Guiana;
  • 4 Centre Gratuit D’Information de Dépistage et de Diagnostic, Centre Hospitalier Agen Nerac - Hôpital Saint-Esprit, Agen, France;
  • 5 Université Paris Descartes, Centre D’Infectiologie Necker Pasteur, IHU Imagine, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France;
  • 6 Laboratory of Parasitology and Mycology, University of French Guiana, Cayenne, French Guiana;
  • 7 Health Centres for Remote Areas, Andrée Rosemon Hospital, Cayenne, French Guiana;
  • 8 Dermatology Department, Andrée Rosemon Hospital, Cayenne, French Guiana

Disseminated histoplasmosis is the most frequent acquired immunodeficiency syndrome–defining illness in French Guiana. Paradoxically, central nervous system (CNS) involvement has been scarcely described. We aimed to identify CNS histoplasmosis in our territory. We conducted an observational, multicentric, descriptive, and retrospective study including patients with proven or probable CNS histoplasmosis according to the European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group (EORTC/MGS). The study population consisted of patients admitted in one of the hospitals of French Guiana between January 1, 1990 and December 31, 2019. During the study period, 390 cases of HIV-associated histoplasmosis were recorded, in which six of them had CNS infections with Histoplasma capsulatum. The male to female sex ratio was 0.25, and the median age at diagnosis was 37.5 years. The median CD4 count was 42 cells/mm3 ([IQR: 29–60]). All patients had disseminated histoplasmosis. Usual signs of meningitis were observed in three patients and focal signs in four patients. One patient had no neurological signs. The median time between the first cerebral symptoms and diagnosis was 22.4 days (IQR 9.5–36.2). Two patients died within a month after diagnosis. In conclusion, few proven CNS localizations of histoplasmosis were observed on 30-year study in French Guiana. This low proportion suggests that the documentation of CNS involvement is often not ascertained for lack of awareness of this particular presentation, and for lack of rapid and sensitive diagnostic tools.

Author Notes

Address correspondence to Loïc Epelboin, Centre Hospitalier Andrée Rosemon, Infectious and Tropical Diseases Department, Av des Flamboyants, Cayenne 97306, French Guiana. E-mail: loic.epelboin@ch-cayenne.fr

Authors’ addresses: Loïc Epelboin, Infectious and Tropical Diseases Department, Centre Hospitalier Andrée Rosemon, Cayenne, French Guiana, and EA 3593 Team, Ecosystèmes amazoniens et pathologie tropicale, Université de la Guyane, Cayenne, French Guiana, E-mail: epelboincrh@hotmail.fr. Aïda Dione and Bastien Bidaud, Infectious and Tropical Diseases Department, Centre Hospitalier Andrée Rosemon, Cayenne, French Guiana, E-mail: bastien.bidaud@gmail.com. Alexandra Serris, Centre d’Infectiologie Necker Pasteur, IHU Imagine, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris 5 Descartes, Paris, France, E-mail: alexandra.serris@gmail.com. Denis Blanchet, Centre Hospitalier Andree Rosemon, Laboratoire Hospitalo-Universitaire de Parasitologie-Mycologie, Cayenne, French Guiana, and EA 3593 EPAT Ecosystèmes Amazoniens et Pathologies Tropicales, Universite de la Guyane, Cayenne, French Guiana, E-mail: denis.blanchet@ch-cayenne.fr. Gaelle Walter, Unite des Maladies infectieuses et tropicales, Cayenne General Hospital, Cayenne, French Guiana, E-mail: gaelle.walter@ch-cayenne.fr. Gaelle Walter, Unite des Maladies infectieuses et tropicales, Cayenne General Hospital, Cayenne, French Guiana, E-mail: gaelle.walter@ch-cayenne.fr. Philippe Abboud, Emilie Mosnier, and Felix djossou, Department of infectious diseases, Cayenne General Hospital, Cayenne, French Guiana, E-mails: philippe.abboud@ch-cayenne.fr, emilie.mosnier@ch-cayenne.fr, and felix.djossou@ch-cayenne.fr. Mélanie Gaillet and Céline Michaud, Pôle des Centres Délocalisés de Prévention et de Soins, Centre Hospitalier Andrée Rosemon, Cayenne, French Guiana, E-mails: melanie.gaillet@ch-cayenne.fr and celine.michaud@ch-cayenne.fr. Pierre Couppie, EA3593 EPAT Epidémiologie des parasitoses et mycoses tropicales, Université des Antilles et de la Guyane, Cayenne, French Guiana, E-mail: pierre.couppie@ch-cayenne.fr. Magalie Demar, Centre Hospitalier Andrée Rosemon, Laboratory of Parasitology and Mycology, Cayenne, French Guiana, and EA3593 EPAT Epidémiologie des parasitoses et mycoses tropicales, Université des Antilles et de la Guyane, Cayenne, French Guiana, E-mail: magalie.demar@ch-cayenne.fr. Mathieu Nacher, EA3593 EPAT Epidémiologie des parasitoses et mycoses tropicales, Université des Antilles et de la Guyane, Cayenne, French Guiana, and Centre d’Investigation Clinique Epidémiologie Clinique Antilles Guyane CIC-EC INSERM CIE 802, Cayenne General Hospital, Cayenne, French Guiana, E-mail: mathieu.nacher@ch-cayenne.fr. Antoine Adenis, Department of Internal Medicine, Centre Hospitalier Andrée Rosemon, Cayenne, French Guiana, E-mail: antoine.adenis@ch-cayenne.fr

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