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Progressive disseminated histoplasmosis in children living with HIV: a case series study

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Abstract

Progressive disseminated histoplasmosis (PDH) is thought to be on the top of the list of AIDS-defining illnesses in South America. Reported experience in children is very scarce. The aim of this study was to describe the clinical characteristics, management, and outcomes of children living with HIV presenting with PDH in Ecuador. We did a retrospective study using collected data on medical records of children living with HIV attended in Francisco Icaza Bustamante Children’s Hospital (Guayaquil) between 1997 and 2019. The inclusion criteria consisted of patients under 18 years of age at admission with documented HIV infection and laboratory-confirmed diagnosis of PDH. Twenty-four children living with HIV were attended due to laboratory-confirmed PDH. Median CD4 cell count was 39 cells/mm³ (p25–p75 21–155) between 1 and 5 years and 22 cells/mm³ (p25–p75 10–57) for those aged 6 years and over. Fever (96%) was the most common clinical manifestation, followed by hepatomegaly (75%), cough (67%), weight loss (63%), diarrhea (63%), and abdominal distension (58%). Most significant laboratory findings were hypoalbuminemia (90%), hypertransaminasemia (78%), and pancytopenia (46%). Intravenous treatment with amphotericin B deoxycholate was started in all but one case in which diagnosis was postmortem. All these 23 patients were discharged after being hospitalized for a median of 68 days (p25–p75 48–90). Two children showed relapse during follow-up, one of whom died during the hospitalization of this second episode of PDH.

Conclusion: Clinical manifestations and laboratory findings of PDH in children living with HIV seem similar to those seen in adults, and low CD4 cell count appears to be the most important risk factor.

What is Known:

• Since 1987, progressive disseminated histoplasmosis has been considered an AIDS-defining illness and, although underdiagnosis is frequent, is thought to be on the top of the list of AIDS-defining illnesses in South America.

• Reported experience in children is very scarce.

What is New:

• Clinical manifestations and laboratory findings of progressive disseminated histoplasmosis in children living with HIV seem similar to those seen in adults.

• Low CD4 cell count to be the most important risk factor.

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Abbreviations

PDH:

progressive disseminated histoplasmosis

SD:

standard deviation

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Author notes

  1. Miguel García-Boyano and Greta Miño-León contributed equally to this work.

Authors and Affiliations

  1. La Paz University Hospital, Madrid, Spain

    Miguel García-Boyano

  2. Faculty of Medicine, University of Guayaquil, Guayaquil, Ecuador

    William Vega

  3. University Hospital 12 de Octubre, Madrid, Spain

    Luis Prieto

  4. Infectious Diseases Department, Francisco Icaza Bustamante Children’s Hospital, Av. Quito, 090315, Guayaquil, Ecuador

    Nelly Chávez-Solórzano, Dalton Solís Montiel & Greta Miño-León

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  1. Miguel García-Boyano
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  2. William Vega
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  5. Dalton Solís Montiel
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  6. Greta Miño-León
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Contributions

Dr. García-Boyano and Dr. Miño-León conceptualized and designed the study, collected data, drafted the initial manuscript, and reviewed and revised the manuscript. Dr. William Vega, Dr. Luis Prieto, Dr. Chávez-Solórzano, and Dr. Solís-Montiel made substantial contributions to the conception of the work and to the acquisition of data and reviewed the manuscript for important intellectual content. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

Corresponding author

Correspondence to Greta Miño-León.

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This retrospective study involving human participants was in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. This study was authorized by the Ethics Committee of our institution.

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García-Boyano, M., Vega, W., Prieto, L. et al. Progressive disseminated histoplasmosis in children living with HIV: a case series study. Eur J Pediatr 180, 1923–1931 (2021). https://doi.org/10.1007/s00431-021-03969-5

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  • DOI: https://doi.org/10.1007/s00431-021-03969-5

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