Histoplasmosis in African children: clinical features, diagnosis and treatment.
Histoplasmosis in African children: clinical features, diagnosis and treatment.
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DOI：
10.1177/20499361211068592
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发表时间：
2022-01
影响因子：
5.7
通讯作者：
Oladele RO
中科院分区：
文献类型：
--
作者：
Ekeng BE;Edem K;Akintan P;Oladele RO
文献中记录的大多数关于组织胞浆菌病的综述都是针对成年人群的。很少有研究强调非洲组织胞浆菌病的特殊性，特别是在儿科人群中。本文就非洲儿童组织胞浆菌病的临床总结和诊断进行综述。我们强调了44例非洲儿童组织胞浆菌病病例报告（1950-2021年），分布在西非（38.6%，n = 17）、东非（9.1%，n = 4）、南部非洲（9.1%，n = 4）和中非（43.2%，n = 19）。未发现来自北方非洲的病例报告。年龄范围为1-17岁，平均9.2岁。44例病例报告中，8例（18.2%，8/44）由荚膜组织胞浆菌荚膜变种引起，33例（75%，33/44）由荚膜组织胞浆菌杜氏变种引起，3例未发现种属鉴定。HIV阳性3例（6.8%），播散性组织胞浆菌病占56.8%（25/44），肺组织胞浆菌病仅占1例（2.3%，1/44）。肺外表现包括皮肤病变（溃疡、瘘管、结节、斑片、色素沉着、丘疹和脓肿）、骨病变、骨关节炎和骨折。最常见的受累部位为皮肤（n = 29，65.9%）、骨骼（n = 20，45.5%）和淋巴结（n = 15，34.1%）。组织学检查是最常见的诊断方法（n = 33，75%）。两性霉素B是45.5%病例（n = 20）的一线治疗，其次是酮康唑（20.5%，n = 9）; 27例病例（61.4%）具有良好结局，8例病例（18.2%）具有致死性结局，而9例病例的结局未显示。本综述揭示了几例组织胞浆菌病误诊为其他疾病的病例，包括结核病（n = 3，6.8%）、肺炎（n = 1，2.3%）、癌症（n = 4，9.1%）、肾病综合征（n = 1，2.3%）、利什曼病（n = 1，2.3%）和高反应性疟疾脾肿大综合征（n = 1，2.3%）。此外，在一些病例报告中，即使症状提示，也未考虑组织胞浆菌病。尸检时诊断为组织胞浆菌病，尸检结果提示组织胞浆菌病（n = 3，6.8%）。本报告强调了非洲儿科医生转变范式的必要性。他们需要超越我们这个年龄组环境中常见的临床条件，并评估包括组织胞浆菌病在内的其他疾病。
Most of the reviews on histoplasmosis documented in literature have been in the adult population. Very few studies highlight the peculiarities associated with histoplasmosis in Africa especially in the pediatric population. This review addresses the above concerns with clinical summaries and diagnosis of some case reports of histoplasmosis in African children. We highlighted 44 case reports of histoplasmosis in African children (1950–2021) distributed across Western Africa (38.6%, n = 17), Eastern Africa (9.1%, n = 4), Southern Africa (9.1%, n = 4), and Central Africa (43.2%, n = 19). No case report was found from Northern Africa. The age range was 1–17 years, with a mean of 9.2. Of the 44 case reports, 8 cases (18.2%, 8/44) were caused by Histoplasma capsulatum var capsulatum, 33 cases (75%, 33/44) were caused by Histoplasma capsulatum var duboisii, and specie identification was not found in 3 cases. Only three (6.8%) cases were HIV positive; 56.8% (25/44) were disseminated histoplasmosis, pulmonary histoplasmosis accounted for just one case (2.3%, 1/44). Extrapulmonary presentation included skin lesions (ulcers, fistulas, nodules, patches, pigmentations, papules, and abscesses), bone lesions, osteoarthritis, and fractures. The commonest sites affected were skin (n = 29, 65.9%), bones (n = 20, 45.5%), and lymph nodes (n = 15, 34.1%). Histopathology was the commonest diagnostic method (n = 33, 75%). Amphotericin B was first-line therapy in 45.5% of the cases (n = 20) followed by ketoconazole (20.5%, n = 9); 27 cases (61.4%) had favorable outcomes, 8 cases (18.2%) had fatal outcomes, while in 9 cases, the outcome was not revealed. This review revealed several cases of histoplasmosis misdiagnosed as other conditions including tuberculosis (n = 3, 6.8%), pneumonia (n = 1, 2.3%), cancers (n = 4, 9.1%), nephritic syndrome (n = 1, 2.3%), leishmaniasis (n = 1, 2.3%), and hyperreactive malarial splenomegaly syndrome (n = 1, 2.3%). In addition, histoplasmosis was not considered in some case reports even when symptoms were suggestive. Diagnosis of histoplasmosis was made at autopsy with postmortem findings suggestive of histoplasmosis (n = 3, 6.8%). This report highlights the need for a paradigm shift on the part of pediatricians in Africa. They need to look beyond clinical conditions considered common in our environment for this age group and evaluate for other diseases including histoplasmosis.
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影响因子：
4.9
作者：
Akpuaka, FC;Gugnani, HC;Iregbulam, LM
通讯作者：
Iregbulam, LM
影响因子：
1
作者：
Kabangila, Rodrick;Semvua, Kilonzo;Peck, Robert N
通讯作者：
Peck, Robert N
影响因子：
9.4
作者：
Babady, N. Esther;Buckwalter, Seanne P.;Wengenack, Nancy L.
通讯作者：
Wengenack, Nancy L.
影响因子：
11.8
作者：
Donnelly, J. Peter;Chen, Sharon C.;Pappas, Peter G.
通讯作者：
Pappas, Peter G.
DOI：
10.7241/ourd.20133.91
发表时间：
2013-01-01
期刊：
Our Dermatology Online
影响因子：
--
作者：
Barro-Traore, F.;Sanwidi, M.;Lemasson, G.
通讯作者：
Lemasson, G.