Acute histoplasmosis in immunocompetent travelers: a systematic review of literature

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Term Occurence Count Dictionary
tuberculosis 1 infectiousdiseases
typhoid fever 1 infectiousdiseases
Itraconazole 1 infectiousdiseasesdrugs
Ketoconazole 1 infectiousdiseasesdrugs
diarrhea 1 infectiousdiseases
histoplasmosis 39 infectiousdiseases
pneumonia 3 infectiousdiseases

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Select Drug Character Offset Drug Term Instance
Itraconazole 16305 activities, DH Disseminated Histoplasmosis, AP Acute Pulmonary Histoplasmosis, AmB Amphotericin B, Itra Itraconazole , Fluco Fluconazole, Keto KetoconazoleFig. 1PRISMA flow chart for study selectionFig. 2Timeline distribution
Ketoconazole 16343 Histoplasmosis, AP Acute Pulmonary Histoplasmosis, AmB Amphotericin B, Itra Itraconazole, Fluco Fluconazole, Keto Ketoconazole Fig. 1PRISMA flow chart for study selectionFig. 2Timeline distribution of the studies reporting cases
Select Disease Character Offset Disease Term Instance
diarrhea 21247 with or without documented fever, were 91 (13%). Gastrointestinal symptoms (158/724, 22%) comprised diarrhea , nausea, abdominal pain or vomit. Oral lesions (5/724, 0.7%) were aftous in 3 cases, ulcerative (lingual
histoplasmosis 36 Title: BMC Infectious DiseasesAcute histoplasmosis in immunocompetent travelers: a systematic review of literatureSilvia StaffolaniDora BuonfrateAndrea
histoplasmosis 618 subjects the clinical manifestations are variable. Aim of this work was to review the cases of acute histoplasmosis in immunocompetent travelers reported in literature.MethodsA systematic review of literature was conducted.
histoplasmosis 1466 The multivariate logistic regression model showed association between the development of disseminated histoplasmosis (DH) and activities that involved the exploration of caves and/or the contact with bats’ guano (adjusted
histoplasmosis 3010 inhalated and deposited in the terminal bronchioles and alveoli of the lung.Clinical manifestations of histoplasmosis depend on the size of the inoculum and the patient’s immunological status/underlying conditions. Low
histoplasmosis 4404 differential diagnosis includes sarcoidosis, tuberculosis (TB) and malignancies [[6]–[8]]. Chronic pulmonary histoplasmosis can be observed in individuals with underlying lung conditions, and it is defined as failure to clear
histoplasmosis 5477 even in those individuals [[9]–[12]].ObjectivesAim of our work was to review the literature on acute histoplasmosis in immunocompetent travelers, describing the main characteristics of the infection in this subgroup
histoplasmosis 5712 Secondary objectives were to investigate the characteristics associated to the development of disseminated histoplasmosis in travelers, and to estimate the attack rate in different areas of the world.MethodsWe conducted a
histoplasmosis 6018 epidemiological and clinical features, diagnostic work-up, treatment, and outcome of cases of acute histoplasmosis in immunocompetent patients, with history of recent travel (≤ 3 months) in an endemic area.Electronic
histoplasmosis 7309 discussion or involvement of a third reviewer (FG).Inclusion criteria-Case reports or case series on acute histoplasmosis .-Patients with history of travel in an endemic area (including travels from an area of no/low endemicity
histoplasmosis 7669 criteria-Reviews of literature.-Cases describing patients presenting with radiologic findings compatible with histoplasmosis (i.e. pulmonary nodules) but no apparent temporal relationship with travel.-Cases native from an endemic
histoplasmosis 7966 endemicity.-Non-immunocompetence status at the time of the travel, at the onset of symptoms or at the time of diagnosis of histoplasmosis .-Occupational exposure in native area.-Cases of reactivation of histoplasmosis acquired in the past.-Cases
histoplasmosis 8045 time of diagnosis of histoplasmosis.-Occupational exposure in native area.-Cases of reactivation of histoplasmosis acquired in the past.-Cases of histoplasmosis due to Histoplasma capsulatum var. duboisii.Case definition
histoplasmosis 8091 histoplasmosis.-Occupational exposure in native area.-Cases of reactivation of histoplasmosis acquired in the past.-Cases of histoplasmosis due to Histoplasma capsulatum var. duboisii.Case definition (adapted from wheat [[13]] and EORTC/MSG
histoplasmosis 8259 definition (adapted from wheat [[13]] and EORTC/MSG criteria [[14]])ProvenIllness consistent with acute histoplasmosis in a patient who had recently (≤ 3 months) travelled to an endemic area and one of the following:-Positive
histoplasmosis 8636 yeasts in tissue macrophages.Probable-Host factor: recent travel (≤ 3 months) in area endemic for histoplasmosis .-Clinical picture and/or radiological findings consistent with acute histoplasmosis.-Mycological evidence
histoplasmosis 8720 area endemic for histoplasmosis.-Clinical picture and/or radiological findings consistent with acute histoplasmosis .-Mycological evidence (histoplasmin test positivity and/or positivity of serology and/or positivity
histoplasmosis 8943 urine-serum Histoplasma antigen).Possible-Host factor: recent travel (≤ 3 months) in area endemic for histoplasmosis .-Clinical picture and/or radiological findings consistent with acute histoplasmosis.-No mycological
histoplasmosis 9027 area endemic for histoplasmosis.-Clinical picture and/or radiological findings consistent with acute histoplasmosis .-No mycological evidence nor serologic evidence but:Belonging to a histoplasmosis cluster and/or efficacy
histoplasmosis 9109 consistent with acute histoplasmosis.-No mycological evidence nor serologic evidence but:Belonging to a histoplasmosis cluster and/or efficacy of oral ex juvantibus itraconazole therapy (resolution of symptoms and normalization
histoplasmosis 9293 (resolution of symptoms and normalization of radiological findings).Activities at risk for developing histoplasmosis Contact with bats excreta and/or visit to a cave.Outdoor activities: forest excursions/trekking, camping
histoplasmosis 9967 wheat [[13]])Asymptomatic (As): asymptomatic case identified through laboratory screening within a histoplasmosis cluster.Acute pulmonary histoplasmosis (AP): febrile illness with respiratory symptoms and/or mediastinal
histoplasmosis 10006 asymptomatic case identified through laboratory screening within a histoplasmosis cluster.Acute pulmonary histoplasmosis (AP): febrile illness with respiratory symptoms and/or mediastinal involvement and/or accompanying constitutional
histoplasmosis 16466 1PRISMA flow chart for study selectionFig. 2Timeline distribution of the studies reporting cases of acute histoplasmosis in immunocompetent travelers. Each bubble corresponds to a study, the diameter of the bubble is proportional
histoplasmosis 16748 correspond to the projection of the center of the bubble on the ordinate axisFig. 3Distribution of acute histoplasmosis reported cases among immunocompetent travelersRegarding the cases diagnosed at the Centre of Tropical
histoplasmosis 16924 cases diagnosed at the Centre of Tropical Diseases, Negrar (VR), briefly, we found 21 cases of acute histoplasmosis in immunocompetent subjects, 17 of them affecting members of a scientific expedition to Ecuador. The
histoplasmosis 17422 excreta, inhalation of contaminated soil, outdoor activities. All cases were classified as possible histoplasmosis , but two probable for positive serology and two proven cases based on histology. The main symptoms were
histoplasmosis 20256 classificationAccording to the above-mentioned definitions, we found 32 proven, 695 probable and 108 possible histoplasmosis cases.Most patients (605/724, 84%) had acute pulmonary histoplasmosis (AP). Of them, 111 (18%) had also
histoplasmosis 20326 695 probable and 108 possible histoplasmosis cases.Most patients (605/724, 84%) had acute pulmonary histoplasmosis (AP). Of them, 111 (18%) had also rheumatologic manifestations and 26 (4%) mediastinal involvement.
histoplasmosis 22670 which was performed on the basis of epidemiological suspicion (travel with patients diagnosed with histoplasmosis ). Of 213 (26%) patients screened with histoplasmin skin test, 199 (93%) resulted positive.ImagingImaging
histoplasmosis 26040 clinical recovery and a partial clearance of the radiological findings. One patient with disseminated histoplasmosis and typhoid fever died because of multi-organ failure and hypercalcemia [[85]].Univariate and multivariate
histoplasmosis 26361 variables of interest. Results from the univariate analysis showed an association between disseminated histoplasmosis and variables such as age (crude OR: 1.03 95% CI: 1.01 to 1.05), Central America (crude OR: 13.01 95%
histoplasmosis 29095 churches or other buildings renovation)DiscussionWe were able to identify in the literature 814 cases of histoplasmosis acquired by immunocompetent travelers, for a total of 835 patients including those diagnosed at CTD.
histoplasmosis 30342 immunocompetent subjects. Moreover, given the long course of the infection, an unrecognized/untreated case of histoplasmosis may reactivate later in life, under immune suppressant conditions. Are there any definite risk factors
histoplasmosis 30550 risk factors for DH in immunocompetent individuals? We found several associations between disseminated histoplasmosis and other covariates at univariate analysis (Table 2). However, these results appear to be very inconsistent
histoplasmosis 31832 “highly” endemic, although the disease can be seen globally.From the clinical point of view, when should histoplasmosis be suspected in a returning traveler? Histoplasmosis can be misdiagnosed, not only because of the common
histoplasmosis 32221 respiratory symptoms in around half of cases. More than 80% of patients have a pulmonary form. Therefore, histoplasmosis should be suspected in all travelers presenting with fever/systemic symptoms or community-acquired pneumonia.
histoplasmosis 33129 strongly contribute to diagnosis when available.Finally, radiologic findings can be of help to distinguish histoplasmosis from bacterial/viral pneumonia in immunocompetent travelers; in our review, 80% of retrieved cases with
histoplasmosis 33597 and this could have led to the loss of some cases. We did not find a standardized definition of acute histoplasmosis in the immunocompetent subject in the scientific literature, hence we adapted the definition and the
histoplasmosis 35228 decided to report results from the best model in terms of goodness of fit.ConclusionsPresumably, cases of histoplasmosis in immunocompetent travelers are largely misdiagnosed and under-reported, because these subjects are
pneumonia 32335 should be suspected in all travelers presenting with fever/systemic symptoms or community-acquired pneumonia . History should be carefully evaluated, in particular exposure to cave/bats or simply outdoor activities
pneumonia 32769 inflammatory markers and half increased transaminases) this is an aspecific finding, especially in pneumonia /febrile systemic illness. However, Histoplasma serology is positive in two third of cases. According
pneumonia 33165 available.Finally, radiologic findings can be of help to distinguish histoplasmosis from bacterial/viral pneumonia in immunocompetent travelers; in our review, 80% of retrieved cases with this information showed pulmonary
tuberculosis 4338 incidental findings on chest radiographs or CT scans, and differential diagnosis includes sarcoidosis, tuberculosis (TB) and malignancies [[6]–[8]]. Chronic pulmonary histoplasmosis can be observed in individuals with
typhoid fever 26059 a partial clearance of the radiological findings. One patient with disseminated histoplasmosis and typhoid fever died because of multi-organ failure and hypercalcemia [[85]].Univariate and multivariate analysesTable 3

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