Journal Article

Prospective Study of Histoplasmosis in Patients Infected with Human Immunodeficiency Virus: Incidence, Risk Factors, and Pathophysiology

David S. McKinsey, Richard A. Spiegel, Lori Hutwagner, James Stanford, Michael R. Driks, Joseph Brewer, Mala R. Gupta, David L. Smith, Mary C. O'Connor and Lawrence Dall

in Clinical Infectious Diseases

Published on behalf of Infectious Diseases Society of America

Volume 24, issue 6, pages 1195-1203
Published in print June 1997 | ISSN: 1058-4838
Published online June 1997 | e-ISSN: 1537-6591 | DOI: http://dx.doi.org/10.1086/513653
Prospective Study of Histoplasmosis in Patients Infected with Human Immunodeficiency Virus: Incidence, Risk Factors, and Pathophysiology

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Histoplasmosis is a common opportunistic infection in patients with human immunodeficiency virus (HIV) infection who reside in areas where Histoplasma capsulatum is endemic. We undertook a prospective study of a cohort of 304 HIV-infected patients in Kansas City from October 1990 through March 1993 to define the incidence-specific risk factors, and pathophysiology of histoplasmosis. The annual incidence of histoplasmosis was 4.7%; 74% of the patients with histoplasmosis were symptomatic (all of whom had disseminated disease). A history of exposure to chicken coops, a positive baseline serology for complement-fixing antibodies to Histoplasma mycelium antigen, and a baseline CD4+ lymphocyte count of <150/µL were associated with an increased risk for histoplasmosis. Histoplasmin reactivity and the presence of pulmonary calcifications were not useful markers for patients at high risk. Symptomatic infection occurred in 9.9% of patients with evidence of prior exposure to H. capsulatum, in 4.0% of patients without documented prior exposure, and in 3.0% of patients who were anergic; these findings suggest that the pathophysiology of histoplasmosis in patients with AIDS involves reactivation of latent infection in some cases and dissemination of exogenously acquired infection in other cases.

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Subjects: Infectious Diseases ; Immunology ; Public Health and Epidemiology ; Microbiology

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