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A Fatal Case of Disseminated Histoplasmosis by Histoplasma capsulatum var. capsulatum Misdiagnosed as Visceral Leishmaniasis—Molecular Diagnosis and Identification

Histoplasmosis is an endemic mycosis in the Americas. However, its diagnosis is challenging due to the complexity and limited availability of conventional laboratory techniques—antigen tests, culture, and staining. Microscopic preparations often confuse with other pathogens, such as Leishmania spp....

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Autores principales: Calvopiña, Manuel, Toro, Marcelo, Bastidas-Caldes, Carlos, Vasco-Julio, David, Muñoz, Greta
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10538155/
https://www.ncbi.nlm.nih.gov/pubmed/37764920
http://dx.doi.org/10.3390/pathogens12091112
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author Calvopiña, Manuel
Toro, Marcelo
Bastidas-Caldes, Carlos
Vasco-Julio, David
Muñoz, Greta
author_facet Calvopiña, Manuel
Toro, Marcelo
Bastidas-Caldes, Carlos
Vasco-Julio, David
Muñoz, Greta
author_sort Calvopiña, Manuel
collection PubMed
description Histoplasmosis is an endemic mycosis in the Americas. However, its diagnosis is challenging due to the complexity and limited availability of conventional laboratory techniques—antigen tests, culture, and staining. Microscopic preparations often confuse with other pathogens, such as Leishmania spp. The genus Histoplasma capsulatum comprises three varieties: var. capsulatum, var. duboissi, and var. farciminosum, which cannot be distinguished using conventional techniques. An infant from a tropical region of Ecuador was hospitalized for fever, bloody diarrhea, and anemia persisting for two months. Upon admission, he received antibiotics and immunosuppressants. Histopathological examination of the lymph nodes, intestines, and bone marrow aspirate reported the presence of Leishmania-like amastigotes, and treatment was initiated with meglumine antimoniate and conventional amphotericin B. However, subsequent analysis of samples using PCR and DNA sequencing identified H. capsulatum var. capsulatum but not Leishmania. Despite fluconazole and amphotericin B, the infant succumbed to the disease. The delay in clinical and laboratory diagnosis of histoplasmosis and the use of nonspecific and ineffective drugs such as fluconazole led to disease dissemination and, ultimately, death. Implementing molecular diagnosis and antigen tests in laboratories located in endemic regions and reference hospitals is crucial.
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spelling pubmed-105381552023-09-29 A Fatal Case of Disseminated Histoplasmosis by Histoplasma capsulatum var. capsulatum Misdiagnosed as Visceral Leishmaniasis—Molecular Diagnosis and Identification Calvopiña, Manuel Toro, Marcelo Bastidas-Caldes, Carlos Vasco-Julio, David Muñoz, Greta Pathogens Case Report Histoplasmosis is an endemic mycosis in the Americas. However, its diagnosis is challenging due to the complexity and limited availability of conventional laboratory techniques—antigen tests, culture, and staining. Microscopic preparations often confuse with other pathogens, such as Leishmania spp. The genus Histoplasma capsulatum comprises three varieties: var. capsulatum, var. duboissi, and var. farciminosum, which cannot be distinguished using conventional techniques. An infant from a tropical region of Ecuador was hospitalized for fever, bloody diarrhea, and anemia persisting for two months. Upon admission, he received antibiotics and immunosuppressants. Histopathological examination of the lymph nodes, intestines, and bone marrow aspirate reported the presence of Leishmania-like amastigotes, and treatment was initiated with meglumine antimoniate and conventional amphotericin B. However, subsequent analysis of samples using PCR and DNA sequencing identified H. capsulatum var. capsulatum but not Leishmania. Despite fluconazole and amphotericin B, the infant succumbed to the disease. The delay in clinical and laboratory diagnosis of histoplasmosis and the use of nonspecific and ineffective drugs such as fluconazole led to disease dissemination and, ultimately, death. Implementing molecular diagnosis and antigen tests in laboratories located in endemic regions and reference hospitals is crucial. MDPI 2023-08-30 /pmc/articles/PMC10538155/ /pubmed/37764920 http://dx.doi.org/10.3390/pathogens12091112 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Case Report
Calvopiña, Manuel
Toro, Marcelo
Bastidas-Caldes, Carlos
Vasco-Julio, David
Muñoz, Greta
A Fatal Case of Disseminated Histoplasmosis by Histoplasma capsulatum var. capsulatum Misdiagnosed as Visceral Leishmaniasis—Molecular Diagnosis and Identification
title A Fatal Case of Disseminated Histoplasmosis by Histoplasma capsulatum var. capsulatum Misdiagnosed as Visceral Leishmaniasis—Molecular Diagnosis and Identification
title_full A Fatal Case of Disseminated Histoplasmosis by Histoplasma capsulatum var. capsulatum Misdiagnosed as Visceral Leishmaniasis—Molecular Diagnosis and Identification
title_fullStr A Fatal Case of Disseminated Histoplasmosis by Histoplasma capsulatum var. capsulatum Misdiagnosed as Visceral Leishmaniasis—Molecular Diagnosis and Identification
title_full_unstemmed A Fatal Case of Disseminated Histoplasmosis by Histoplasma capsulatum var. capsulatum Misdiagnosed as Visceral Leishmaniasis—Molecular Diagnosis and Identification
title_short A Fatal Case of Disseminated Histoplasmosis by Histoplasma capsulatum var. capsulatum Misdiagnosed as Visceral Leishmaniasis—Molecular Diagnosis and Identification
title_sort fatal case of disseminated histoplasmosis by histoplasma capsulatum var. capsulatum misdiagnosed as visceral leishmaniasis—molecular diagnosis and identification
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10538155/
https://www.ncbi.nlm.nih.gov/pubmed/37764920
http://dx.doi.org/10.3390/pathogens12091112
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