1699. Presentations and Outcomes of Histoplasma capsulatum Infection Vary by Immune Status: A Retrospective Cohort Study

BACKGROUND: Few large cohorts have examined Histoplasma infection across patients with varying immune status in the era of modern antiretroviral therapy. We describe the differences in clinical presentation and outcomes of Histoplasma infection by immune status. METHODS: We conducted a single-center retrospective cohort study of adult patients diagnosed with histoplasmosis from 2002 through 2017. Data included demographics, clinical features, diagnostics, and mortality. Patients were separated into three groups based on their immune status: Immunocompetent (IC), People living with HIV (PLWH), and patients who were HIV-negative but were otherwise immunocompromised (OIC). OIC was defined as the presence of any of the following: cancer, chemotherapy, solid-organ or stem-cell transplant, or immunosuppressive medications. Immunocompetence was defined as the absence of HIV and any of the conditions that defined OIC. Localized histoplasmosis was defined as histoplasma infection confined to the lungs and/or hilar and mediastinal lymph nodes. Disease that occurred outside these locations was defined as disseminated. RESULTS: We identified 263 patients with histoplasma infection: 54 (21%) were PLWH, 99 (28%) were OIC, and 110 (42%) were IC. Disseminated disease was more common among PLWH (76%) and OIC (52%) than among IC patients (32%) (P < 0.001). For survival analysis the HIV and OIC groups were pooled to create a single immunocompromised group. In localized disease mean survival was longer in the immunocompetent group (12.7 years) than in the immunocompromised group (8.9 years) (P = 0.029). For patients with disseminated disease, however, there was no significant difference in mean survival between the immunocompetent group (9.4 years) and the immunocompromised group (9.1 years) (P = .838). CONCLUSION: Disseminated disease was more common among immunocompromised than immunocompetent patients. In patients with localized histoplasmosis, mean survival was longer for immunocompetent patients, whereas for patients with disseminated disease there was no significant difference in mean survival. [Image: see text] [Image: see text] [Image: see text] DISCLOSURES: All authors: No reported disclosures.