{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,9]],"date-time":"2026-05-09T15:09:49Z","timestamp":1778339389287,"version":"3.51.4"},"reference-count":31,"publisher":"Oxford University Press (OUP)","issue":"5","license":[{"start":{"date-parts":[[2026,4,23]],"date-time":"2026-04-23T00:00:00Z","timestamp":1776902400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,5,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Disseminated histoplasmosis remains a major cause of morbidity and mortality among people living with advanced HIV disease (AHD), particularly in Latin America, where delayed diagnosis and limited access to optimal antifungal therapy persist. Accurate tools to assess disease severity and predict mortality are essential to guide clinical decision-making, including hospitalization, intensive care unit admission, and treatment strategies. We conducted a retrospective observational cohort study of hospitalized adults with AHD (CD4 \u2264 200 cells\/mm\u00b3) and a first episode of probable or proven disseminated histoplasmosis at a tertiary referral center in S\u00e3o Paulo, Brazil, between 2013 and 2023. Disease severity at admission was assessed using four tools: the World Health Organization (WHO) severity classification, the Histoplasmosis Fatality Score (HFS), the Sequential Organ Failure Assessment (SOFA), and the quick SOFA (qSOFA). The primary outcome was in-hospital mortality. Eighty-nine individuals were included; most were male (77.5%), with a median age of 39 years and profound immunosuppression (median CD4 count 24 cells\/mm\u00b3). In-hospital mortality was 34.8%. Individuals who died had significantly higher HFS and SOFA scores. In multivariable analysis, HFS, SOFA score, and serum creatinine were independently associated with in-hospital mortality, whereas qSOFA was not. HFS showed the best discriminatory performance (AUC 0.798; 95% CI 0.707\u20130.889). The combination of HFS and elevated creatinine further improved discrimination (AUC 0.840; 95% CI 0.758\u20130.922), outperforming the WHO classification, SOFA, and qSOFA in predicting in-hospital mortality. These findings support the use of HFS as a practical and reliable tool for stratifying disease severity, optimizing resource allocation, and guiding clinical decision-making in high-burden settings.<\/jats:p>","DOI":"10.1093\/mmy\/myag040","type":"journal-article","created":{"date-parts":[[2026,4,22]],"date-time":"2026-04-22T11:51:28Z","timestamp":1776858688000},"source":"Crossref","is-referenced-by-count":0,"title":["Predictors of mortality in individuals with disseminated histoplasmosis and advanced HIV disease"],"prefix":"10.1093","volume":"64","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5240-0514","authenticated-orcid":false,"given":"Jussemara Souza","family":"da\u00a0Silva","sequence":"first","affiliation":[{"name":"Instituto de Infectologia Em\u00edlio Ribas Department of Neurology, , S\u00e3o Paulo ,","place":["Brazil"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Victor Garcia","family":"Nu\u00f1ez","sequence":"additional","affiliation":[{"name":"Instituto de Infectologia Em\u00edlio Ribas Department of Neurology, , S\u00e3o Paulo ,","place":["Brazil"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vict\u00f3ria Sp\u00ednola D","family":"de\u00a0Oliveira","sequence":"additional","affiliation":[{"name":"Instituto de Infectologia Em\u00edlio Ribas Department of Neurology, , S\u00e3o Paulo ,","place":["Brazil"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alessandro C","family":"Pasqualotto","sequence":"additional","affiliation":[{"name":"Universidade Federal de Ci\u00eancias da Sa\u00fade de Porto Alegre Department of Clinical Medicine and Post-Graduation Program in Pathology, , Porto Alegre ,","place":["Brazil"]},{"name":"Infectious Diseases Service, Santa Casa de Miseric\u00f3rdia de Porto Alegre , Porto Alegre ,","place":["Brazil"]},{"name":"Division of Infectious Diseases, University of Minnesota , MN ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7830-8716","authenticated-orcid":false,"given":"Jos\u00e9 E","family":"Vidal","sequence":"additional","affiliation":[{"name":"Instituto de Infectologia Em\u00edlio Ribas Department of Neurology, , S\u00e3o Paulo ,","place":["Brazil"]},{"name":"Servi\u00e7o de Extens\u00e3o ao Atendimento de Paciente HIV\/Aids, Hospital das Cl\u00ednicas, Departamento de Infectologia e Medicina Tropical, Faculdade de Medicina da Universidade de S\u00e3o Paulo , S\u00e3o Paulo ,","place":["Brazil"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2026,4,23]]},"reference":[{"key":"2026050910214620800_bib1","doi-asserted-by":"publisher","first-page":"myaf112","DOI":"10.1093\/mmy\/myaf112","article-title":"Trends in the epidemiology of systemic endemic mycoses in Latin America","volume":"63","author":"Giusiano","year":"2025","journal-title":"Med Mycol"},{"key":"2026050910214620800_bib2","doi-asserted-by":"publisher","first-page":"101348","DOI":"10.1016\/j.mam.2025.101348","article-title":"When to suspect and how properly early detect and treat patients with endemic mycoses","volume":"102","author":"Colombo","year":"2025","journal-title":"Mol Aspects Med"},{"key":"2026050910214620800_bib3","doi-asserted-by":"publisher","first-page":"ofz073","DOI":"10.1093\/ofid\/ofz073","article-title":"Histoplasmosis, an underdiagnosed disease affecting people living with HIV\/AIDS in Brazil: Results of a multicenter prospective cohort study using both classical mycology tests and Histoplasma urine antigen detection","volume":"6","author":"Falci","year":"2019","journal-title":"Open Forum Infect Dis"},{"key":"2026050910214620800_bib4","doi-asserted-by":"publisher","first-page":"326","DOI":"10.3390\/jof6040326","article-title":"Risk factors for mortality among HIV-infected patients with disseminated histoplasmosis","volume":"6","author":"Nacher","year":"2020","journal-title":"J Fungi"},{"key":"2026050910214620800_bib5","doi-asserted-by":"publisher","first-page":"e367","DOI":"10.1016\/S1473-3099(17)30306-7","article-title":"Neglected endemic mycoses","volume":"17","author":"Queiroz-Telles","year":"2017","journal-title":"Lancet Infect Dis"},{"key":"2026050910214620800_bib6","doi-asserted-by":"publisher","first-page":"100037","DOI":"10.1016\/j.lana.2021.100037","article-title":"The era of histoplasmosis in Brazilian endemic mycoses","volume":"3","author":"Falci","year":"2021","journal-title":"Lancet Regional Health\u2014Americas"},{"key":"2026050910214620800_bib7","doi-asserted-by":"publisher","DOI":"10.37774\/9789275122488","article-title":"Pan American Health Organization. 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