{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,4]],"date-time":"2025-12-04T18:44:13Z","timestamp":1764873853828,"version":"build-2065373602"},"reference-count":24,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2021,4,2]],"date-time":"2021-04-02T00:00:00Z","timestamp":1617321600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Children"],"abstract":"<jats:p>Histoplasmosis is an uncommon opportunistic infection in human immunodeficiency virus (HIV) positive children. The most common form is primary disseminated histoplasmosis, characterized by persistent fever and failure to thrive. A 10-year-old HIV positive girl presented to the Baylor College of Medicine Children\u2019s Foundation\u2014Tanzania Mbeya Center of Excellence (COE) with ulcerated skin lesions and a violaceous facial rash. She also had persistent fevers, severe acute malnutrition, and severe anemia. At diagnosis, the patient was failing first line antiretroviral therapy (ART) with a cluster of differentiation 4 immune cells (CD4) of 24 cells\/\u00b5L and an HIV viral load (VL) of 196,658 cp\/mL. The patient was changed to a second line ART regimen (abacavir, lamivudine, and ritonavir-boosted lopinavir) and received nutritional support, blood transfusions, multiple antibiotics, and meticulous wound care. She also received comprehensive symptom management, psychosocial support, and emergency housing through the COE\u2019s palliative care program. Biopsy of a lesion showed intracytoplasmic organisms consistent with Histoplasmosis capsulatum var capsulatum. The patient was treated with conventional amphotericin B and oral itraconazole and she achieved wound healing as well as immune reconstitution and HIV viral suppression. Amphotericin infusions were given as an outpatient despite the resource constraints of the setting in southwestern Tanzania. Histoplasmosis should be considered in the differential diagnosis of the immunocompromised host with unusual skin manifestations and persistent fever.<\/jats:p>","DOI":"10.3390\/children8040273","type":"journal-article","created":{"date-parts":[[2021,4,2]],"date-time":"2021-04-02T10:34:09Z","timestamp":1617359649000},"page":"273","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Successful Use of Multidisciplinary Palliative Care in the Outpatient Treatment of Disseminated Histoplasmosis in an HIV Positive Child"],"prefix":"10.3390","volume":"8","author":[{"given":"Alison","family":"Lopez","sequence":"first","affiliation":[{"name":"Pediatric Infectious Diseases, University of Manitoba, Winnipeg, MB R3E3P5, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1093-5227","authenticated-orcid":false,"given":"Jason","family":"Bacha","sequence":"additional","affiliation":[{"name":"Baylor College of Medicine International Pediatric AIDS Initiative at Texas Children\u2019s Hospital, Houston, TX 77030, USA"},{"name":"Department of Pediatrics, Baylor College of Medicine, Houston, TX 77030, USA"},{"name":"Baylor College of Medicine Children\u2019s Foundation\u2014Tanzania, Mbeya 53107, Tanzania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carrie","family":"Kovarik","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Liane","family":"Campbell","sequence":"additional","affiliation":[{"name":"Baylor College of Medicine International Pediatric AIDS Initiative at Texas Children\u2019s Hospital, Houston, TX 77030, USA"},{"name":"Department of Pediatrics, Baylor College of Medicine, Houston, TX 77030, USA"},{"name":"Baylor College of Medicine Children\u2019s Foundation\u2014Tanzania, Mbeya 53107, Tanzania"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2021,4,2]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Oladele, R.O., Ayanlowo, O.O., Richardson, M.D., and Denning, D.W. 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