{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T04:52:01Z","timestamp":1787028721199,"version":"build-2736575974"},"reference-count":40,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2025,6,18]],"date-time":"2025-06-18T00:00:00Z","timestamp":1750204800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JoF"],"abstract":"<jats:p>Background:\u00a0Histoplasma capsulatum is an environmentally acquired dimorphic fungus. Infection results in histoplasmosis, a clinical syndrome often underdiagnosed and that may progress to life-threatening disseminated infection not only in immunocompromised individuals but also, following high-level exposure, in immunocompetent hosts. Epidemiological data from Caribbean regions, and particularly from Guadeloupe, remain limited. Methods: We performed a retrospective cohort study of all microbiologically confirmed histoplasmosis cases managed at the University Hospital of Guadeloupe between January 2014 and October 2024. Demographic, clinical, diagnostic, therapeutic, and outcome data were retrieved from medical records and analyzed using descriptive statistics. Results: Forty-two patients met the inclusion criteria, corresponding to an estimated annual incidence rate of 1 per 100,000 inhabitants. The median age was 52 years, and the male-to-female ratio was 4:1. An underlying immunocompromising condition was present in 85% of cases, most commonly HIV infection (48%). Common clinical features included weight loss (97%), fever (89%), and pulmonary manifestations (81%). The mean time to diagnosis from hospital admission was 3.5 \u00b1 10.3 days. Direct microscopy was positive in 67% of cases, and culture was positive in 88% of cases. Intravenous liposomal amphotericin B constituted the initial therapy in 71% of patients. Overall, the in-hospital mortality was 29%, rising to 40% among HIV-positive individuals. The 30-day survival rate was 71%. Conclusions: Histoplasmosis in Guadeloupe is under-recognized and associated with appreciable morbidity and mortality in both immunocompromised and immunocompetent patients. The wider availability of rapid diagnostics and heightened clinical vigilance are essential to shorten diagnostic delays and improve outcomes in this Caribbean population.<\/jats:p>","DOI":"10.3390\/jof11060462","type":"journal-article","created":{"date-parts":[[2025,6,18]],"date-time":"2025-06-18T07:38:15Z","timestamp":1750232295000},"page":"462","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Histoplasmosis in Immunocompromised and Immunocompetent Patients in Guadeloupe"],"prefix":"10.3390","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-2494-1444","authenticated-orcid":false,"given":"Constance","family":"Lahuna","sequence":"first","affiliation":[{"name":"Infectious Disease Department, Guadeloupe University Hospital, 97159 Pointe-\u00e0 Pitre, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-7864-6805","authenticated-orcid":false,"given":"Tanguy","family":"Dequidt","sequence":"additional","affiliation":[{"name":"Infectious Disease Department, Guadeloupe University Hospital, 97159 Pointe-\u00e0 Pitre, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pierre","family":"Postel-Vinay","sequence":"additional","affiliation":[{"name":"Intensive Care Unit Department, Guadeloupe University Hospital, 97159 Pointe-\u00e0 Pitre, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7023-9795","authenticated-orcid":false,"given":"Sandrine","family":"Peugny","sequence":"additional","affiliation":[{"name":"Infectious Disease Department, Guadeloupe University Hospital, 97159 Pointe-\u00e0 Pitre, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marwan","family":"Haboub","sequence":"additional","affiliation":[{"name":"Mycology Department, Guadeloupe University Hospital, 97159 Pointe-\u00e0 Pitre, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samuel","family":"Markowicz","sequence":"additional","affiliation":[{"name":"Infectious Disease Department, Guadeloupe University Hospital, 97159 Pointe-\u00e0 Pitre, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muriel","family":"Nicolas","sequence":"additional","affiliation":[{"name":"Mycology Department, Guadeloupe University Hospital, 97159 Pointe-\u00e0 Pitre, France"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,6,18]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Barros, N., Wheat, J.L., and Hage, C. (2023). Pulmonary histoplasmosis: A clinical update. J. Fungi, 9.","DOI":"10.3390\/jof9020236"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"e02010-21","DOI":"10.1128\/aem.02010-21","article-title":"Considerations about the geographic distribution of Histoplasma species","volume":"88","author":"Taylor","year":"2022","journal-title":"Appl. Environ. Microbiol."},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Nacher, M., Couppi\u00e9, P., Epelboin, L., Djossou, F., Demar, M., Adenis, A., and Chowdhary, A. (2020). Disseminated histoplasmosis: Fighting a neglected killer of patients with advanced HIV disease in Latin America. PLoS Pathog., 16.","DOI":"10.1371\/journal.ppat.1008449"},{"key":"ref_4","unstructured":"World Health Organization (2022). WHO Fungal Priority Pathogens List to Guide Research, Development and Public Health Action, World Health Organization."},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Neglected Histoplasmosis in Latin America Group (2016). Disseminated histoplasmosis in Central and South America, the invisible elephant: The lethal blind spot of international health organizations. AIDS, 30, 167\u2013170.","DOI":"10.1097\/QAD.0000000000000961"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"S21","DOI":"10.1016\/j.cmi.2018.02.002","article-title":"ESCMID Study Group for Infections in Compromised Hosts (ESGICH) consensus document on the safety of targeted and biological therapies: An infectious diseases perspective (Soluble immune effector molecules [II])","volume":"24","author":"Winthrop","year":"2018","journal-title":"Clin. Microbiol. Infect."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1007\/s11926-016-0572-1","article-title":"Fungal infections and new biologic therapies","volume":"18","author":"Vallabhaneni","year":"2016","journal-title":"Curr. Rheumatol. Rep."},{"key":"ref_8","unstructured":"Moriane, E., and Pitot, S. (2006). Atlas des Populations Immigr\u00e9es en Guadeloupe, INSEE."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"264","DOI":"10.1016\/S0035-9203(99)90016-0","article-title":"Epidemiology of histoplasmosis in the French West Indies (Martinique)","volume":"93","author":"Garsaud","year":"1999","journal-title":"Trans. R. Soc. Trop. Med. Hyg."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Nacher, M., Adenis, A., Mc Donald, S., Gomes, M.D.S.M., Singh, S., Lima, I.L., Leite, R.M., Hermelijn, S., Wongsokarijo, M., and Van Eer, M. (2013). Disseminated histoplasmosis in HIV-infected patients in South America: A neglected killer continues on its rampage. PLoS Negl. Trop. Dis., 7.","DOI":"10.1371\/journal.pntd.0002319"},{"key":"ref_11","first-page":"1813","article-title":"Revised definitions of invasive fungal disease from the EORTC\/MSG Consensus Group","volume":"46","author":"Walsh","year":"2008","journal-title":"Clin. Infect. Dis."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"370","DOI":"10.3201\/eid2203.151117","article-title":"Epidemiology of histoplasmosis outbreaks, United States, 1938\u20132013","volume":"22","author":"Benedict","year":"2016","journal-title":"Emerg. Infect. Dis."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"531","DOI":"10.1016\/j.wem.2018.06.008","article-title":"Environmental and wilderness-related risk factors for histoplasmosis: More than bats in caves","volume":"29","author":"Diaz","year":"2018","journal-title":"Wilderness Environ. Med."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"742","DOI":"10.1177\/0272989X241280611","article-title":"Incorporating social determinants of health in infectious disease models: A systematic review of guidelines","volume":"44","author":"Ali","year":"2024","journal-title":"Med. Decis. Making"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"ofaa119","DOI":"10.1093\/ofid\/ofaa119","article-title":"Chronic pulmonary histoplasmosis\u2014A scoping literature review","volume":"7","author":"Baker","year":"2020","journal-title":"Open Forum Infect. Dis."},{"key":"ref_16","unstructured":"Pan American Health Organization, and World Health Organization (2020). Diagnosing and Managing Disseminated Histoplasmosis Among People Living with HIV, WHO."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"myaa112","DOI":"10.1093\/mmy\/myaa112","article-title":"A comparison of presentations and outcomes of histoplasmosis across patients with varying immune status","volume":"59","author":"Franklin","year":"2021","journal-title":"Med. Mycol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"121","DOI":"10.1146\/annurev-immunol-101220-034306","article-title":"Immunity to invasive fungal diseases","volume":"40","author":"Casadevall","year":"2022","journal-title":"Annu. Rev. Immunol."},{"key":"ref_19","unstructured":"American Thoracic Society (2009). An official ATS statement: Treatment of fungal infections in adult pulmonary and critical care patients. Am. J. Respir. Crit. Care Med., 180, 96\u2013128."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"e29","DOI":"10.1097\/MD.0000000000000016","article-title":"Histoplasmosis in patients with HIV\/AIDS: Multicenter study of outcomes and factors associated with relapse","volume":"93","author":"Myint","year":"2014","journal-title":"Medicine"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"S5","DOI":"10.1016\/j.medmal.2020.06.016","article-title":"\u00c9pid\u00e9miologie des infections \u00e0 Histoplasma capsulatum diagnostiqu\u00e9es en France m\u00e9tropolitaine: \u00c9tude transversale multicentrique 2007\u20132018","volume":"50","author":"Chiaruzzi","year":"2020","journal-title":"Med. Mal. Infect."},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Adenis, A., Nacher, M., Hanf, M., Vantilcke, V., Boukhari, R., Blachet, D., Demar, M., Aznar, C., Carme, B., and Couppie, P. (2014). HIV-associated histoplasmosis early mortality and incidence trends: From neglect to priority. PLoS Negl. Trop. Dis., 8.","DOI":"10.1371\/journal.pntd.0003100"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"296","DOI":"10.1128\/CMR.00062-10","article-title":"Hormones and the resistance of women to paracoccidioidomycosis","volume":"24","author":"Shankar","year":"2011","journal-title":"Clin. Microbiol. Rev."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"656","DOI":"10.1177\/0956462413516299","article-title":"Fever in hospitalized HIV-infected patients in Western French Guiana: First think histoplasmosis","volume":"25","author":"Vantilcke","year":"2014","journal-title":"Int. J. STD AIDS"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"A84","DOI":"10.1016\/j.revmed.2016.10.044","article-title":"Lymphop\u00e9nie T CD4+ idiopathique: Revue syst\u00e9matique de la litt\u00e9rature","volume":"37","author":"Masson","year":"2016","journal-title":"La Rev. M\u00e9d. Interne"},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Nacher, M., Valdes, A., Adenis, A., Blaizot, R., Abboud, P., Demar, M., Djossou, F., Epelboin, L., Drak Alsibai, K., and Misslin, C. (2020). Heterogeneity of clinical presentations and paraclinical explorations to diagnose disseminated histoplasmosis in patients with advanced HIV: 34 years of experience in French Guiana. J. Fungi, 6.","DOI":"10.3390\/jof6030165"},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Couppi\u00e9, P., Herceg, K., Bourne-Watrin, M., Thomas, V., Blanchet, D., Alsibai, K.D., Louvel, D., Djossou, F., Demar, M., and Blaizot, R. (2019). The broad clinical spectrum of disseminated histoplasmosis in HIV-infected patients: A 30 years\u2019 experience in French Guiana. J. Fungi, 5.","DOI":"10.3390\/jof5040115"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"eRC5488","DOI":"10.31744\/einstein_journal\/2021RC5488","article-title":"Primary cutaneous histoplasmosis difficult to treat in an immunocompetent patient: Case report and literature review","volume":"19","author":"Batista","year":"2021","journal-title":"Einstein"},{"key":"ref_29","first-page":"10","article-title":"Genome sequences reveal cryptic speciation in the human pathogen Histoplasma Capsulatum","volume":"8","author":"Turissini","year":"2017","journal-title":"MBio"},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Nguyen, D., Nacher, M., Epelboin, L., Melzani, A., Demar, M., Blanchet, D., Blaizot, R., Alsibai, K.D., Abboud, P., and Djossou, F. (2020). Hemophagocytic lymphohistiocytosis during HIV infection in Cayenne Hospital 2012\u20132015: First think histoplasmosis. Front. Cell Infect. Microbiol., 10.","DOI":"10.3389\/fcimb.2020.574584"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1128\/microbiolspec.FUNK-0052-2016","article-title":"Fungal diversity revisited: 2.2 to 3.8 million species","volume":"5","author":"Hawksworth","year":"2017","journal-title":"Microbiol. Spectr."},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Caceres, D.H., Knuth, M., Derado, G., and Lindsley, M.D. (2019). Diagnosis of progressive disseminated histoplasmosis in advanced HIV: A meta-analysis of assay analytical performance. J. Fungi, 5.","DOI":"10.3390\/jof5030076"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1016\/S0732-8893(97)89158-4","article-title":"Duration of fungal culture incubation in an area endemic for Histoplasma capsulatum","volume":"28","author":"Hove","year":"1997","journal-title":"Diagn. Microbiol. Infect. Dis."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1587","DOI":"10.1128\/CVI.00071-07","article-title":"Detection of Histoplasma antigen by a quantitative enzyme immunoassay","volume":"14","author":"Connolly","year":"2007","journal-title":"Clin. Vaccine Immunol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1016\/j.ijid.2023.03.048","article-title":"Development of a case fatality prognostic score for HIV-associated histoplasmosis","volume":"132","author":"Nacher","year":"2023","journal-title":"Int. J. Infect. Dis."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"236","DOI":"10.1097\/MD.0b013e3181e9441b","article-title":"Drug-induced nephrotoxicity caused by amphotericin B lipid complex and liposomal amphotericin B: A review and meta-analysis","volume":"89","author":"Safdar","year":"2010","journal-title":"Medicine"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1097\/01.aids.0000199014.66139.39","article-title":"Immune reconstitution inflammatory syndrome in HIV-infected patients with disseminated histoplasmosis","volume":"20","author":"Breton","year":"2006","journal-title":"AIDS"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"643","DOI":"10.1093\/cid\/ciz247","article-title":"Incidence and trends in immune reconstitution inflammatory syndrome associated with Histoplasma capsulatum among people living with HIV: A 20-year case series and literature review","volume":"70","author":"Melzani","year":"2020","journal-title":"Clin. Infect. Dis."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"54","DOI":"10.1007\/s12281-023-00456-2","article-title":"The impact of corticosteroids on the outcome of fungal disease: A systematic review and meta-analysis","volume":"17","author":"Li","year":"2023","journal-title":"Curr. Fungal Infect. Rep."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"1150","DOI":"10.1016\/S1473-3099(18)30354-2","article-title":"Burden of HIV-associated histoplasmosis compared with tuberculosis in Latin America: A modelling study","volume":"18","author":"Adenis","year":"2018","journal-title":"Lancet Infect. Dis."}],"container-title":["Journal of Fungi"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2309-608X\/11\/6\/462\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T17:54:08Z","timestamp":1760032448000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2309-608X\/11\/6\/462"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,6,18]]},"references-count":40,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2025,6]]}},"alternative-id":["jof11060462"],"URL":"https:\/\/doi.org\/10.3390\/jof11060462","relation":{},"ISSN":["2309-608X"],"issn-type":[{"value":"2309-608X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,6,18]]}}}