{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T13:43:54Z","timestamp":1790257434478,"version":"4.1.0"},"reference-count":17,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2020,9,8]],"date-time":"2020-09-08T00:00:00Z","timestamp":1599523200000},"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>We aimed to describe the ways patients with disseminated histoplasmosis\u2014a multifaceted and often lethal disease\u2014present themselves and are explored. A retrospective, observational, multicentric study spanned the period between 1 January 1981 and 1 October 2014. Principal component analysis was performed for the sampling sites and for the clinical signs and symptoms. The factor loadings of the principal components were selected for eigenvalues &gt; 1. The most frequent signs and symptoms were an alteration of the WHO general performance status, fever, digestive tract, respiratory signs and symptoms and lymphadenopathies. The most common sites sampled were bone marrow, respiratory tract, blood, lymph node and liver biopsies, with significant variations in the number of sites from which samples were taken to try to identify the pathogen. The principal component analysis clinical signs and symptoms leading to the diagnosis showed four main lines of variation. The factor loadings of the four main components were compatible with four broad types of clinical presentations and four types of exploration strategies. Extracting simple algorithms was difficult, emphasizing the importance of clinical expertise when diagnosis depends on obtaining a sample where Histoplasma can be seen or grown. Histoplasma antigen detection tests will help simplifying the algorithms.<\/jats:p>","DOI":"10.3390\/jof6030165","type":"journal-article","created":{"date-parts":[[2020,9,8]],"date-time":"2020-09-08T09:03:48Z","timestamp":1599555828000},"page":"165","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Heterogeneity of Clinical Presentations and Paraclinical Explorations to Diagnose Disseminated Histoplasmosis in Patients with Advanced HIV: 34 Years of Experience in French Guiana"],"prefix":"10.3390","volume":"6","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9397-3204","authenticated-orcid":false,"given":"Mathieu","family":"Nacher","sequence":"first","affiliation":[{"name":"CIC INSERM 1424, Centre Hospitalier Andree Rosemon Cayenne, 97300 Cayenne, French Guiana"},{"name":"D\u00e9partement Formation Recherche Sant\u00e9, Universit\u00e9 de Guyane, 97300 Cayenne, French Guiana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Audrey","family":"Valdes","sequence":"additional","affiliation":[{"name":"Equipe Op\u00e9rationnelle d\u2019Hygi\u00e8ne Hospitali\u00e8re, Centre Hospitalier Andree Rosemon Cayenne, 97300 Cayenne, French Guiana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antoine","family":"Adenis","sequence":"additional","affiliation":[{"name":"CIC INSERM 1424, Centre Hospitalier Andree Rosemon Cayenne, 97300 Cayenne, French Guiana"},{"name":"D\u00e9partement Formation Recherche Sant\u00e9, Universit\u00e9 de Guyane, 97300 Cayenne, French Guiana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Romain","family":"Blaizot","sequence":"additional","affiliation":[{"name":"D\u00e9partement Formation Recherche Sant\u00e9, Universit\u00e9 de Guyane, 97300 Cayenne, French Guiana"},{"name":"Department of Dermatology, Centre Hospitalier Andree Rosemon Cayenne, 97300 Cayenne, French Guiana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5449-4913","authenticated-orcid":false,"given":"Philippe","family":"Abboud","sequence":"additional","affiliation":[{"name":"Service des Maladies Infectieuses et Tropicales, Centre Hospitalier Andree Rosemon Cayenne, 97300 Cayenne, French Guiana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Magalie","family":"Demar","sequence":"additional","affiliation":[{"name":"Laboratory, Centre Hospitalier Andree Rosemon Cayenne, 97300 Cayenne, French Guiana"},{"name":"Unit\u00e9 Mixte de Recherche Tropical Biome and Immunopathology, Universit\u00e9 de Guyane, 97300 Cayenne, French Guiana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"F\u00e9lix","family":"Djossou","sequence":"additional","affiliation":[{"name":"Service des Maladies Infectieuses et Tropicales, Centre Hospitalier Andree Rosemon Cayenne, 97300 Cayenne, French Guiana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lo\u00efc","family":"Epelboin","sequence":"additional","affiliation":[{"name":"Service des Maladies Infectieuses et Tropicales, Centre Hospitalier Andree Rosemon Cayenne, 97300 Cayenne, French Guiana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5975-2627","authenticated-orcid":false,"given":"Kinan","family":"Drak Alsibai","sequence":"additional","affiliation":[{"name":"Service d\u2019Anatomopathologie, Centre Hospitalier Andree Rosemon Cayenne, 97300 Cayenne, French Guiana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caroline","family":"Misslin","sequence":"additional","affiliation":[{"name":"Service de M\u00e9decine, Centre Hospitalier de l\u2019Ouest Guyanais, 97320 Saint Laurent du Maroni, French Guiana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Balthazar","family":"Ntab","sequence":"additional","affiliation":[{"name":"D\u00e9partement d\u2019Information M\u00e9dicale, Centre Hospitalier de l\u2019Ouest Guyanais, 97320 Saint Laurent du Maroni, French Guiana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pierre","family":"Couppi\u00e9","sequence":"additional","affiliation":[{"name":"D\u00e9partement Formation Recherche Sant\u00e9, Universit\u00e9 de Guyane, 97300 Cayenne, French Guiana"},{"name":"Department of Dermatology, Centre Hospitalier Andree Rosemon Cayenne, 97300 Cayenne, French Guiana"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2020,9,8]]},"reference":[{"key":"ref_1","unstructured":"(2020, August 06). 90-90-90: Treatment for All|UNAIDS. Available online: https:\/\/www.unaids.org\/en\/resources\/909090."},{"key":"ref_2","unstructured":"(2019, October 15). WHO|Guidelines for Managing Advanced HIV Disease and Rapid Initiation of Antiretroviral Therapy. Available online: http:\/\/www.who.int\/hiv\/pub\/guidelines\/advanced-HIV-disease\/en\/."},{"key":"ref_3","unstructured":"(2020, August 06). HIV\/AIDS Treatment Guidelines, Available online: https:\/\/aidsinfo.nih.gov\/guidelines."},{"key":"ref_4","unstructured":"(2020, September 07). WHO|Consolidated Guidelines on the Use of Antiretroviral Drugs for Treating and Preventing HIV Infection. Available online: https:\/\/www.who.int\/hiv\/pub\/guidelines\/arv2013\/en\/."},{"key":"ref_5","unstructured":"Bressy, J. (2019). Prise en Charge du VIH\u2014Recommandations du Groupe d\u2019Experts. Cons. Natl. Sida H\u00e9pat. Virales, 6, Available online: https:\/\/cns.sante.fr\/actualites\/prise-en-charge-du-vih-recommandations-du-groupe-dexperts\/."},{"key":"ref_6","unstructured":"(2020, February 29). Modeling of the HIV Epidemic and Continuum of Care in French Guiana. Available online: https:\/\/journals.plos.org\/plosone\/article?id=10.1371\/journal.pone.0197990."},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Nacher, M., Adriouch, L., Van Melle, A., Parriault, M.-C., Adenis, A., and Couppi\u00e9, P. (2018). Country of infection among HIV-infected patients born abroad living in French Guiana. PLoS ONE, 13.","DOI":"10.1371\/journal.pone.0192564"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1738","DOI":"10.3389\/fmicb.2018.01738","article-title":"The HIV-1 subtype B epidemic in French Guiana and Suriname is driven by ongoing transmissions of pandemic and non-pandemic lineages","volume":"9","author":"Bello","year":"2018","journal-title":"Front. Microbiol."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Nacher, M., Adenis, A., Guarmit, B., Lucarelli, A., Blanchet, D., Demar, M., Djossou, F., Abboud, P., Epelboin, L., and Couppi\u00e9, P. (2020). What is AIDS in the Amazon and the Guianas in the 90-90-90 era?. bioRxiv.","DOI":"10.1101\/2020.03.13.990473"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"239","DOI":"10.4269\/ajtmh.2011.10-0251","article-title":"What is AIDS in the Amazon and the Guianas? Establishing the burden of disseminated histoplasmosis","volume":"84","author":"Nacher","year":"2011","journal-title":"Am. J. Trop. Med. Hyg."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Nacher, M., Leitao, T.S., G\u00f3mez, B.L., Couppi\u00e9, P., Adenis, A., Damasceno, L., Demar, M., Samayoa, B., C\u00e1ceres, D.H., and Pradinaud, R. (2019). The Fight against HIV-Associated Disseminated Histoplasmosis in the Americas: Unfolding the Different Stories of Four Centers. J. Fungi., 5.","DOI":"10.3390\/jof5020051"},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Morote, S., Nacher, M., Blaizot, R., Ntab, B., Blanchet, D., Drak Alsibai, K., Demar, M., Djossou, F., Couppie, P., and Adenis, A. (2020). Temporal Trends of Cutaneo-Mucous Histoplasmosis in Persons Living with HIV in French Guiana: Early Diagnosis Defuses South American Strain Dermotropism. PLoS Negl. Trop. Dis., in press.","DOI":"10.1371\/journal.pntd.0008663"},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"The 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_14","doi-asserted-by":"crossref","unstructured":"Nacher, M., Adenis, A., Mc Donald, S., Do Socorro Mendonca Gomes, M., Singh, S., Lopes Lima, I., Malcher Leite, R., 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_15","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."},{"key":"ref_16","unstructured":"(2020, August 06). Guidelines for Diagnosing and Managing Disseminated Histoplasmosis among People Living with HIV (S\u00f3lo en ingl\u00e9s)\u2014PAHO\/WHO|Pan American Health Organization. Available online: https:\/\/www.paho.org\/en\/node\/71472."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1813","DOI":"10.1086\/588660","article-title":"Revised definitions of invasive fungal disease from the European Organization for Research and Treatment of Cancer\/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group (EORTC\/MSG) Consensus Group","volume":"46","author":"Walsh","year":"2008","journal-title":"Clin. Infect. 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