Disseminated histoplasmosis in Peruvian non-HIV patients: an underrecognized endemic disease

Background: Histoplasmosis is a worldwide mycosis with endemic areas throughout Latin America. Disseminated histoplasmosis (DH) has been described in Peru, but there are few reports about its clinical presentation in non-HIV patients. Methods: Case series was done with review of clinical and laboratory charts from Hospital Cayetano Heredia and Instituto de Medicina Tropical Alexander von Humboldt. Eight patients meet the case definition: HIV negative test and definitive diagnosis of DH (isolation of H. capsulatum in culture and/or presence of yeasts on the histopathology), between 2000-2019. Results: Six were men with median age of 53 years [IQR 35-63,5], most of them were farmers or merchants and with a history of being born in or traveled to the jungle. The median time of illness until diagnosis was 390 days [IQR 60-730] and in 7 out 8 cases the diagnosis was made by isolation of fungi in culture. Isolates required 11 days [IQR 10-18] to become detectable in culture. Six cases had another concomitant disease that probably caused an immunosuppression. Conclusion: DH form occurs rarely in apparently healthy people. In this series, men in their fifties, working in farming or merchant, with history of being born in or traveled to the jungle were the most frequent epidemiological characteristics. Culture and histopathology were used for the diagnosis but obtaining the results required several days. It is necessary the use of other faster techniques and to strengthen the clinical awareness about this disease.