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Volume 13, Number 11—November 2007

Synopsis

Literature Review and Case Histories of Histoplasma capsulatum var. duboisii Infections in HIV-infected Patients

Pierre Loulergue*†, Frédéric Bastides‡, Véronique Baudouin§, Jacques Chandenier‡, Patricia Mariani-Kurkdjian§, Bertrand Dupont*†, Jean-Paul Viard*†, Françoise Dromer¶, and Olivier Lortholary†¶Comments to Author 
Author affiliations: *University Paris V, Paris, France; †Hôpital Necker-Enfants Malades, Paris, France; ‡Centre Hospitalier Universitaire Bretonneau, Tours, France; §Hôpital Robert Debré, Paris, France; ¶Institut Pasteur, Paris, France;

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Table 1

Description of HIV-infected patients with histoplasmosis due to Histoplasma capsulatum var. duboisii*

Case no.† Age, y Sex Country Clinical findings CD4 count/mm3 Pathology Positive fungal culture Treatment Outcome
1 20 F Congo Skin lesions NR Skin AmB 1 mg/kg/d, Itr 300 mg/d Relapse
2 44 M Congo Skin lesions, weight loss, lymph nodes, peritonitis NR Skin, pus Ketoconazole 600 mg/d, AmB, Itr 300 mg/d Relapse
3 41 M Congo Skin lesions, weight loss, lymph nodes, hepatomegaly, splenomegaly NR Skin AmB Death
4 65 M DRC Fever, weight loss, anemia NR Bone marrow Bone marrow, blood AmB Death
5 28 M DRC Fever, skin lesions, lymph nodes, weight loss, bone lesions NR Skin Skin Ketoconazole 600 mg/d NR
6 31 F Cameroon Septic shock 2 Bone marrow Bone marrow, blood ABLC 5 mg/kg/d, Itr 400 mg/d No relapse
7 29 M Liberia Skin lesions NR Skin Skin Itr 200 mg/d NR
8 43 F Guinea-Bissau Fever, weight loss, anemia, abdominal pain 68 Colon Itr 400 mg/d No relapse
9 30 M Nigeria Fever, skin lesions, lymph nodes, anemia 2 Skin Skin AmB 1 mg/kg/d, Itr 400 mg/d Relapse
10 38 M DRC Fever, weight loss, lymph nodes 160 Lymph nodes Bone marrow, lymph nodes AmB No relapse
11 26 M Congo Fever, skin lesions, lymph nodes NR Lymph nodes AmB 1 mg/kg/48 h No relapse
12 30 M Côte d’Ivoire Fever, weight loss, lymph nodes 6 Bone marrow Itr 400 mg/d No relapse
13 50 F Nigeria Skin lesions, bone lesions NR Skin, bone Fluconazole 100 mg/d No relapse
14 45 M Ghana Fever, weight loss, splenomegaly 24 Blood AmB 0.7 mg/kg/d Death
15 37 M DRC Fever, lymph nodes 100 Lymph nodes Itr 400 mg/d Death
16 41 M DRC Lymph nodes, skin lesions 50 Lymph nodes Lymph nodes Liposomal AmB, Itr 400 mg/d No relapse
17 2 F DRC Fever, skin lesions, bone lesions, blood 45 Skin, bone, blood Skin Liposomal AmB, fluconazole No relapse

*NR, not reported; AmB, amphotericin B deoxycholate; Itr, itraconazole; DRC, Democratic Republic of Congo; ABLC, amphotericin B lipid complex.
†Cases 1–14 are from the literature review; cases 15–17 are personal cases; see text.

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