Pathophysiology and clinical outcomes of pancytopenia in disseminated histoplasmosis: a scoping review.

Autor: Ekeng BE; Department of Medical microbiology and parasitology, University of Calabar Teaching Hospital, Calabar, Nigeria. basseyewaeekeng@gmail.com., Elem DE; Department of Internal Medicine, University of Calabar Teaching Hospital, Calabar, Nigeria., Kokelu AN; Department of Haematology and Blood Transfusion, University of Calabar Teaching Hospital, Calabar, Nigeria., Onukak A; Department of Internal Medicine, University of Uyo, Uyo, Nigeria., Egbara WO; Department of Internal Medicine, University of Calabar Teaching Hospital, Calabar, Nigeria., Benjamin OO; Department of Haematology and Blood Transfusion, University of Calabar Teaching Hospital, Calabar, Nigeria., Ogar AN; Department of Haematology and Blood Transfusion, University of Calabar Teaching Hospital, Calabar, Nigeria., Chukwuma ST; Department of Medical Microbiology, College of Medicine, Enugu State University of Science and Technology, Enugu, Nigeria., Okafor LE; Department of Internal Medicine, University of Calabar Teaching Hospital, Calabar, Nigeria., Essien KA; Department of Paediatrics, University of Calabar Teaching Hospital, Calabar, Nigeria., Ekpenyong DU; Department of Community Medicine, University of Benin Teaching Hospital, Edo State, Nigeria., Bongomin F; Department of Medical Microbiology and Immunology, Faculty of Medicine, Gulu University, Gulu, Uganda.; Division of Infection, Genomics and Evolution, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.
Jazyk: angličtina
Zdroj: Infection [Infection] 2025 Jan 02. Date of Electronic Publication: 2025 Jan 02.
DOI: 10.1007/s15010-024-02431-6
Abstrakt: Purpose: Pancytopenia in the setting of disseminated histoplasmosis is sparsely described in the literature. We investigated the underlying mechanisms of pancytopenia in disseminated histoplasmosis and highlighted clinical outcomes.
Methods: We conducted a scoping review of cases and series on disseminated histoplasmosis presenting with pancytopenia published between 2001 and 2024. PubMed database was used for the search. The search terms were (disseminated histoplasmosis) AND (pancytopenia OR haemophagocytic syndrome OR lymphohistiocytosis).
Results: We identified 72 cases. Forty-four (61.1%) cases were from the Americas, 18 (25.5%) from Asia, 8 (11.1%) from Europe, and 1(1.4%) each from Africa and Australia. Of the 72 cases, five cases (6.9%) were reported in children. The mean age was 41.9 ± 16.7 years with a range of 3 months to 78 years. Seven cases (9.7%) were immunocompetent, 27 (37.5%) had an underlying HIV infection and 45 (62.5%) were complicated with haemophagocytic lymphohistiocytosis syndrome. Histoplasma antigen assay (n = 29, 40.2%) was the major diagnostic method followed by bone marrow biopsy (n = 28, 38.9%). Fifty-three cases (73.6%) recovered, 15 (20.8%) died and outcomes were not stated in 4 cases (5.65%). The relationship between haemophagocytic lymphohistiocytosis and fatal outcomes was not statistically significant (P = 0.5). Likewise, HIV infection was not significantly associated with fatal outcomes (P = 0.6). Fatal outcomes were predominantly due to difficulty or delayed diagnosis of disseminated histoplasmosis and/or haemophagocytic lymphohistiocytosis (n = 5, 6.9%), multiple organ failure (n = 4, 5.6%) and late presentation (n = 2, 2.8%).
Conclusion: Pancytopenia in disseminated histoplasmosis is associated with poor outcomes. Such a hematologic finding should arouse the index of suspicion in the attending clinician for an invasive mycosis like disseminated histoplasmosis to avert fatal outcomes. Besides haemophagocytic lymphohistiocytosis, other factors associated with pancytopenia in disseminated histoplasmosis were the cooccurrence of viral and bacterial infections.
Competing Interests: Declarations. Competing interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence this review.
(© 2024. Springer-Verlag GmbH Germany, part of Springer Nature.)
Databáze: MEDLINE
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