950. Temporal trends, Clinical Characteristics and Outcome of Histoplasmosis in an Endemic Tertiary Care Center in Kentucky, 2000-2009
Session: Poster Abstract Session: Clinical Mycology
Saturday, October 22, 2011
Room: Poster Hall B1
Handouts
  • IDSA_poster 092311.pdf (214.4 kB)
  • Background: The impact of better utilization of HAART in individuals with HIV infection in the past decade on the epidemiology of histoplasmosis has remained poorly defined.

    Methods: All patients with newly diagnosed histoplasmosis at the University of Kentucky Medical Center in Lexington, Kentucky, from 01/01/2000 to 12/31/2009 were identified using the ICD-9 codes and the databases of the Clinical Microbiology and Anatomic Pathology laboratories. Logistic regression was used to analyze the temporal trends in this study.  

    Results: Among 110 patients with histoplasmosis, 49 patients (45%) were immunocompetent, 34 (31%) were immunocompromised due to HIV infection and 27 (25%) were immunocompromised due to conditions other than HIV infection (e.g. patients with bone marrow or solid organ transplantation or patients taking immunosuppressive medications).  

    The relative proportion of immunocompromised patients with histoplasmosis remained stable throughout the study period (65% during 2000-2001 interval of the study vs. 56% in 2008-2009 interval, p=0.31). However, there was a linear decrease in the proportion of HIV-infected patients with histoplasmosis from 59% to 16% in the same interval (p=0.006). Interestingly, there was an increase in the proportion of immunocompromised patients due to conditions other than HIV infection from 6% to 40% within the same period (p=0.06).

    Compared to immunocompetent patients with histoplasmosis, immunocompromised patients were more likely to have fever, 69% vs 48% (p= 0.005), gastrointestinal symptoms, 50% vs 19% (p<0.001), weight loss 33% vs 5% (p= 0.006), anemia 29% vs 10% (p=0.03), leukopenia, 41% vs 18% (p=0.01), thrombocytopenia, 49% vs 23% (p=0.01), elevation in serum alkaline phosphatase 21% vs 3% (p=0.03), hypoalbuminemia 94% vs 68% (p<0.001), detection of urinary Histoplasma antigen, 91% vs 64% (p=0.004) and longer hospitalization (p=0.02). 

    Conclusion: The epidemiology of histoplasmosis in this endemic area has evolved in the era of HAART, advancements in organ transplantation and increasing use of immunosuppressive agents for chronic inflammatory conditions. There were significant differences among these patient populations in regard to their clinical presentation and laboratory results.

     


    Subject Category: M. Mycology including clinical and basic studies of fungal infections

    Thein Myint, MD, MBBS1, Richard N Greenberg, MD1, Julie A. Ribes, MD, PhD2, Brian S. Murphy, MD, MPH1 and Majdi N. Al-Hasan, MD, MBBS1, (1)Division of Infectious Diseases, University of Kentucky, Lexington, KY, (2)Department of Pathology, University of Kentucky, Lexington, KY

    Disclosures:

    T. Myint, None

    R. N. Greenberg, Pfizer: Grant Investigator, Research support
    Tibotec: Grant Investigator, Research grant
    Virxsys: Grant Investigator, Research grant
    ParVax: Grant Investigator, Research grant
    Bavarian Nordic: Grant Investigator, Research grant

    J. A. Ribes, None

    B. S. Murphy, None

    M. N. Al-Hasan, None

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