396. Clinical Features of Proven and Probable Cases of Histoplasmosis and the Role of Urinary Histoplasma Antigen Testing: A Case Series from India
Session: Poster Abstract Session: Fungal Disease: Management and Outcomes
Thursday, October 4, 2018
Room: S Poster Hall
Posters
  • Urine histo poster(1).pdf (161.0 kB)
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    Background: Histoplasmosis is considered uncommon in India, and the diagnosis usually depends on invasive tissue sampling. The histoplasma urinary antigen assay is a non-invasive test that has been recently introduced in India.

    Methods: This was a single centre retrospective study done from January 2013 till February 2018. Case records of patients with proven (confirmed by demonstrating intra-cellular yeast like organisms on histopathology or culture) and probable (presence of antigenuria – done by IMMY Alpha Histoplasma enzyme immunoassay) histoplasmosis were analysed.

    Results: A total of 37 patients (18 proven & 19 probable) with mean age of 51.59±11.17 years were studied. Diabetes was the most common co-morbidity (15 patients) followed by HIV (6), whereas no co-morbidity was found in 10 patients. Adrenals (29%), lungs (27%), lymph nodes (27%) and skin & oral mucosa (24.3%) were the most common organs involved [Figure 1]. Anti-tubercular therapy based on granulomatous inflammation was given to 10 patients prior to the diagnosis. Raised GGTP & ALP (54%) and hyperglobulinemia (40%) were the common laboratory features. Most patients (83.7%) came from endemic areas (North-Eastern states, West Bengal & Bangladesh) whereas all 6 cases from non-endemic areas were classified as probable [Figure 2]. All-cause mortality rate was 10.8%, with 27 cases (72.9%) showing improvement at a median follow-up of 6 months. Comparison of proven and probable cases revealed that the following features were significantly higher in the probable group: female sex (p=0.001), coming from non-endemic areas (p=0.009), requiring in-patient care (p=0.001), leucocytosis (p=0.043), absence of skin & oral mucosal findings (p=0.002), simultaneous alternate diagnosis (p=0.039) & death (p=0.039).

    Conclusion: This study emphasises that histoplasmosis is an under recognised entity in India. Histoplasma antigenuria does help in making the diagnosis easily & needs to be more extensively utilised by clinicians. However it can yield false positive results in patients belonging to non-endemic areas & lacking typical clinical features of histoplasmosis. Further studies are needed to determine the utility of the antigen test in Indian settings.

     

     

     

     

     

     

     

    Figure 1: Distribution of involved organs

     

     

     

     

     

     

     

     

     

     

     

     

     

    Figure 2: Distribution of cases in the study across Indian states.

     

    Nitin Bansal, MD internal Medicine1, Nandini Sethuraman, MD2, Madhumitha R, MD FNB3, P Senthur Nambi, FNB ID3, Suresh Kumar D, MD FNB3, V Ramasubramanian, MD, MRCP3 and Ram Gopalakrishnan, MD, MRCP, AB (Internal Medicine), AB (Infectious Diseases), FIDSA3, (1)Infectious Diseases, APOLLO HOSPITALS, CHENNAI, India, (2)Microbiology, Apollo Hospitals, Chennai, India, (3)Infectious Diseases, Apollo Hospitals, Chennai, India

    Disclosures:

    N. Bansal, None

    N. Sethuraman, None

    M. R, None

    P. Senthur Nambi, None

    S. Kumar D, None

    V. Ramasubramanian, None

    R. Gopalakrishnan, None

    Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 3rd with the exception of research findings presented at the IDWeek press conferences.