African histoplasmosis

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African histoplasmosis is a fungal infection caused by Histoplasma capsulatum var. duboisii, or Histoplama duboisii (Hcd).{{cite book | vauthors = James WD, Elston DM, Berger TG, Andrews GC |title=Andrews' Diseases of the Skin: clinical Dermatology |publisher=Saunders Elsevier |year=2006 |isbn=0-7216-2921-0 }}{{rp|316}}{{cite journal | vauthors = Valero C, Gago S, Monteiro MC, Alastruey-Izquierdo A, Buitrago MJ | title = African histoplasmosis: new clinical and microbiological insights | journal = Medical Mycology | volume = 56 | issue = 1 | pages = 51–59 | date = January 2018 | pmid = 28431110 | doi = 10.1093/mmy/myx020 | doi-access = free }} Disease has been most often reported in Uganda, Nigeria, Zaire (Democratic Republic of the Congo) and Senegal, as Hcd is exclusive to Africa.{{cite journal | vauthors = Gugnani HC | title = Histoplasmosis in Africa: a review | journal = The Indian Journal of Chest Diseases & Allied Sciences | volume = 42 | issue = 4 | pages = 271–7 | date = November 2000 | pmid = 15597674 }} In human disease it manifests differently than histoplasmosis (caused by Histoplasma capsulatum, or Hcc), most often involving the skin and bones and rarely involving the lungs.{{cite book | veditors = Bennett JE, Dolin R, Blaser MJ |title = Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases | edition = 8th |isbn = 978-1-4557-4801-3 | vauthors = Deepe Jr GS |chapter = Histoplama capsulatum (Histoplasmosis) |date = 28 August 2014 | pages = 393–6 }} Also unlike Hcc, Hcd has been reported to rarely present in those with HIV, likely due to underreporting.{{cite journal | vauthors = Carme B, Ngolet A, Ebikili B, Ngaporo AI | title = Is African histoplasmosis an opportunistic fungal infection in AIDS? | journal = Transactions of the Royal Society of Tropical Medicine and Hygiene | volume = 84 | issue = 2 | pages = 293 | date = 1990-03-01 | pmid = 2389325 | doi = 10.1016/0035-9203(90)90292-M }}{{cite journal | vauthors = Chandenier J, Goma D, Moyen G, Samba-Lefèbvre MC, Nzingoula S, Mbitsi A, Nkiwabonga L, Ngaporo AI | display-authors = 6 | title = [African histoplasmosis due to Histoplasma capsulatum var. duboisii: relationship with AIDS in recent Congolese cases] | language = fr | journal = Santé | volume = 5 | issue = 4 | pages = 227–34 | date = July 1995 | pmid = 7582643 | url = https://pubmed.ncbi.nlm.nih.gov/7582643/ | trans-title = African histoplasmosis due to Histoplasma capsulatum var. duboisii: relationship with AIDS in recent Congolese cases }}{{cite journal | vauthors = Antinori S, Magni C, Nebuloni M, Parravicini C, Corbellino M, Sollima S, Galimberti L, Ridolfo AL, Wheat LJ | display-authors = 6 | title = Histoplasmosis among human immunodeficiency virus-infected people in Europe: report of 4 cases and review of the literature | journal = Medicine | volume = 85 | issue = 1 | pages = 22–36 | date = January 2006 | pmid = 16523050 | doi = 10.1097/01.md.0000199934.38120.d4 | s2cid = 29349515 | doi-access = free }} However, this along with the differences in Hcc and Hcd have been disputed.

The favored locations of African histoplasmosis are "osteoarticular, ganglionic and pulmonary".{{cite journal | vauthors = Darré T, Kpatcha M, Djiwa T, Sewa E, Dorkenoo AM, Kouyaté M, Napo-Koura G | title = African histoplasmosis of the penis | journal = Oxford Medical Case Reports | volume = 2020 | issue = 6 | pages = omaa043 | date = June 2020 | pmid = 32617170 | doi = 10.1093/omcr/omaa043 | pmc = 7315929 }}{{cite journal | vauthors = Darré T, Saka B, Mouhari-Touré A, Dorkenoo AM, Amégbor K, Pitche VP, Napo-Koura G | title = Histoplasmosis by Histoplasma capsulatum var. duboisii Observed at the Laboratory of Pathological Anatomy of Lomé in Togo | journal = Journal of Pathogens | volume = 2017 | pages = 2323412 | date = 2017 | pmid = 28804654 | pmc = 5539941 | doi = 10.1155/2017/2323412 | doi-access = free }} Genitourinary skin damage is rare, occurring in only 4-11% patients and typically as a secondary skin invasion in those with disseminated infection.{{cite journal | vauthors = Cipriano A, Neves-Maia J, Lopes V, Fleming CE, Ferreira MA, Bathay J | title = African histoplasmosis in a Guinea Bissau patient with HIV-2: Case report and review | journal = Journal de Mycologie Médicale | volume = 30 | issue = 1 | pages = 100904 | date = April 2020 | pmid = 31706701 | doi = 10.1016/j.mycmed.2019.100904 | s2cid = 207949374 }}{{cite journal | vauthors = Pasqualotto AC, Oliveira FM, Severo LC | title = Histoplasma capsulatum recovery from the urine and a short review of genitourinary histoplasmosis | journal = Mycopathologia | volume = 167 | issue = 6 | pages = 315–23 | date = June 2009 | pmid = 19184526 | doi = 10.1007/s11046-009-9182-z | s2cid = 13490328 }}

It presents as "localized with isolated skin, bone, or lymph node infections or disseminated with multiple cutaneous lesions present all over the body, subcutaneous abscesses, enlarged lymph nodes, liver and spleen, and visceral organ enlargement"{{cite journal | vauthors = Paixão M, Miot HA, Avancini J, Belda Júnior W | title = Primary cutaneous histoplasmosis developed in the penis of an immunocompetent patient | journal = Anais Brasileiros de Dermatologia | volume = 90 | issue = 2 | pages = 255–7 | date = April 2015 | pmid = 25831000 | pmc = 4371679 | doi = 10.1590/abd1806-4841.20153224 }}{{cite journal | vauthors = Chaurasia D, Agrawal R, Misra V, Bhargava A | title = Penoscrotal histoplasmosis following bladder carcinoma | journal = International Journal of Urology | volume = 14 | issue = 6 | pages = 571–2 | date = June 2007 | pmid = 17593111 | doi = 10.1111/j.1442-2042.2007.01766.x | s2cid = 21331549 }} Cutaneous manifestations can be isolated or present with nodules, papules, or ulcers.{{cite journal | vauthors = Sachdev R, Goel RK, Malviya S, Goel S, Gajendra S | title = Scrotal Histoplasmosis Masquerading as Fournier's Gangrene | journal = International Journal of Surgical Pathology | volume = 25 | issue = 6 | pages = 509–510 | date = September 2017 | pmid = 28112039 | doi = 10.1177/1066896916687078 | s2cid = 26101993 }} They may present with subcutaneous swelling, cold abscesses progressing to spontaneous fistulization, or ulcers that may bud. If left alone, lesions may turn into a large ulcer.