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Comparative Study
. 2014 Feb;90(2):216-23.
doi: 10.4269/ajtmh.13-0084. Epub 2014 Jan 6.

Tuberculosis and histoplasmosis among human immunodeficiency virus-infected patients: a comparative study

Affiliations
Comparative Study

Tuberculosis and histoplasmosis among human immunodeficiency virus-infected patients: a comparative study

Antoine Adenis et al. Am J Trop Med Hyg. 2014 Feb.

Abstract

In disease-endemic areas, histoplasmosis is the main differential diagnosis for tuberculosis among human immunodeficiency virus (HIV)-infected patients. However, no study has compared the two diseases. Thus, the objective of this study was to compare tuberculosis and histoplasmosis in HIV-infected patients. A population of 205 HIV-infected patients (99 with tuberculosis and 106 with histoplasmosis) hospitalized in Cayenne, French Guiana during January 1, 1997-December 31, 2008 were selected retrospectively from the French Hospital Database on HIV. Multivariate analysis showed that tuberculosis was associated with cough (adjusted odds ratio [AOR] = 0.20, 95% confidence interval [CI] = 0.05-0.73) and a C-reactive protein level > 70 mg/L (AOR = 0.98, 95% CI = 0.97-0.99). Variables associated with disseminated histoplasmosis were a γ-glutamyl transferase level > 72 IU/L (AOR = 4.99, 95% CI = 1.31-18.99), origin from French Guiana (AOR = 5.20, 95% CI = 1.30-20.73), disseminated localization (AOR = 6.40, 95% CI = 1.44-28.45), a concomitant opportunistic infection (AOR = 6.71, 95% CI = 1.50-29.96), a neutrophil count < 2,750 cells/mm(3) (AOR = 10.54, 95% CI = 2.83-39.24), a CD4 cell count < 60 cells/mm(3) (AOR = 11.62, 95% CI = 2.30-58.63), and a platelet count < 150,000/mm(3) (AOR = 19.20, 95% CI = 3.35-110.14). Tuberculosis and histoplasmosis have similarities, but some factors show a greater association with one of these diseases. Thus, adapted therapeutic choices can be made by using simple clinical and paraclinical criteria.

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Figures

Figure 1.
Figure 1.
Comparison of clinical and biological aspects of tuberculosis and histoplasmosis, French Guiana. Circles indicate no. positive patients/no. tested (%). The scale used proportions to avoid distortion of data. Circles intersections indicate n, which corresponded to the number of patients concerned. Because of missing values, the total for each group is different from the 99 patients with tuberculosis and the 106 patients with histoplasmosis. Anomalous liver test results were defined by an aspartate aminotransferase level> 34 IU/L, an alanine aminotransferase level> 44 IU/L, a γ-glutamyl transferase level> 72 IU/L, or an alkaline phosphatase level> 100 IU/L. Cytopenia was defined by a hemoglobin level < 9 g/dL, a neutrophil count < 2,750 cells/mm3, or a platelet count < 150,000/mm3. Inflammatory markers were defined by a C-reactive protein level > 70 mg/L.
Figure 2.
Figure 2.
Comparison of significant results (P < 0.05) in multivariate analysis for tuberculosis and histoplasmosis, French Guiana. Adjusted odds ratios and 95% confidence intervals (horizontal gray bars) are indicated on a logarithmic scale.

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