Pediatric Cases of Disseminated Histoplasmosis Treated at a Tertiary-Level Hospital, Honduras: Lessons Learned
TL;DR
The importance of recognizing histoplasmosis in high-risk populations and the need for integrated care approaches is emphasized and increased awareness, early clinical suspicion, and access to appropriate diagnostics are essential to improve outcomes.
Abstract
Histoplasmosis is a fungal infection caused by Histoplasma capsulatum, highly endemic in Central and South America, the United States, and Africa. The fungus exists as a mold in the environment and as yeast in human tissue, proliferating in soils contaminated by bird and bat excrement in environments like caves, abandoned buildings, and construction sites. In immunocompetent hosts, histoplasmosis is often asymptomatic, but in immunocompromised individuals, including pediatric patients, it can lead to disseminated disease with severe outcomes. Misdiagnosis as tuberculosis is common, and incidence rates are underreported. Nonspecific symptoms such as fever, fatigue, hepatosplenomegaly, and hematologic abnormalities complicate diagnosis, and the disease disproportionately affects children under 2 years old or those with compromised cellular immunity. This study reports four pediatric cases of disseminated histoplasmosis from Hospital Escuela in Honduras. Case 1: A 3-year-old male with interleukin-12 receptor deficiency and a history of Mycobacterium bovis infection developed severe disseminated histoplasmosis and succumbed to multiorgan failure. Case 2: A 3-year-old female from a rural area presented with neuroinfection and hydrocephalus; post-mortem analysis confirmed Histoplasma capsulatum. Case 3: A 14-year-old male with previous histoplasmosis presented with reactivation and responded favorably to itraconazole. Case 4: A 6-year-old male with disseminated tuberculosis and histoplasmosis faced disease related complications resulting in death. Disseminated histoplasmosis in pediatric patients presents unique challenges, particularly in resource-limited settings, where diagnostic tools such as antigen detection, cultures, and molecular techniques may be unavailable. Increased awareness, early clinical suspicion, and access to appropriate diagnostics are essential to improve outcomes. This study emphasizes the importance of recognizing histoplasmosis in high-risk populations and the need for integrated care approaches.