Disseminated histoplasmosis: a 10-year retrospective study at the National Children’s Hospital of Costa Rica.

Abstract

Background: Histoplasmosis is an infectious disease caused by Histoplasma capsulatum, a dimorphic fungus endemic to Costa Rica. In healthy children, this disease is usually asymptomatic and rarely requires treatment, while patients with primary or secondary immunodeficiency have a greater risk of dissemination and fatal outcomes. Aim: To characterize patients with disseminated disease by H. capsulatum, en el Hospital Nacional de Niños “Dr. Carlos Sáenz Herrera. Methods: Retrospective, observational, descriptive study of a series of confirmed cases of disseminated H. capsulatum, at the National Children's Hospital “Dr. Carlos Sáenz Herrera” between January 1, 2010 and December 31, 2019. Results: 18 patients were included, where 13 (72%) were male, with a mean age of 12 months. The most frequent clinical findings at diagnosis were hepatomegaly (89%), splenomegaly (83%), and fever (78%). Identification of Histoplasma sp. was observed in bone marrow samples in half of the cases. All patients received intravenous treatment with deoxycholate amphotericin B. There were three reported deaths (16.7%) and three diagnoses of hemophagocytic lymphohistiocytosis. Discussion: Patients under 2 years of age have an increased risk of disseminated disease, with a wide range of clinical manifestations. These characteristics provide a diagnostic challenge, where a high suspicion is necessary to provide early and effective treatment.