A CLINICOPATHOLOGICAL STUDY ON DISSEMINATED HISTOPLASMOSIS WITH SPECIAL REFERENCE TO ATYPICAL CASES IN A TERTIARY CARE CENTRE -IN EASTERN INDIA.

Abstract

INTRODUCTION: Untreated Histoplasmosis is fatal for all, immunocompetent or immunocompromised. Histoplasmosis has seen a steady increase in incidence from a single recorded case in Kolkata, India in 1954 to 388 cases from 2004-17 and 161 from 2017-till date all over India. Yet, it has been consistently relegated to a niche of opportunistic infections without a proper diagnostic protocol. To study the clinical OBJECTIVES: features and natural history of disseminated histoplasmosis(DH) and analysis of cases with atypical clinical presentation of Histoplasmosis simulating malignancy in search of a consolidated and efcient diagnostic algorithm in a tertiary care centre. MATERIALS AND METHODS: The retrospective institution-based study was conducted in the Department of Pathology, CSTM from February 2011 to July 2019 in collaboration of Dept. of Tropical Medicine on specimens collected from 33 cases of Skin biopsy, Lymph node biopsy and FNAC aspirate from enlarged lymphnodes, slit skin smear followed by BM Aspirate analysis done in cases of disseminated histoplasmosis, Bone Marrow Biopsy was done in selected cases. Histoplasma capsulatum like yeast cells were detected with Leishman Giemsa stained slit skin smears in 9 cases and in FNA smears in 13cases and they were PAS positive. Diagnosis were conrmed in Histopathological examination along with special stain for fungus in all cases. Radiological investigations (CXR, USG, CT), Routine investigations (Haemogram, LFT, RFT, Electrolytes) along with CD4 count in ART clinic and microbiological tests like Gram stain of SSS, India Ink, KOH preparation, Cryptococcal Ag testing, urine C/S) were corroborated with. RESULTS: All 33 cases FNAC (13),slit skin smear(9) and HPE on rest of the specimen show small, oval yeast cells on LG stain. Biopsy showed histiocytic phagocytosis of yeast cells with foamy macrophages and PMN inltration with NO granulomas in seroposive cases. Gomori Methenamine Silver stain of BM biopsy showed black intracellular yeast consistent with . PAS stained FNAC smears Histoplasma capsulatum showed yeast cells with chromatin dot and surrounding halos with no kinetoplasts. Mycological cultures were in agreement. Here, in most cases, CD4 count and Disseminated Histoplasmosis ndings were not in accordance. DH CONCLUSION: is not uncommon in India and is being increasing day by day and it should be considered in the diagnosis of patients with prolonged fever, weight loss, oropharyngeal ulcers, hepatosplenomegaly, lymphadenopathy and adrenal enlargement. Correct diagnosis by well designed analytical studies utilising appropriate diagnostic modalities in an immunocompromised patient even with minimum suspicion of opportunistic infection, a consolidation of selective investigations like FNAC, HPE and relevant microbiological tests into a diagnostic design for maximum utilization of nances, resources and time, all of which can help to understand the epidemiology of this neglected disease for accurate treatment leading to a favourable outcome.