Histoplasmosis, the most common endemic mycosis in North America, presents in a myriad of ways, spanning the spectrum from self-limiting pneumonia to progressive disseminated histoplasmosis (PDH). Towards better describing contemporary histoplasmosis syndromes, risks, and outcomes, this single-center retrospective cohort study was performed (2009-2019). The population that developed PDH was similar to that with other forms of histoplasmosis (OFH) except for higher rates of preexisting immunocompromising conditions (91.3% vs 40%, P < 0.001) and a trend towards receiving more chronic immunosuppression (65.2% vs 33.3%, P = 0.054) compared to those with OFH. Diagnosis was most frequently achieved by urinary or serum antigen positivity. People with PDH more frequently tested positive compared to those with OFH, but negative tests did not rule-out histoplasmosis. Median time to diagnosis was prolonged among people with both PDH and OFH (32 vs 31 days, respectively). Following diagnosis, people with PDH received more liposomal amphotericin (78.3% vs 20%, P < 0.001). Subsequent survival at 90- and 365- days and treatment response were similar in both groups. Patients with PDH were more often hospitalized (95.7% vs 60%, P = 0.006); however, once admitted, there were no differences in hospital length of stay or ICU admission rate. The challenges of diagnosing histoplasmosis based on clinical presentation alone highlight the need for heightened awareness of these entities especially given the recent reports in expanded endemicity and delays in diagnosis.

中文翻译：

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进行性播散性组织胞浆菌病：一个非地方性医疗中心的经验。

组织胞浆菌病是北美最常见的地方性真菌病，其表现形式多种多样，从自限性肺炎到进行性播散性组织胞浆菌病 (PDH)。为了更好地描述当代组织胞浆菌病综合征、风险和结果，进行了这项单中心回顾性队列研究（2009-2019）。发生 PDH 的人群与其他形式的组织胞浆菌病 (OFH) 的人群相似，只是先前存在免疫功能低下的比例较高（91.3% vs 40%，P < 0.001），并且有接受更多慢性免疫抑制的趋势（65.2% vs 33.3%） , P = 0.054) 与 OFH 患者相比。最常通过尿液或血清抗原阳性来诊断。与 OFH 患者相比，PDH 患者检测结果呈阳性的频率更高，但阴性检测结果并不能排除组织胞浆菌病。PDH 和 OFH 患者的中位诊断时间延长（分别为 32 天和 31 天）。诊断后，PDH 患者接受了更多的脂质体两性霉素治疗（78.3% vs 20%，P < 0.001）。两组随后的 90 天和 365 天生存率以及治疗反应相似。PDH 患者住院的比例更高（95.7% vs 60%，P = 0.006）；然而，一旦入院，住院时间或 ICU 入住率没有差异。仅根据临床表现诊断组织胞浆菌病的挑战凸显了提高对这些实体的认识的必要性，特别是考虑到最近有关扩大流行和诊断延误的报告。