The spectrum of cutaneous deep fungal infections in HIV positive patients at Chris Hani Baragwanath academic hospital (August 2013-July 2016)gu
Date
2019
Authors
Motau, Ayanda
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Abstract
Background
Cutaneous deep fungal infections may be classified as subcutaneous or systemic. Populations
that are particularly at risk are patients with human immunodeficiency virus (HIV) or
haematological malignancies, recipients of solid organ or hematopoietic stem cell transplants,
and patients on immunosuppressants. Early diagnosis and prompt treatment are imperative
in these potentially life-threatening infections where mortality rates for localised disease
range from 4-10% and can be as high as 94% in patients with systemic infections.
Unfortunately few studies have been published on this subject especially against the
background of HIV infection. South Africa is at the epicentre of the HIV epidemic and the true
spectrum of cutaneous deep fungal infections in HIV-infected patients in South Africa should
ideally be demonstrated.
Objectives
To describe the prevalence and aetiological spectrum of cutaneous deep fungal infections
in HIV positive adults at Chris Hani Baragwanath Academic Hospital.
Methods
This was a retrospective descriptive study of patients seen at Chris Hani Baragwanath
Academic Hospital (CHBAH) from 1st August 2013 - 31st July 2016, who were HIV infected and
had a skin biopsy done which proved a cutaneous deep fungal infection histologically. A
list of subjects was obtained from the Department of Anatomical Pathology at CHBAH using
the National Health Laboratory Services(NHLS) computer system. Participants’ demographic
information and HIV status were obtained from the histopathology report. Fungal culture
results as well as other relevant results not found in the report were obtained using the
NHLS Trakcare system.
Results
A total of 53 patients were diagnosed with a deep fungal infection on histopathology amongst
2576 adults who had skin biopsies giving a 2% prevalence rate. Only 20/53 (37%) cases had a
definite diagnosis. The commonest infection was cryptococcosis with 9 cases, followed by
emergomycosis (formerly known as emmonsiosis) with 7 cases and sporotrichosis and
candidiasis with 2 cases each. Microbiology culture was positive in only 5 (17%) of 30 cases
who had tissue cultures done and in only 9 (29%) of 31 who had blood culture performed.
The other 33 cases did not have a definitive diagnosis. . However 22/53 cases were classified
as having a possible diagnosis as suggested on histopathology and of these, 19/53 were
classified as possible histoplasmosis/emergomycosis and 3/53 were possible
sporotrichosis/cryptococcosis. The average CD4 count was 43 cell/mm3 and 57% of patients
were on antiretroviral treatment.
Conclusion
The prevalence of cutaneous deep fungal infections in adults with advanced HIV infection in
South Africa who have skin biopsies performed is significant. There has been a striking
emergence of emergomycosis, which was only recently recognised as a cause of disease in
the HIV infected. Improved methods for definitive aetiological diagnosis are needed. We need
to have a high index of suspicion in diagnosing and treating these potentially life threatening
infections.
Description
A research report submitted to the University of The Witwatersrand, Johannesburg in
partial fulfillment for the requirements of the degree of Master of Dermatology 2018