The Spectrum of Skin Biopsy Proven Cutaneous Invasive Fungal Infections in Patients at Johannesburg Academic Hospitals

Abstract

Background Fungal infections affect a large percentage of the population, particularly in the setting of HIV (human immunodeficiency virus). It is not well described in low- and middle- income settings. 1 We aimed to describe the aetiology, demographics, and clinical manifestations of invasive fungal infection in Johannesburg, South Africa. Methods We conducted a retrospective, descriptive review of skin biopsies done by dermatologists at Johannesburg Academic Hospitals from January 2019 to December 2021. Biopsies done on patients 18 years, reviewed by the Department of Anatomical Pathology, with the diagnosis of invasive fungal infections, were included. Data was obtained from National Health Laboratory Service (NHLS) reports and patient files. Demographics, HIV status, certain serum tests and biopsy results was collected. Results 60 patients were included with a median age was 40.8 years (median=39; IQR (Interquartile Range) =36-48). The majority of patients were males (66.7%). 46 patients were HIV positive (76.7%). Only 17 (37%) were on ARVs (antiretrovirals). In the HIV positive subgroup, the median CD4 count was 35.5 cells/L (IQR 8-208) with a median VL (viral load) of 102 copies/mL (IQR 0-276 000). The head and neck areas were predominantly involved (40%). Papules were the most common type of lesions (43.3%). Cryptococcosis (25.7%) and histoplasmosis/emergomycosis (27.3%) were - 13 - the most common infections identified. Anaemia was the most predominant abnormality found on laboratory results (67.9%). Conclusion Histoplasmosis/emergomycosis and cryptococcosis in HIV positive patients were the most frequently encountered invasive fungal infections in our study population. Untreated/poorly controlled HIV poses a major risk factor for developing invasive fungal infections.