Prior subclinical histoplasmosis revealed in Nigeria using histoplasmin skin testing.

TitlePrior subclinical histoplasmosis revealed in Nigeria using histoplasmin skin testing.
Publication TypeJournal Article
Year of Publication2018
AuthorsOladele, RO, Toriello, C, Ogunsola, FT, Ayanlowo, OO, Foden, P, Fayemiwo, AS, Osaigbovo, II, Iwuafor, AA, Shettima, S, Ekundayo, HA, Richardson, MD, Denning, DW
JournalPLoS One
Date Published2018

OBJECTIVES: Disseminated histoplasmosis is an AIDS-defining illness. Histoplasmosis is commonly misdiagnosed as tuberculosis. Nigeria has the second highest number of people living with HIV/AIDS in Africa. The present study was carried out to investigate the prevalence of skin sensitivity amongst Nigerians to histoplasmin.

DESIGN: A cross-sectional study was conducted in six centres across five geopolitical zones of Nigeria.

METHODS: We recruited both healthy non-HIV and HIV-positive adults with CD4 count ≥ 350 cells/mm3 regardless of their ART status from March to May 2017. Skin tests were performed intradermally; induration ≥5 mm were considered to be histoplasmin positive.

RESULTS: 750 participants were recruited from Lagos (n = 52), Yola (n = 156), Ilorin (n = 125), Calabar (n = 120), Ibadan (n = 202) and Benin (n = 95). 467 (62.3%) were HIV negative, 247 (32.9%) were HIV positive and 36 (4.8%) did not know their HIV status. A total of 32/735 (4.4%) participants had a positive skin test. Study centre (p<0.001), education (p = 0.002) and age (p = 0.005) appeared to be significantly associated with positive skin reactivity at the 0.5% significance level, while sex (p = 0.031) and occupation (p = 0.031) would have been significant at the 5% significance level. Males had a higher rate of reactivity than females (p = 0.031, 7% vs 3%). The highest positive rates were recorded from Benin City (13/86 (15%)) and Calabar (7/120 (6%)) and no positives were recorded in Lagos (p<0.001). HIV status was not statistically significant (p = 0.70).

CONCLUSION: Histoplasmosis diagnostics should be included in the Nigerian HIV guidelines. Epidemiological vigilance of progressive disseminated histoplasmosis should be considered by local health authorities.

Alternate JournalPLoS ONE
PubMed ID29742119
PubMed Central IDPMC5942784