Successful Use of Multidisciplinary Palliative Care in the Outpatient Treatment of Disseminated Histoplasmosis in an HIV Positive Child
Histoplasmosis is an uncommon opportunistic infection in human immunodeficiency virus (HIV) positive children. The most common form is primary disseminated histoplasmosis, characterized by persistent fever and failure to thrive. A 10-year-old HIV positive girl presented to the Baylor College of Medi...
Main Authors: | , , , |
---|---|
Format: | Article |
Language: | English |
Published: |
MDPI AG
2021-04-01
|
Series: | Children |
Subjects: | |
Online Access: | https://www.mdpi.com/2227-9067/8/4/273 |
id |
doaj-7c313e690df5415097c04474babdd878 |
---|---|
record_format |
Article |
spelling |
doaj-7c313e690df5415097c04474babdd8782021-04-02T23:02:36ZengMDPI AGChildren2227-90672021-04-01827327310.3390/children8040273Successful Use of Multidisciplinary Palliative Care in the Outpatient Treatment of Disseminated Histoplasmosis in an HIV Positive ChildAlison Lopez0Jason Bacha1Carrie Kovarik2Liane Campbell3Pediatric Infectious Diseases, University of Manitoba, Winnipeg, MB R3E3P5, CanadaBaylor College of Medicine International Pediatric AIDS Initiative at Texas Children’s Hospital, Houston, TX 77030, USADepartment of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USABaylor College of Medicine International Pediatric AIDS Initiative at Texas Children’s Hospital, Houston, TX 77030, USAHistoplasmosis is an uncommon opportunistic infection in human immunodeficiency virus (HIV) positive children. The most common form is primary disseminated histoplasmosis, characterized by persistent fever and failure to thrive. A 10-year-old HIV positive girl presented to the Baylor College of Medicine Children’s Foundation—Tanzania Mbeya Center of Excellence (COE) with ulcerated skin lesions and a violaceous facial rash. She also had persistent fevers, severe acute malnutrition, and severe anemia. At diagnosis, the patient was failing first line antiretroviral therapy (ART) with a cluster of differentiation 4 immune cells (CD4) of 24 cells/µL and an HIV viral load (VL) of 196,658 cp/mL. The patient was changed to a second line ART regimen (abacavir, lamivudine, and ritonavir-boosted lopinavir) and received nutritional support, blood transfusions, multiple antibiotics, and meticulous wound care. She also received comprehensive symptom management, psychosocial support, and emergency housing through the COE’s palliative care program. Biopsy of a lesion showed intracytoplasmic organisms consistent with <i>Histoplasmosis capsulatum</i> var <i>capsulatum.</i> The patient was treated with conventional amphotericin B and oral itraconazole and she achieved wound healing as well as immune reconstitution and HIV viral suppression. Amphotericin infusions were given as an outpatient despite the resource constraints of the setting in southwestern Tanzania. Histoplasmosis should be considered in the differential diagnosis of the immunocompromised host with unusual skin manifestations and persistent fever.https://www.mdpi.com/2227-9067/8/4/273pediatricsglobal healthhistoplasmosissymptom managementHIV/acquired immunodeficiency syndrome (AIDS)resiliency |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Alison Lopez Jason Bacha Carrie Kovarik Liane Campbell |
spellingShingle |
Alison Lopez Jason Bacha Carrie Kovarik Liane Campbell Successful Use of Multidisciplinary Palliative Care in the Outpatient Treatment of Disseminated Histoplasmosis in an HIV Positive Child Children pediatrics global health histoplasmosis symptom management HIV/acquired immunodeficiency syndrome (AIDS) resiliency |
author_facet |
Alison Lopez Jason Bacha Carrie Kovarik Liane Campbell |
author_sort |
Alison Lopez |
title |
Successful Use of Multidisciplinary Palliative Care in the Outpatient Treatment of Disseminated Histoplasmosis in an HIV Positive Child |
title_short |
Successful Use of Multidisciplinary Palliative Care in the Outpatient Treatment of Disseminated Histoplasmosis in an HIV Positive Child |
title_full |
Successful Use of Multidisciplinary Palliative Care in the Outpatient Treatment of Disseminated Histoplasmosis in an HIV Positive Child |
title_fullStr |
Successful Use of Multidisciplinary Palliative Care in the Outpatient Treatment of Disseminated Histoplasmosis in an HIV Positive Child |
title_full_unstemmed |
Successful Use of Multidisciplinary Palliative Care in the Outpatient Treatment of Disseminated Histoplasmosis in an HIV Positive Child |
title_sort |
successful use of multidisciplinary palliative care in the outpatient treatment of disseminated histoplasmosis in an hiv positive child |
publisher |
MDPI AG |
series |
Children |
issn |
2227-9067 |
publishDate |
2021-04-01 |
description |
Histoplasmosis is an uncommon opportunistic infection in human immunodeficiency virus (HIV) positive children. The most common form is primary disseminated histoplasmosis, characterized by persistent fever and failure to thrive. A 10-year-old HIV positive girl presented to the Baylor College of Medicine Children’s Foundation—Tanzania Mbeya Center of Excellence (COE) with ulcerated skin lesions and a violaceous facial rash. She also had persistent fevers, severe acute malnutrition, and severe anemia. At diagnosis, the patient was failing first line antiretroviral therapy (ART) with a cluster of differentiation 4 immune cells (CD4) of 24 cells/µL and an HIV viral load (VL) of 196,658 cp/mL. The patient was changed to a second line ART regimen (abacavir, lamivudine, and ritonavir-boosted lopinavir) and received nutritional support, blood transfusions, multiple antibiotics, and meticulous wound care. She also received comprehensive symptom management, psychosocial support, and emergency housing through the COE’s palliative care program. Biopsy of a lesion showed intracytoplasmic organisms consistent with <i>Histoplasmosis capsulatum</i> var <i>capsulatum.</i> The patient was treated with conventional amphotericin B and oral itraconazole and she achieved wound healing as well as immune reconstitution and HIV viral suppression. Amphotericin infusions were given as an outpatient despite the resource constraints of the setting in southwestern Tanzania. Histoplasmosis should be considered in the differential diagnosis of the immunocompromised host with unusual skin manifestations and persistent fever. |
topic |
pediatrics global health histoplasmosis symptom management HIV/acquired immunodeficiency syndrome (AIDS) resiliency |
url |
https://www.mdpi.com/2227-9067/8/4/273 |
work_keys_str_mv |
AT alisonlopez successfuluseofmultidisciplinarypalliativecareintheoutpatienttreatmentofdisseminatedhistoplasmosisinanhivpositivechild AT jasonbacha successfuluseofmultidisciplinarypalliativecareintheoutpatienttreatmentofdisseminatedhistoplasmosisinanhivpositivechild AT carriekovarik successfuluseofmultidisciplinarypalliativecareintheoutpatienttreatmentofdisseminatedhistoplasmosisinanhivpositivechild AT lianecampbell successfuluseofmultidisciplinarypalliativecareintheoutpatienttreatmentofdisseminatedhistoplasmosisinanhivpositivechild |
_version_ |
1721544630596534272 |