[African histoplasmosis: clinical and therapeutic aspects relation to AIDS. 4 cases including a case with HIV-1 and HTLV-I co-infection]

African histoplasmosis caused by Histoplasma duboisii (HD) is a rare mycosis observed outside its small endemic zone only by importation. Four cases occurring in Zaire are described. A 32- year-old HIV seronegative nurse was diagnosed with subacute cutaneous-osseous HD infection. The patient was cured with amphotericin B and was free of disease four years later. A 50- year-old cultivator diagnosed with chronic cutaneous osseous lymphatic and probably intestinal HD infection died shortly after diagnosis with no treatment. A 30-year-old HIV seronegative cultivator with subacute cutaneous HD infection was completely cured with amphotericin B and remained free of disease for three years of follow-up. A 28-year-old cultivator seropositive for HIV-1 and HTLV was diagnosed with cutaneous- osseous and probably lymphatic and splenic HD infection. Favorable results were obtained with short-term ketoconazole treatment before the patient was lost to follow-up. 245 cases of African histoplasmosis have been described in the literature including seven associated with AIDS. The incidence does not seem to have increased with AIDS but the association is likely to become more common as the HIV infection spreads in rural areas. In the absence of treatment African histoplasmosis inexorably progresses to dissemination and death. Prolonged follow-up is required after treatment because of the possibility of recurrence. Treatment with amphotericin B ketoconazole or itraconazole is available and effective a long as the duration of treatment and of follow-up are prolonged.