Disseminated histoplasmosis in Central and South America, the invisible elephant: The lethal blind spot of international health organizations

Histoplasma capsulatum is endemic in the Americas [1,2]. It has been an AIDS-defining infection since 1987 [3]. In the USA, it is a well known pathogen that can be promptly diagnosed and treated. In South and Central America, and may be the Caribbean, it is another story. Since the onset of the HIV epidemic, there have been a number of convergent reports that suggest that disseminated histoplasmosis is one of the major AIDS-defining infections and a major killer of HIV-infected patients [4–8]. However, most hospitals still have no way of diagnosing the disease and often lack the best treatments for the disease. There is thus a double tragedy, with clinicians failing to diagnose what is killing their patients, and public health authorities failing to tackle one of the major burdens of disease. Mycologic diagnosis rests on direct examination and culture of tissue samples that is often invasive and may take weeks to reveal H. capsulatum[9]. Molecular biology is not commercially available and thus not available in most hospitals. The detection of H. capsulatum antigens in urine or serum by enzyme immune assays remains a simple, noninvasive, sensitive method, with an increasing number of alternatives that are being evaluated but are still distributed on a small scale in Latin America [9]. The future diagnostic tests that could radically change the picture should be ASSURED, that is affordable, sensitive, specific, user friendly, rapid, equipment free, and delivered to those who need it [10].