A Simple Predictive Score to Distinguish between Disseminated Histoplasmosis and Tuberculosis in Patients with HIV
2021
Mathieu Nacher | Kinan Drak Alsibai | Loïc Epelboin | Philippe Abboud | Frédégonde About | Magalie Demar | Félix Djossou | Romain Blaizot | Maylis Douine | Nadia Sabbah | Nicolas Vignier | Leila Adriouch | Aude Lucarelli | Mathilde Boutrou | Pierre Couppié | Antoine Adenis
Disseminated histoplasmosis is a common differential diagnosis of tuberculosis in disease-endemic areas. We aimed to find a predictive score to orient clinicians towards disseminated histoplasmosis or tuberculosis when facing a non-specific infectious syndrome in patients with advanced HIV disease. We reanalyzed data from a retrospective study in Cayenne Hospital between January 1997&ndash:December 2008 comparing disseminated histoplasmosis and tuberculosis: 100 confirmed disseminated histoplasmosis cases and 88 confirmed tuberculosis cases were included. A simple logit regression model was constructed to predict whether a case was tuberculosis or disseminated histoplasmosis. From this model, a score may be obtained, where the natural logarithm of the probability of disseminated histoplasmosis/tuberculosis = +3.917962 ×: WHO performance score (1 if >:2, 0 if &le:2) &minus:1.624642 ×: Pulmonary presentation (1 yes, 0 no) +2.245819 ×: Adenopathies >: 2 cm (1 yes, 0 no) &minus:0.015898 ×: CD4 count &minus: 0.001851 ×: ASAT &minus: 0.000871 ×: Neutrophil count &minus: 0.000018 ×: Platelet count + 6.053793. The area under the curve was 98.55%. The sensitivity of the model to distinguish between disseminated histoplasmosis and tuberculosis was 95% (95% CI = 88.7&ndash:98.3%), and the specificity was 93% (95% CI = 85.7.3&ndash:97.4%). In conclusion, we here present a clinical-biological predictive score, using simple variables available on admission, that seemed to perform very well to discriminate disseminated histoplasmosis from tuberculosis in French Guiana in well characterized patients.
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