Ospedale Luigi Sacco

Outside of classic endemic areas, histoplasmosis has gained attention due to an increased incidence in immunocompetent travellers, attributable to changes in behaviours during travel.

A cluster of five patients who presented with acute pulmonary histoplasmosis after travelling to the Ecuadorian Amazon Region is described in this article.

Five patients (four females and one male), all in their 20s, presented with acute pulmonary histoplasmosis between sixteen and twenty-three days after the potential airborne exposure after travelling to the Ecuadorian Amazon Region. The initial common exposure is presumed to have occurred during activities inside a hollow tree trunk with guano exposure. Initial symptoms included fever and arthro-myalgias in three cases, and gastrointestinal symptoms with asthenia and lymphadenopathy in the other two cases. Symptoms progressed variably within one week to include chest pain, dyspnoea, and night sweats. Serology was negative in 2 patients during the acute phase but subsequently turned positive in all five cases. Chest CT scans performed within one week from symptom onset in all cases revealed multiple bilateral nodules. In three cases, follow-up chest CT scans performed four-six weeks after symptom onset showed the evolution of nodules into cavitations despite treatment with itraconazole.

This cluster of histoplasmosis cases highlights the clinical variability associated with this fungal infection. The development of pulmonary cavitation during the acute phase of the disease is an infrequent finding that poses additional clinical challenges and suggests the requirement of rigorous follow-up in individuals with acute histoplasmosis returning from the Amazon region.

Under standard therapies, the incidence of drug-induced liver injury (DILI) in patients with tuberculosis ranges from 2% to 28%. Numerous studies have identified the risk factors for antituberculosis DILI; however, none have been conducted in a multiethnic real-world setting. The primary outcome of the current study was to identify the risk factors that could be used as the best predictors of DILI in a multiethnic cohort.

A nested case-control study was conducted in patients at the tuberculosis clinic of Luigi Sacco Hospital in Milan.

The study included 102 patients (mean age [SD], 45.6 [15.6] years). For each patient with hepatotoxicity, 2 controls were matched for sex, age, body mass index, tuberculosis/tuberculosis infection diagnosis, and index date. We found that N-acetyltransferase 2 gene (NAT2) slow acetylator status was the best independent predictor of DILI (odds ratio, 5.97 [95% confidence interval, 1.38–25.76]; P = .02].

NAT2 genotype–guided dosing may help optimize antituberculosis drug treatment and prevent treatment failure.

ClinicalTrials.gov NCT06539455