Prior subclinical histoplasmosis revealed in Nigeria using histoplasmin skin testing

Rita Oladele, Folasade T Ogunsola, Conchita Toriello, Olusola Ayanlowo, Paul Foden, Adetona Fayemiwo, Iriagbonse Osaigbovo, Anthony Iwuafor, Shuwaram Shettima, Halimat Ekundayo, Malcolm Richardson, David Denning

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Objectives: Disseminated histoplasmosis is an AIDS-defining illness. Histoplasmosis is commonly misdiagnosed as tuberculosis. Nigeria has the second highest number of people living with HIV/AIDS in Africa. The present study was carried out to investigate the prevalence of skin sensitivity amongst Nigerians to histoplasmin. Design: A cross-sectional study was conducted in six centres across five geopolitical zones of Nigeria. Methods: We recruited both healthy non-HIV and HIV-positive adults with CD4 count ≥ 350 cells/mm3 regardless of their ART status from March to May 2017. Skin tests were performed intradermally; induration ≥5 mm were considered to be histoplasmin positive. Results: 750 participants were recruited from Lagos (n=52), Yola (n=156), Ilorin (n=125), Calabar (n=120), Ibadan (n=202) and Benin (n=95). 467 (62.3%) were HIV negative, 247 (32.9%) were HIV positive and 36 (4.8%) did not know their HIV status. A total of 32/735 (4.4%) participants had a positive skin test. Study centre (p<0.001), education (p=0.002) and age (p=0.005) appeared to be significantly associated with positive skin reactivity at the 0.5% significance level, while sex (p=0.031) and occupation (p=0.031) would have been significant at the 5% significance level. Males had a higher rate of reactivity than females (p=0.031, 7% vs 3%). The highest positive rates were recorded from Benin City (13/86 (15%)) and Calabar (7/120 (6%)) and no positives were recorded in Lagos (p<0.001). HIV status was not statistically significant (p=0.70). Conclusion: Histoplasmosis diagnostics should be included in the Nigerian HIV guidelines. Epidemiological vigilance of progressive disseminated histoplasmosis should be considered by local health authorities.
Original languageEnglish
JournalPLoS ONE
Issue number5
Early online date9 May 2018
Publication statusPublished - 2018


  • Histoplasmosis
  • Nigeria


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