# Misdiagnosis and Coinfection of Localized Pulmonary Histoplasmosis with Pulmonary Tuberculosis: A Systematic Review of Published Cases

## TL;DR

This study reviews cases where lung histoplasmosis was misdiagnosed or coinfected with tuberculosis, highlighting diagnostic challenges and suggesting better methods for accurate diagnosis.

## Contribution

The study systematically reviews published cases to highlight misdiagnosis and coinfection patterns between pulmonary histoplasmosis and tuberculosis.

## Key findings

- Males aged around 54 years and those exposed to caves or farming were most commonly affected.
- Chest CT scans detected more nodules than X-rays, and radiologic abnormalities occurred in any lung region.
- Combining clinical suspicion, radiology, and antibody or antigen testing can improve histoplasmosis diagnosis.

## Abstract

Pulmonary histoplasmosis is often misdiagnosed as or coinfected with pulmonary tuberculosis (TB). This study aims to analyze the misdiagnosis or co-occurrence of published cases of pulmonary TB and pulmonary histoplasmosis. Cases of histoplasmosis with dissemination were excluded, as it affects other organs. Systematic research was conducted using PubMed, EBSCOhost, ProQuest, BioRxiv, and MedRxiv databases. Twenty-seven articles were included, covering a total of 51 cases. Males were predominantly affected, with a median age of 54 years. Exposure to caves and farming occupations were identified as the primary sources of infection (61.9%). The most common clinical symptoms were fever (80%) and cough (82.5%). Laboratory tests revealed culture positivity in 77.1% of cases, with sputum being the most frequently used specimens. In proven pulmonary histoplasmosis, antibody tests were positive in 18 out of 24 cases. Chest X-rays commonly showed cavities, infiltrates, and nodules, with an increase in nodular pattern in recent cases. The number of pulmonary nodules detected was higher on chest computed tomography (CT). Radiologic abnormality could occur in any lung region. This review suggests the potential for misdiagnosis and/or coinfection of pulmonary histoplasmosis and pulmonary TB. The combination of clinical suspicion, radiological findings, antibody and/or antigen testing could improve the diagnosis of pulmonary histoplasmosis.