Differences in Histoplasmosis in Patients with Acquired Immunodeficiency Syndrome in the United States and Brazil

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Abstract
Demographic and clinical parameters among patients with acquired immunodeficiency syndrome and histoplasmosis in Brazil and United States were compared. The Brazilian isolates were typed by restriction-fragment length polymorphism analysis and were DNA fingerprinted by random amplification of polymorphic DNA (RAPD)–polymerase chain reaction (PCR). Skin lesions occurred in 66% of Brazilian case patients, compared with 1%–7% of US case patients. Of 21 treated case patients, 4 (19%) died, a rate similar to that of the US case patients (5%–13%). By nuclear gene typing, the Brazilian isolates were equally divided between South American classes 5 and 6, and RAPD-PCR showed 18 distinct genetic fingerprints in 20 isolates. Skin lesions are more common in infection with class 5 or 6 organisms than with class 2 Histoplasma capsulatum. The role of genetic differences in the organism as a cause for the clinical differences requires investigation

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