Histoplasmose disseminada e síndrome de imunodeficiência adquirida. Estudo clínico-laboratorial de 28 casos

Abstract

Com o objetivo de estudar o quadro clínico-laboratorial da histoplasmose disseminada associada à síndrome de imunodeficiência adquirida, selecionamos 28 pacientes com aquela infecção fúngica. Infecção oportunística, rara no início da década de 80, este tipo de patologia fúngica tem elevado sua freqüência, em áreas endêmicas de histoplasmose, como conseqüência da pandemia da síndrome de imunodeficiência adquirida (AIDS). Neste resumo destacamos a histór ia da histoplasmose clássica e africana, seus agentes etiológicos, as características morfobiológicas mais importantes do Histoplasma capsulatum var. capsulatum e var. duboisii, bem como sua ecologia e epidemiologia. Os marcos fundamentais no estudo da histoplasmose foram destacados com uma avaliação do quadro clínico do paciente imunocompetente e imunocomprometido. Analisamos o diagnóstico laborator ial e destacamos a importância do exame histopatológico, do isolamento e identificação do fungo e das provas sorológicas na revelação de anticorpos e antígenos circulantes. A viabilidade do tratamento destes casos com drogas antifúngicas disponíveis, mostra que um diagnóstico precoce desta associação pode conduzir a uma cura clínica e micológica. Dados epidemiológicos sugerem que a fonte de infecção da histoplasmose em metade dos casos tenha sido contato com fezes de galinhas. Febre, perda de peso, dispnéia e lesões cutâneas disseminadas, adenomegalias, hepatomegalia e esplenomegalia foram evidentes, bem como infiltração intersticial difusa dos pulmões. A histoplasmose disseminada deve fazer parte do diagnóstico diferencial de todo paciente com AIDS que apresente alguns desses sinais ou sintomas. Nossos resultados demonstravam o valor da histopatologia, sorologia (pesquisa de anticorpos) e cultura na busca de um diagnóstico específico, especialmente, nos pacientes com AIDS. RESUMO DE TESE Disseminated histoplasmosis associated with immunodeficiency syndrome. A clinical-laboratory study of 28 casesWith the purpose of studying the clinical and laboratoirial situation of disseminated histoplasmosis associated with acquired immunodeficiency syndrome, we studied 28 AIDS patients with this fungal infection. This opportunistic infection was rare in the beginning of the 1980's but the frequency of this fungal pathogen has increased in many areas where histoplasmosis is endemic as a consequence of the aquired immunodeficiency syndrome (AIDS) pandemic. In this summary, we emphasized the history of classical and African histoplasmosis, their etiological agents, the more impor tant morphobiological characteristics of Histoplasma capsulatum var. capsulatum and var. duboisil, as well as their ecology and epidemiology. The fundamental points of the classical and African histoplasmosis were emphasized by comparing and contrasting the clinical presentation in immuno-competent and immunocompromissed patients. We analyzed laboratory diagnosis and emphasized the importance of histopathological examination, the isolation and identification of the fungal species, measurement of circulating...

Disseminated histoplasmosis in HIV positive patients in Espírito Santo state, Brazil: a clinical-laboratory study of 12 cases (1999-2001)

“…These authors reported biopsy and myeloculture as the most sensitive diagnostic procedures for histoplasmosis in AIDS, achieving 69% positivity. Alves [1,2] reported an even higher rate of positivity (79%). In our series, the diagnosis was made more often by histopathology (positive results in 9/12 cases, five from skin biopsies), emphasizing the need for adequate examination of any possible source of tissue alterations in the diagnosis work-up.…”

“…When submitted to biopsy procedures, skin lesions yielded a positive result in all of instances. Johnson et al [7] reported positive results in 5% of the procedures and Alves in 79% [1,2]. Apparently, skin lesions are more frequently found in Brazil in comparison to other countries, without an obvious explanation.…”

“…Histoplasmosis is a systemic fungal disease caused by Histoplasma capsulatum. This disease has worldwide distribution, but it is more prevalent in some regions of North and Central America [1][2][3]. Its real incidence is not known, since case reporting is not mandatory and depends on the decision of the physician.…”

“…Its real incidence is not known, since case reporting is not mandatory and depends on the decision of the physician. Prevalence data defining endemic areas comes from the results of past epidemiological surveys, based on the histoplasmin skin test [1][2][3].…”

Histoplasma capsulatum fungemia in patients with acquired immunodeficiency syndrome: detection by lysis-centrifugation blood-culturing technique

“…In Brazil, specimens of blood have been reported for diagnosis of progressive disseminated histoplasmosis (PDH) in patient with acquired immunodeficiency syndrome (AIDS) 2,5,10 , but rarely with lysiscentrifugation blood-culturing technique 14,16 . The limited data in our country justify this report.…”