Características clínico-evolutivas de 134 pacientes com histoplasmose disseminada associada a SIDA no Estado do Ceará

Abstract

RESUMOIntrodução: Desde o início da epidemia de HIV no Ceará, histoplasmose disseminada tem sido detectada com frequência em pacientes com aids. Métodos: De modo a conhecer características clínico-laboratoriais, evolução e sobrevida da co-infecção HD/AIDS, analisou-se retrospectivamente 134 prontuários casos de HD internados de 1999 a 2005 no hospital referência para HIV no Ceará. Resultados: Pacientes com HD apresentaram maior frequência de febre diária, tosse, perda de peso, hepatoesplenomegalia e insuficiência renal aguda. Diagnóstico foi dado por pesquisa e/ou cultura. À admissão, foram fatores de risco relacionados ao óbito de pacientes com HD: vômitos, dispnéia, insuficiência respiratória e IRA, hemoglobina≤8g/L, uréia≥40mg/dL e creatinina ≥1,5mg/dL. Conclusões: Pacientes com HD apresentaram caracteristicamente febre mais elevada, internamentos anteriores por infecção respiratória, mais complicações clínicas e como fatores independentes para óbito, anemia importante e elevação de uréia. Palavras-chaves:Histoplasmose disseminada. AIDS. Ceará. Doença oportunista. ABSTRACTIntroduction: Since the beginning of the HIV epidemic in Ceará, disseminated histoplasmosis (DH) has often been detected among AIDS patients. Methods: In order to investigate the clinical and laboratory characteristics, evolution and survival of cases of DH/AIDS coinfection, the medical records on 134 cases of DH admitted to a reference hospital in Ceará between 1999 and 2005 were analyzed. Results: Patients with DH presented higher frequency of daily fever, coughing, weight loss, enlarged liver and spleen and acute kidney failure. The diagnosis was made using investigation and/or cultures. At admission, the following were risk factors for death among DH patients: vomiting, dyspnea, respiratory failure, acute kidney failure, hemoglobin ≤ 8g/l, urea ≥ 40mg/dl and creatinine ≥1.5 mg/dl. Conclusions: Patients with DH characteristically presented higher fever, previous hospitalization due to respiratory infection and more clinical complications. Significant anemia and elevated urea were independent risk factors for death among DH patients.

Disseminated histoplasmosis and aids: relapse and late mortality in endemic area in north‐eastern Brazil

“…A high number of cases of this co-infection (38 cases per year) was detected in this study when compared with a previous series (19 cases per year) from the same area 16,24 and with other endemic areas of Panama (28 cases per year) and Guyana (9 cases per year). 13,14 This larger number of DH cases appears to be consistent with the increased number of AIDS cases detected in the same study period in Cear a.…”

“…14,15 However, a preliminary study conducted in Cear a from 1999 to 2005 in patients with this co-infection indicated a relapse index greater than 20% during a 2-year follow-up period. 16 There is no consensus regarding the suspension of secondary prophylaxis; however, clinical follow-up data have demonstrated that interruption is possible once immune recovery is achieved after highly active antiretroviral therapy (HAART). 11,[17][18][19][20][21] Mortality due to DH and AIDS is variable throughout the world and is~10% in developed countries and 30% in areas with limited financial resources.…”

“…11,[17][18][19][20][21] Mortality due to DH and AIDS is variable throughout the world and is~10% in developed countries and 30% in areas with limited financial resources. 16,17 In the early 2000s, the mortality of the first DH episode in AIDS patients in the state of Cear a was 32.8%, with a higher figure of 47.8% if the deaths occurred in the 2-year period of follow-up. 16 The purpose of this study was to better characterise the relapse and late mortality (death after the hospital discharge) of AIDS patients after the first DH episode that were followed up in the reference units of an endemic area from 2002 to 2008.…”

Development of a Loop-Mediated Isothermal Amplification Method for Detection of Histoplasma capsulatum DNA in Clinical Samples

“…In the case of PDH associated with HIV, the need for straightforward and inexpensive laboratory diagnostic tools remains important, because PDH can cause death in 95% of cases (21) misdiagnosed. Delayed antifungal treatment of PDH results in mortality rates between 30 and 42% (22)(23)(24)(25)(26) in regions where the disease is endemic and where there are underserved populations or limited diagnostic resources. Molecular diagnostic tests have the potential to detect very small amounts of DNA with high specificity, and the LAMP method is both rapid and inexpensive.…”

Histoplasmin Survey in Hiv-Positive Patients: Results From an Endemic Area in Northeastern Brazil

“…However, since the 1980s, the disseminated form has been observed mainly in HIV-infected patients with advanced immunosuppression 13,16 . Several Brazilian states have reported cases of histoplasmosis associated with HIV infection 2,26 , however, the state of Ceará in Northeastern Brazil has had the highest incidence of AIDS/ histoplasmosis association in recent years 7,24 and one of the highest in the world 6 . In a retrospective study that was conducted from 1995 to 2004 in Fortaleza, the capital of Ceará, 164 patients were diagnosed with concurrent HIV infection and disseminated histoplasmosis 8 .…”