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

Abstract

Twelve cases of histoplasmosis in HIV-infected patients were found in a retrospective analysis at the Hospital Universitário Cassiano Antônio de Moraes of the Universidade Federal do Espírito Santo (HUCAM), Vitória (ES), from June 1999 to May 2001. The frequency of histoplasmosis among HIV-positive patients was 2.1% in the infectious diseases division of the hospital during this period. Histoplasmosis compromised mainly males (11/12), 27 to 44 years old, and residents of the metropolitan urban area (10/12). Alcohol abuse and tobacco smoking were described in 10 of the 12 patients. For all patients, this was the first opportunistic infection. Two of the 12 patients died; 10 patients had disseminated disease, one patient had an intestinal presentation and one had disease restricted to the lungs. The most frequent clinical manifestations were weight loss, fever, hepatomegaly and splenomegaly, coughing, abdominal pain, and diarrhea. Six of the 12 patients had skin lesions. Time of symptoms preceding the diagnosis varied from two months to one year. CD4 counts were below 200 cells/mm(3) in 9 of 10 patients. Diagnosis was made by histology in two thirds of the patients. The typical adult patient with HIV infection and histoplasmosis in our series was male, had a CD4 count below 200 cells/mm(3), had fever, weight loss, cough, abdominal pain and hepatomegaly in the last two months or more, had a high probability of alcohol and tobacco addiction, was having his first opportunistic infection, and had no identifiable environmental exposure risk.

Clinical and Laboratory Profile of Persons Living with Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome and Histoplasmosis from a Colombian Hospital

“…These lesions include ulcers, papules, crusted lesions, and hyperpigmented and hypopigmented lesions. A high proportion of skin manifestations had been previously reported in studies conducted in Latin American countries such as French Guyana (13%), Panama (17%), and Brazil (43-66%), [9][10][11]14,18,30,31 in contrast to much lower rates reported among patients in the United States (1-7%). 28,29,37 Karimi and others 11 have proposed an association between these skin and mucosal lesions and genetic variations occurring in the etiological agent infecting the patient and suggest that more studies are needed to further evaluate this observation.…”

“…Splenomegaly and hepatomegaly have been reported frequently among PDH patients (10-93%) in similar cohorts from Europe, United States, Panama, French Guyana, Brazil, and Argentina. 9,10,12,13,18,28,30,31 The signs of hepatomegaly and/ or splenomegaly are often nonspecific and are frequently present in PLWHA having other opportunistic coinfections, especially TB.…”

“…Similar findings were described in previous studies. [9][10][11]14,18,30,31,34,35 The similarity between the two groups of patients in this respect could well be due to other diseases in the non-PDH patients affecting the respective organs (e.g., caused by Mycobacterium species, Pneumocystis jirovecii, Cryptococcus neoformans, and Toxoplasma gondii).…”

Histoplasma capsulatum Cell Wall β-Glucan Induces Lipid Body Formation through CD18, TLR2, and Dectin-1 Receptors: Correlation with Leukotriene B4 Generation and Role in HIV-1 Infection

“…One consequence of the depletion and dysfunction of CD4 ϩ T lymphocytes in AIDS is the decline of production of cytokines such as GM-CSF (46) and the inability of patients to elaborate 5-LO products, resulting in a marked impairment of LT synthesis (5). Moreover, chemotaxis, phagocytosis, and the killing of microorganisms by macrophages, monocytes, and neutrophils (47) are also reduced with the progression of AIDS, facilitating opportunistic infections such as that by Hc (48). Extending our mouse results and literature findings, we suggest that PBMC from CD4 ϩ T lymphocyte-depleted patients form only discrete amounts of LB, LTB 4 , and PGE 2 following in vitro stimulation with F1 and ␤-glucan, due to an inability to express 5-LO and/or FLAP.…”

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

“…5,6 Currently, AIDS is the most important risk factor for DH, 7 affecting predominantly male young adults due to primary acquisition or reactivation of a latent infection. [7][8][9][10] The estimated incidence of histoplasmosis varies from 5% to 25% in HIV residents of endemic areas. 11,12 The Cear a State in the north-east region of Brazil reports one of the largest numbers of cases of DH in the world.…”