Clinical and laboratory features of disseminated histoplasmosis in HIV patients from Brazil

Abstract

Summaryobjectives To identify the main clinical and laboratory features of disseminated histoplasmosis (DH) in human immunodeficiency virus (HIV) patients and compare them with those of HIV patients with other opportunistic diseases.methods Retrospective study of HIV patients comparing the clinical and laboratory data of patients with and without DH. Univariate and multivariate analyses were performed to verify the risk factors related to DH.results In total, 378 HIV patients were included, 164 with DH and 214 with other opportunistic diseases. Acute renal failure, respiratory insufficiency and septic shock were more frequent in DH patients, who also had a higher mortality (32% vs. 14%, P < 0.001). Independent risk factors for DH were: acute renal failure [odds ratio (OR) 5.2; 95% confidence interval (CI) 3.2-8.5; P < 0.001], splenomegaly (OR 3.4; 95% CI 1.19-9.9; P < 0.001), respiratory insufficiency (OR 2.7 95% CI 1.5-5.0; P < 0.001), proteinuria (OR 2.7; 95% CI 1.3-5.2; P = 0.03), hypotension (OR 2.5; 95% CI 1.2-5.0; P = 0.008), hepatomegaly (OR 2.4; 95% CI 1.2-4.8; P = 0.01), cutaneous lesions (OR, 1.9; 95% CI 1.0-3.3; P = 0.02) and weight loss (OR 1.8; 95% CI 1.0-3.1; P = 0.03).conclusion Our results suggest that DH is a severe opportunistic disease with high mortality rate, which should be promptly recognized in order to provide early specific treatment.

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

“…It is important to note that individuals presenting comorbidities with hepatitis B and C viruses and drug interactions were not observed in the study. Similar findings have also been reported in other studies, 9,14,18,28,30 and high AST and ALT levels frequently correlate with hepatomegaly. 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.…”

“…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.…”

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

“…Skin tests were subsequently performed by intradermally injecting 0.1 mL of histoplasmin antigen (HMIN) 9 , in a 1:1000 dilution 12 , into the inside of the left forearm of each selected individual 7 . HMIN is a metabolic antigen from the filamentous phase of H. capsulatum produced in-house, isolated from sputum of a case of chronic pulmonary histoplasmosis, (IPEC3356), in Rio de Janeiro provided by the Mycology Laboratory at FIOCRUZ -Rio de Janeiro.…”

“…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 .…”