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

Abstract

The State of Ceará in north-eastern Brazil has one of the highest rates in the world of relapse and death due to disseminated histoplasmosis (DH) in acquired immunodeficiency syndrome (AIDS) patients. The objective of this study is to characterise the relapse and mortality of DH in AIDS cases residents in Ceará. We performed a retrospective analysis of the medical records of AIDS patients who had a first episode of DH from 2002 to 2008. We analysed the outcomes until December 31, 2010. A total of 145 patients participated in the study. The mean clinical follow-up duration was 3.38 years (SD = 2.2; 95% CI = 3.01-3.75). The majority of the subjects were male with a mean age of 35 years (SD = 2.2; 95% CI = 3.01-3.75) and were born in the capital of Ceará. DH was the first manifestation of AIDS in 59% of the patients. The relapse rate was 23.3%, with a disseminated presentation in 90% of these patients. The overall mortality during the study period was 30.2%. The majority of patients who relapsed or died had irregular treatment with antifungals or highly active antiretroviral therapy and did not have active clinical follow-up. High rates of recurrence and mortality were found in AIDS-associated DH in this area of the country.

Prevalence and lethality among patients with histoplasmosis and AIDS in the Midwest Region of Brazil

“…Histoplasmosis continues to be an important opportunistic mycosis among AIDS patients. 11,12 In endemic areas, the incidence of histoplasmosis occurs in 5 to 20% of these patients. 2,13 This work confirms that histoplasmosis is largely associated with AIDS.…”

Role of western blot assay for the diagnosis of histoplasmosis in AIDS patients from a National Institute of Infectious Diseases in Rio de Janeiro, Brazil

“…The viral load (VL) was available for 45 patients, and the mean VL was 217,877 copies/mm 3 . Five individuals had undetectable VL and three patients had VL > 500,000 copies/mm 3 (Table 1).…”

“…It is one of the most common respiratory mycosis in endemic regions of the United States and Latin America . In Brazil, histoplasmosis has been described in several regions especially in the Midwest, Northeastern and Southeast regions of the country …”

Endemic Mycoses in Immunocompromised Hosts

“…Numerous recent retrospective chart review studies have added important new information to our understanding of the risk factors, clinical presentation, emergence, management and outcomes of endemic mycoses in various regions throughout the world. These include reports of high rates of relapse (23%) and overall mortality (30%) among HIV/AIDS patients with disseminated histoplasmosis in Brazil [15], clinical presentation and management of patients that developed coccidioidomycosis while receiving biological response modifiers (BRMs) or disease-modifying anti-rheumatic drugs (DMARDs) for rheumatic diseases [16], and clinical presentation of histoplasmosis and penicilliosis among HIV/AIDS patients in Thailand [17]. In a case series of all published cases of proven Penicillium marneffei infection in Mainland China (N=668), Hu et al [7] report that 87.7% of all cases occurred in HIV-infected individuals.…”