Histoplasmose

Abstract

RESUMOA histoplasmose é uma micose causada por fungo dimórfico, o Histoplasma capsulatum. É considerada classicamente uma micose endêmica, embora o fungo tenha um comportamento oportunístico em pacientes com depressão da imunidade celular. O homem adquire a infecção através da inalação de conídeos presentes na natureza (cavernas com morcegos, galinheiros, etc). O quadro clínico pode variar, desde infecções assintomáticas até quadros graves disseminados, que acometem pacientes com Aids, transplantados ou com neoplasias hematológicas. O diagnóstico baseia-se no encontro do fungo em fluidos orgânicos (escarro, sangue, líquor) ou tecidos (histopatologia), na cultura de materiais biológicos e na sorologia. O tratamento das formas agudas graves, respiratória crônica ou de formas localizadas pode ser feito com azólicos orais (itraconazol) e nas disseminadas, a Anfotericina B (preferencialmente as formulações lipídicas) constitui a droga da eleição para iniciar a terapia. A histoplasmose representa, hoje uma das micoses sistêmicas mais importantes nas Américas, com ampla distribuição em todas as regiões do Brasil. Palavras-chaves:Histoplasmose. Histoplasma capsulatum. Micose sistêmica. Síndrome da imunodeficiência adquirida. ABSTRACTHistoplasmosis is a fungal infection caused by the dimorphic fungus Histoplasma capsulatum. It is classically considered an endemic mycosis, even though the fungus has an opportunistic behavior in immunocompromised patients. People acquired the infection through the inhalation of conidial forms present in the environmental, such as caves dwelling bats and soils inhabited by chickens. The clinical features may vary from asymptomatic infections to disseminated severe forms that affect patients with acquired immunodeficiency syndrome or hematological malignancies and allograft recipients. The diagnosis is based on the detection of the fungus in organic fluids (sputum, blood, liquor) or tissues (histopathological assays), in the culture of biological samples and serological assays. The treatment of severe chronic respiratory acute or localized forms can be performed with oral azolic (itraconazol) and in the disseminated forms, the amphotericin B (preferentially the lipidic formulations) consists in the elected drug to initiate the therapy. Nowadays, histoplasmosis represents one of the most important systemic mycosis in the Americas, with broad distribution in all regions of Brazil. Key-words: Histoplasmosis. Histoplasma capsulatum. Systemic mycosis. Acquired immunodeficiency syndrome.A histoplasmose é uma micose sistêmica causada por um fungo dimórfico, o Histoplasma capsulatum. A doença foi pela primeira vez descrita por Samuel Darling, no Panamá, que entre 1905 e 1906 necropsiou três casos disseminados da doença, dois dos quais provenientes da Ilha de Martinica, onde hoje esta micose é reconhecidamente endêmica. A doença descrita por este patologista era similar à leishmaniose visceral e, portanto, foi por ele considerada erroneamente ser causada por um protozoário encapsulado. Somente em 193...

Histoplasmosis en Colombia: resultados de la encuesta nacional, 1992-2008

“…A significant difference, p=0.01, was found between AIDS and non-AIDS patients, a difference already noticed in other reports and considered to be connected to the seriousness of the disease course in HIV patients (2,4,5,31,(37)(38)(39). The advanced stage of the latter infection in this series explains the clinical behavior of the mycosis, as observed by the lesser age found in this group as compared with those in the other risk factor groups; it may also explain, partially at least, the observed sex differences although here a more intense environmental exposure is also attributed to males.…”

“…Besides presenting a more rapid course, the clinical course of the AIDS patients was also more aggressive and exhibited peculiar characteristics rarely informed in other patients groups, such as indicated by hematologic abnormalities and frequency and severity of skin lesions, as described earlier (2,4,5,31,(37)(38)(39). It should be noticed that skin lesions are seldom observed in North American patients (8,9).…”

Genetic risk factors for human susceptibility to infections of relevance in dermatology

“…The clinical features may vary from asymptomatic infection to disseminated severe forms; the outcome of the infection with H. capsulatum is dependent on dynamic interactions between innate immunity, adaptive immunity and fungal virulence factors. 86 Skin and mucosal manifestations of histoplasmosis may occur, especially in the disseminated form (more frequent in the setting of immune suppression), as a result of hematogenic dissemination, together with lymph node involvement.…”

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

“…Prior to the AIDS epidemic, histoplasmosis was most frequently reported in outbreak events 20,23 , and the disseminated form was found primarily in patients with lymphoma or other cancers and sporadically in renal transplant patients 13 . However, since the 1980s, the disseminated form has been observed mainly in HIV-infected patients with advanced immunosuppression 13,16 .…”

“…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 .…”