Histoplasmose disseminada aguda em indivíduo imunocompetente

Abstract

A histoplasmose é uma doença fúngica causada pela inalação de esporos de Histoplasma capsulatum. A maioria dos indivíduos normais não apresenta doença após pequena inalação, porém exposições mais prolongadas podem levar ao desenvolvimento de infecção pulmonar aguda, crônica ou disseminada. Nos pacientes imunocomprometidos a infecção é disseminada e grave. Relatamos o caso de um paciente de treze anos, imunocompetente, com febre, tosse seca e dispnéia progressiva havia dois meses. O radiograma e a tomografia computadorizada de tórax evidenciavam infiltrado intersticial com micronódulos difusos. O paciente relatava contato intenso com pássaros em sua residência. Foi submetido a biópsia pulmonar a céu aberto, que evidenciou Histoplasma capsulatum em tecido pulmonar. A cultura do fragmento da biópsia confirmou a presença de Histoplasma capsulatum sp. O paciente foi tratado com anfotericina-B por 28 dias, seguida de itraconazol por seis meses, com resolução do quadro.

Delayed Diagnosis of Pulmonary Histoplasmosis in an Immunocompetent Young Asthmatic Female from Florida, a Non-Endemic Area for Histoplasma Capsulatum

“…Both Chronic pulmonary and disseminated histoplasmosis are more usually reported in immunosuppressed and are major opportunistic infections in HIV/AIDS [18,21], organ transplant recipients [22] and patients on immunosuppressive therapy such as tumor necrosis factor inhibitors [23][24][25]. However there has been a case of acute disseminated histoplasmosis reported in a 13 year old immunocompetent subject [26]. In immunocompetent subjects, disease is usually self-limited or subclinical.…”

“…Unfortunately his histoplasmosis was not diagnosed and he died within seven days of inpatient admission and diagnosis was made on autopsy. The third case of acute disseminated histoplasmosis was in a 13 year old immunocompetent boy who presented with dry cough and dyspnea for one month [26]. Extensive work up established the diagnosis and he made complete recovery with treatment.…”

Importance of the association of molecular and immunological diagnosis in immunocompetent patient with Histoplasma capsulatum and Cryptoccocus neoformans infection: a case report

“…Fortaleza et al . [ 10 ] reported one case of an immunocompetent patient with histoplasmosis that developed a severe form of the disease, presumably due to the intensity of exposure and delayed diagnosis.…”

“…The manifestations of mycoses were influenced by genetic and environmental conditions such as the amount of the fungal propagules in the soil, the immune status of the host and the virulence of the infecting strain [ 8 ]. Epidemiology of fungal infections is important in immunocompetent individuals, especially when the available diagnostic tools do not show conclusive results [ 9 , 10 ].…”

Histoplasmose Adrenal Bilateral: Um Relato De Caso

“…3 No entanto, para o paciente apresentar esses sintomas, a glândula deve ser destruída em torno de 90%, o que se torna raro na histoplasmose disseminada, já que outros sintomas levarão o paciente a procurar atendimento médico (FORTALEZA et al, 2004). O diagnóstico é feito pela biópsia percutânea de fragmentos ("core biopsy"), dirigida por ecografia e/ou tomografia 7 computadorizada.…”