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2.
Medicina (B.Aires) ; 81(4): 641-644, ago. 2021. graf
Article in Spanish | LILACS | ID: biblio-1346518

ABSTRACT

Resumen Histoplasma capsulatum es un hongo ambiental que se encuentra distribuido comúnmente en los valles de los ríos Ohio y Mississippi, América Central, Sudamérica y Asia. Las zonas más afectadas en Argentina son las cuencas de los ríos Paraná y de La Plata. Los pacientes con histoplasmosis tienen una amplia variedad de manifestaciones clínicas. La mayoría son asintomáticos, mientras que aquellos con com promiso de la inmunidad celular tienen un riesgo aumentado de padecer la forma diseminada. Presentamos el caso de una mujer adulta, en tratamiento con metotrexato por una artritis seronegativa, que desarrolló la forma diseminada de la enfermedad, y que representó un desafío diagnóstico debido a la dificultad para identificar el agente etiológico.


Abstract Histoplasma capsulatum is an environmental fungus commonly found in the Ohio and Mississippi River valleys, Central and South America, and Asia. The most affected areas in Argentina are the Paraná and de La Plata river basins. Patients with histoplasmosis can have a wide range of clinical presentations. Most of them are asymptomatic, while those with compromised cellular immunity are at increased risk for the disseminated form. We present the case of a patient undergoing treatment with methotrexate for seronegative arthritis who developed the disseminated form of the disease, and who represented a diagnostic challenge due to the difficulty in identifying the etiologic agent.


Subject(s)
Humans , Female , Arthritis/drug therapy , Histoplasmosis/diagnosis , Histoplasmosis/drug therapy , Argentina , Methotrexate , Histoplasma
3.
Medicentro (Villa Clara) ; 25(2): 345-354, graf
Article in Spanish | LILACS | ID: biblio-1279428

ABSTRACT

RESUMEN La histoplasmosis diseminada progresiva constituye una expresión singular y rara de la infección por Histoplasma capsulatum. Sus formas agudas de presentación suelen aparecer en pacientes con deficiencias inmunitarias graves (fundamentalmente VIH). Sin embargo, en regiones de alta endemicidad, incluso pacientes sin inmunodeficiencia demostrada pueden desarrollar esta afección. Se presentó un paciente de 47 años de edad, con antecedentes de haber sufrido un cuadro grave de histoplasmosis pulmonar 18 años antes. El paciente fue ingresado por un cuadro de: fiebre, astenia, sudoración nocturna, disnea, tos seca, hepatoesplenomegalia, anemia y trombocitopenia marcada. Progresó a una insuficiencia respiratoria aguda y fue internado en cuidados intensivos con ventilación mecánica invasiva. Se demostró crecimiento de Histoplasma capsulatum en la muestra de lavado bronquioalveolar y reacción granulomatosa no caseificante en médula ósea, confirmándose el diagnóstico de histoplasmosis diseminada progresiva. El paciente recibió tratamiento con anfotericina B y se recuperó totalmente en pocas semanas.


ABSTRACT Progressive disseminated histoplasmosis is a unique and rare expression of the infection cause by Histoplasma capsulatum. Its acute forms of presentation usually appear in patients with severe immunodeficiency disorders (mainly HIV). However, even patients without proven immunodeficiency can develop this condition in regions of high endemicity. We present a 47-year-old male patient with a previous history of severe pulmonary histoplasmosis eighteen years earlier. The patient was admitted due to the presence of fever, asthenia, night sweats, dyspnea, dry cough, hepatosplenomegaly, anemia and marked thrombocytopenia. He progressed to acute respiratory failure and was admitted to the intensive care unit requiring invasive mechanical ventilation. Growth of Histoplasma capsulatum was demonstrated in the bronchoalveolar lavage sample and a non-caseating granulomatous reaction was found in the bone marrow, confirming the diagnosis of progressive disseminated histoplasmosis. The patient received amphotericin B treatment and made a full recovery within a few weeks.


Subject(s)
Histoplasma , Histoplasmosis , Immunity
4.
Rev. cuba. med. trop ; 73(1): e528, graf
Article in Spanish | LILACS, CUMED | ID: biblio-1280335

ABSTRACT

Introducción: La histoplasmosis es una micosis causada por Histoplasma capsulatum. Este hongo se encuentra en las excretas de algunos animales (murciélagos y aves) y su reservorio es el suelo. Es una enfermedad endémica en el continente americano. La inhalación de esporas causa infección pulmonar primaria que puede diseminarse. Objetivo: Describir un caso de histoplasmosis bucal en un paciente seronegativo al virus de inmunodeficiencia humana. Caso clínico: Paciente diabético, fumador y alcohólico con cuadro febril de varios meses acompañado de manifestaciones respiratorias. Además, se constataron úlceras en encías y lengua, lesiones nodulares en mucosas del carrillo, fondo del surco vestibular y reborde alveolar. Se informó anemia, leucopenia y aumento de la velocidad de sedimentación globular. El diagnóstico se confirmó mediante citología e histopatología. La terapéutica empleada fue itraconazol 200 mg tres veces al día, luego 200 mg dos veces al día por dos meses y una tableta diaria hasta seis meses después del segundo mes. El paciente se encuentra asintomático y las lesiones bucales desaparecieron. Conclusiones: La histoplasmosis se diagnostica fundamentalmente por la epidemiología, la clínica y el cultivo. Los estudios citopatológicos e histopatológicos de la úlcera confirman el diagnóstico. Este caso representa una forma no habitual de presentación de la enfermedad, que aunque no se sospecha usualmente, puede ocurrir. Este trabajo es una alerta a los estomatólogos, maxilofaciales y a todo aquel personal de la salud que asiste a pacientes con manifestaciones sistémicas(AU)


Introduction: Histoplasmosis is a mycosis caused by Histoplasma capsulatum. This fungus is found in the feces of some animals (bats and birds) and its reservoir is the soil. Histoplasmosis is an endemic disease in the American continent. Inhalation of spores causes primary pulmonary infection, which may in turn be disseminated. Objective: Describe a case of oral histoplasmosis in a patient seronegative to the human immunodeficiency virus. Clinical case: A case is presented of a diabetic, smoker and alcoholic patient with fever of several months' evolution and respiratory manifestations. Examination revealed ulcers in the patient's gums and tongue, as well as nodular lesions in the mouth mucosa, the bottom of the vestibular sulcus and the alveolar ridge. Laboratory testing found anemia, leucopenia and an increased globular sedimentation rate. The diagnosis was confirmed by cytology and histopathology. The treatment indicated was 200 mg itraconazole three times a day and then 200 mg twice a day for two months, and a daily tablet for six months after the second month. The patient is now asymptomatic and the oral lesions have disappeared. Conclusions: Histoplasmosis is mainly diagnosed by epidemiological testing, clinical examination and culture. Cytopathologic and histopathological analysis of the ulcer confirm the diagnosis. The case illustrates an infrequent form of presentation of the disease, not usually suspected but possible. The study is a warning to dentists, maxillofacial specialists and all the health personnel caring for patients with systemic manifestations(AU)


Subject(s)
Humans , Male , Ulcer , Itraconazole , Alcoholics , Smokers , Histoplasmosis , Leukopenia , Mouth Mucosa
5.
Rev. Asoc. Odontol. Argent ; 109(1): 59-63, ene.-abr. 2021. ilus
Article in Spanish | LILACS | ID: biblio-1281778

ABSTRACT

Objetivo: Describir el diagnóstico y el tratamiento interdisciplinario de un caso clínico de histoplasmosis. Caso clínico: Un paciente masculino de 39 años, con antecedentes de consumo de drogas, alcohol, tabaquismo crónico y VIH+ sin adherencia al tratamiento, acudió al Servicio de Odontología por una interconsulta del Servicio de Clínica Médica para la evaluación de lesiones erosivas en paladar duro y blando, reborde alveolar anterior, dorso lingual y lesión tumoral en encía anterosuperior. El diagnóstico definitivo se obtuvo por medio del análisis de muestras de biopsia transbronquial, lavado broncoalveolar y biopsia de lesión en piel. El paciente recibió tratamiento sistémico con antimicóticos (anfotericina B e itraconazol según esquema) y tratamiento local con colutorio de clorhexidina al 0,12% y 100.000 UI de nistatina en suspensión. Al momento del alta, presentaba una considerable mejoría de su estado general y de las lesiones orales, con disminución de sintomatología dolorosa. Se indicó turno para control a los 7 días de forma ambulatoria, al cual el paciente no asistió. El abordaje interdisciplinario y el análisis de los diferentes aspectos socioeconómicos, culturales, ambientales y sistémicos del paciente facilitaron el diagnóstico temprano de la enfermedad (AU)


Aim: To describe the diagnosis and interdisciplinary treatment of a clinical case of histoplasmosis. Clinical case: 39-year-old male patient with a history of drug abuse, alcohol, and chronic smoking, HIV+ without treatment compliance, attends the dental department referred by the medical department for the diagnosis of erosive lesions in the hard and soft palate, anterior alveolar ridge, lingual dorsum and tumor lesion in the anterosuperior gingiva. The definitive diagnosis was obtained by the analysis of transbronchial biopsy, bronchoalveolar lavage and skin lesion biopsy. The patient received systemic treatment with antifungals (amphotericin b, itraconazole according to protocol), and local treatment with 0.12% chlorhexidine mouthwash and 100,000 IU nystatin suspension. At the time of medical discharge, the patient presented a considerable improvement in his general condition and of the oral lesions with a reduced pain. A 7 days recall was prescribed, however the patient failed to attend. The interdisciplinary approach to the patient and the analysis of the different socio-economic, cultural, environmental and systemic aspects of the patient facilitates the early diagnosis of the disease (AU)


Subject(s)
Humans , Male , Adult , Oral Manifestations , HIV , Dental Care for Chronically Ill , Histoplasmosis , Argentina , Biopsy , Amphotericin B , Nystatin , Immunosuppression/adverse effects , Itraconazole , Bronchoalveolar Lavage , Dental Service, Hospital , Early Diagnosis , Mouth Mucosa/injuries , Antifungal Agents
6.
Einstein (Säo Paulo) ; 19: eRC5488, 2021. tab, graf
Article in English | LILACS | ID: biblio-1249741

ABSTRACT

ABSTRACT Histoplasmosis is an infection caused by the dimorphic fungus Histoplasma capsulatum. The disease is endemic in several regions of tropical and temperate climate. The fungus presents opportunistic behavior, causing widespread infection in immunocompromised patients, resulting from complication of primary pulmonary infection, due to exogenous reinfection or reactivation of a quiescent source. In immunocompetent individuals, approximately 95% of pulmonary infections are asymptomatic. However, prolonged exposure to high amount spores may lead to acute or chronic lung infection. Due to the low amount of inoculum, primary cutaneous histoplasmosis caused by traumatic implantation is extremely rare and effectively treated with triazoles. Thus, the present study aims to report a case of primary cutaneous histoplasmosis that is difficult to treat in an immunocompetent patient, and to review the literature on the incidence of drug-resistant Histoplasma capsulatum strains in clinical practice.


RESUMO A histoplasmose é uma infecção causada pelo fungo dimórfico Histoplasma capsulatum. A doença é endêmica em diversas regiões de clima tropical e temperado. O fungo apresenta comportamento oportunístico, causando infecção disseminada em pacientes imunocomprometidos, resultante da complicação da infecção pulmonar primária, por reinfecção exógena ou reativação de um foco quiescente. Em indivíduos imunocompetentes, cerca de 95% das infecções pulmonares são assintomáticas. No entanto, a exposição prolongada à quantidade elevada de esporos pode levar à infecção pulmonar aguda ou crônica. Devido à baixa quantidade de inóculo, a histoplasmose cutânea primária causada por implantação traumática é extremamente rara e efetivamente tratada com triazóis. Assim, o presente estudo tem como objetivos relatar um caso de histoplasmose cutânea primária de difícil tratamento em paciente imunocompetente, e revisar a literatura a respeito da incidência de cepas de Histoplasma capsulatum resistentes aos fármacos utilizados na prática clínica.


Subject(s)
Humans , Histoplasmosis/drug therapy , Histoplasma
8.
Rev. cuba. med. trop ; 72(3): e562, sept.-dic. 2020. tab, graf
Article in Spanish | LILACS, CUMED | ID: biblio-1156548

ABSTRACT

Introducción: La histoplasmosis es una micosis profunda o sistémica causada por un hongo dimórfico que se puede diseminar principalmente en pacientes con inmunosupresión, como los que tienen diagnóstico de virus de la inmunodeficiencia humana. El síndrome de reconstitución inmune consiste en un empeoramiento paradójico de una condición conocida o de nueva aparición después del inicio de la terapia antirretroviral. Objetivo: Describir un caso de histoplasmosis diseminada asociada a síndrome de reconstitución inmune en un paciente con infección por virus de la inmunodeficiencia humana. Caso clínico: Paciente masculino de 32 años con diagnóstico de infección por virus de la inmunodeficiencia humana, con cuadro clínico de tres semanas de evolución. Este cuadro inició posterior al comienzo de la terapia antirretroviral, que consistió en pápulo-nódulos umbilicados diseminados, con compromiso pulmonar; además, tenía histopatología y cultivo positivos para Histoplasma capsulatum sl. y prueba de antigenuria para histoplasma también positiva. Se consideró un diagnóstico de histoplasmosis diseminada con presentación cutánea, fue la expresión de un síndrome de reconstitución inmune por desenmascaramiento. Se inició manejo con anfotericina B liposomal y se mantuvo la terapia antirretroviral; posteriormente se continuó el tratamiento con itraconazol durante 12 meses con mejoría de las lesiones. Conclusiones: El diagnóstico clínico, histopatológico y microbiológico fue oportuno; el paciente presentó una adecuada respuesta al tratamiento. Esta es una micosis curable e incluso prevenible, si se diagnostica a tiempo, se inicia tratamiento precoz y se mantiene la terapia retroviral(AU)


Introduction: Histoplasmosis is a deep or systemic mycosis caused by a dimorphic fungus which may disseminate mainly in immunocompromised patients, such as those diagnosed with human immunodeficiency virus. Immune reconstitution syndrome is a paradoxical worsening of a known condition or a condition appearing after the start of antiretroviral therapy. Objective: Describe a case of disseminated histoplasmosis associated to immune reconstitution syndrome in a patient with human immunodeficiency virus infection. Case report: A case is presented of a male 32-year-old patient diagnosed with human immunodeficiency virus with a clinical status of three weeks' evolution. The current status developed after the start of antiretroviral therapy. It consisted in disseminated umbilicated papular nodules with pulmonary involvement, as well as positive Histoplasma capsulatum sl. histopathology and culture, and a positive histoplasma antigen test. A diagnosis of disseminated histoplasmosis with a cutaneous presentation was considered. It was the expression of immune reconstitution syndrome by unmasking. Treatment was started with liposomal amphotericin B, maintaining the antiretroviral therapy. Management was then continued with itraconazole for 12 months with improvement of the lesions. Conclusions: Timely clinical, histopathological and microbiological diagnosis was performed. The patient displayed an adequate response to treatment. This mycosis is curable and even preventable when a diagnosis is made in time, treatment is started early and the retroviral therapy is maintained(AU)


Subject(s)
Humans , Skin Diseases , HIV , Immune Reconstitution Inflammatory Syndrome/complications , Mycoses , Histoplasmosis/etiology
9.
Braz. j. infect. dis ; 24(1): 44-50, Feb. 2020. tab, graf
Article in English | LILACS | ID: biblio-1089329

ABSTRACT

ABSTRACT The yeast phase of 22 Histoplasma capsulatum clinical isolates from Mexico, Argentina, Colombia, and Guatemala and three reference strains, one from Panama and two from the United States of America (USA), were screened for thermosensitivity characteristics using different analyses. Growth curves at 0, 3, 6, 12, 24, and 30 h of incubation at 37 and 40 °C, the growth inhibition percentage at 40 °C, and the doubling time at 37 and 40 °C were determined for all yeasts studied. Most of the isolates examined exhibited thermotolerant phenotypes at 40 °C, whereas a thermosensitive phenotype at 40 °C was only detected in the Downs reference strain from the USA. Growth inhibition values lower than 33.8% supported the predominance of the thermotolerant phenotype at 40 °C. The doubling time means found for the different isolates were 5.14 h ± 1.47 h at 37 °C and 5.55 h ± 1.87 h at 40 °C. This is the first report to underscore the predominance of thermotolerant and delayed doubling time phenotypes in H. capsulatum clinical isolates from different regions of Latin America.


Subject(s)
Thermotolerance/physiology , Histoplasma/isolation & purification , Histoplasma/growth & development , Phenotype , Phylogeny , Reference Values , Temperature , Time Factors , Histoplasma/genetics , Histoplasmosis/microbiology , Latin America
10.
San Salvador; s.n; 2020. 30 p. graf.
Thesis in Spanish | LILACS, BISSAL | ID: biblio-1150823

ABSTRACT

La histoplasmosis es una infección micótica endémica y sistémica producida por el hongo dimórfico térmico Histoplasma capsulatum variedad capsulatum, frecuente en América latina que resulta por exposición pasiva al hongo. Compromete más a hombres que a mujeres, con una relación de 6:1. Suele presentarse en todas las edades, pero es más severa en niños, personas mayores y en aquellos con algún tipo de inmunodeficiencia, especialmente en personas infectadas por el virus de la inmunodeficiencia humana (VIH). En El Salvador, la Histoplasmosis es la infección oportunista más frecuente en el paciente con SIDA. Se considera una enfermedad definitoria de SIDA, y a pesar de la importancia de la terapia antirretroviral altamente efectiva, que reduce significativamente la frecuencia de esta micosis, esta continúa presentándose como una infección oportunista grave y mortal, frecuente en pacientes que desconocen estar infectados por el VIH y quienes, por consiguiente, están sin terapia antirretroviral altamente efectiva, o aquellos que son conscientes de su diagnóstico, pero por motivos personales han suspendido tratamiento retroviral. Por tal razón es de suma importancia conocer e identificar las características clínicas, epidemiológicas, diagnóstico, tratamiento actualizado y factores de riesgo asociados a la mortalidad en pacientes con SIDA coinfectados con histoplasmosis


Subject(s)
Histoplasmosis , Acquired Immunodeficiency Syndrome , Internal Medicine
11.
Int. j. odontostomatol. (Print) ; 14(3): 342-347, 2020. tab, graf
Article in Spanish | LILACS | ID: biblio-1114904

ABSTRACT

La Leishmaniasis es un grupo de enfermedades transmitidas por vectores y causada por la Leishmania, un parásito intracelular, que se presenta de preferencia en regiones tropicales y subtropicales. Se manifiesta mediante un amplio rango de formas clínicas como la cutánea, mucocutánea, y visceral, dependiendo de la especie y respuesta inmunológica del paciente. Se presenta el caso de un hombre de 35 años que acudió derivado a Unidad de Estomatología del Hospital Señor del Milagro, Salta, Argentina, presentando en la cavidad oral lesión, granulomatosa, ulcerada, dolorosa a la palpación, única, en paladar blando, de tres meses de evolución. Se realizaron estudios serológicos, parasitológicos y PCR. Los ELISAs lisados, PCRs y cultivos de materiales de lesiones fueron positivos, confirmando diagnóstico de leishmaniasis mucocutánea. El paciente fue derivado al Servicio de Dermatología donde recibió tratamiento con Antimoniato de Meglumina, con repuesta clínica favorable. El conocimiento de las manifestaciones orales puede llevar al diagnóstico clínico de leishmaniasis mucocutánea por parte del odontólogo, pudiendo entregar un tratamiento oportuno y a la vez ayudar al paciente, evitando complicaciones de esta enfermedad.


Leishmaniasis is a group of vector-borne diseases caused by Leishmania, an intracellular parasite, which occurs preferentially in tropical and subtropical regions. It manifests itself through a wide range of clinical forms such as cutaneous, mucocutaneous, and visceral, depending on the species and the patient's immune response. We present a case of a 35-year-old man who was referred to the Stomatology Unit of the Señor del Milagro Hospital, Salta, Argentina, presenting in the oral cavity lesion, granulomatous, ulcerated, painful on palpation, unique, soft palate with three months of evolution. Serological, parasitological and PCR studies were performed. Lysed ELISAs, PCRs and cultures of lesion materials were positive, confirming diagnosis of mucocutaneous leishmaniasis. The patient was referred to the Dermatology Service where he received treatment with Meglumine Antimony, with favorable clinical response. The knowledge of the oral manifestations can lead to the clinical diagnosis of mucocutaneous leishmaniasis by the dentist, being able to provide timely treatment and at the same time help the patient, avoiding complications of this disease.


Subject(s)
Humans , Male , Adult , Leishmaniasis, Mucocutaneous/diagnosis , Leishmaniasis, Mucocutaneous/parasitology , Mouth Diseases/diagnosis , Mouth Diseases/parasitology , Paracoccidioidomycosis/diagnosis , Enzyme-Linked Immunosorbent Assay , Polymerase Chain Reaction , Diagnosis, Differential , Histoplasmosis/diagnosis , Leishmania/isolation & purification , Mouth Mucosa/parasitology
12.
Rev. Soc. Bras. Med. Trop ; 53: e20190364, 2020. tab, graf
Article in English | LILACS | ID: biblio-1057277

ABSTRACT

Abstract The present report describes the first case of postpartum disseminated histoplasmosis in a 24-year-old HIV-negative woman. On the tenth day after vaginal delivery, the patient presented with dyspnea, fever, hypotension, tachycardia, and painful hepatomegaly. Yeast-like Histoplasma capsulatum features were isolated in the buffy coat. The phylogenetic analysis demonstrated that the fungal isolate was similar to other H. capsulatum isolates identified in HIV patients from Ceará and Latin America. Thus, histoplasmosis development in individuals with transitory immunosuppression or during the period of immunological recovery should be carefully examined.


Subject(s)
Humans , Female , Adult , DNA, Fungal/analysis , DNA, Ribosomal Spacer/genetics , Postpartum Period , Histoplasma/genetics , Histoplasmosis/diagnosis , Phylogeny , Polymerase Chain Reaction , Histoplasma/isolation & purification , Histoplasmosis/microbiology
13.
Rev. Soc. Bras. Med. Trop ; 53: e20180463, 2020. tab, graf
Article in English | LILACS | ID: biblio-1057304

ABSTRACT

Abstract INTRODUCTION: The therapeutic efficacy of daily amphotericin B infusion is related to its maximum concentration in blood; however, trough levels may be useful in intermittent regimens of this antifungal drug. METHODS : High performance liquid chromatography (HPLC) was used to determine the minimum concentration (Cmin) of amphotericin B in the serum of patients receiving deoxycholate (D-Amph) or liposomal amphotericin B (L-AmB) for the treatment of cryptococcal meningitis (n=28), histoplasmosis (n=8), paracoccidioidomycosis (n=1), and leishmaniasis (n=1). RESULTS: Daily use of D-Amph 30 to 50 mg or L-AmB 50 mg resulted in a similar Cmin, but a significant increase ocurred with L-AmB 100 mg/day. The geometric mean Cmin tended to decrease with a reduction in the dose and frequency of intermittent L-AmB infusions: 357 ng/mL (100 mg 4 to 5 times/week) > 263 ng/mL (50 mg 4 to 5 times/week) > 227 ng/mL (50 mg 1 to 3 times/week). The impact on Cmin was variable in patients whose dose or therapeutic scheme was changed, especially when administered the intermittent infusion of amphotericin B. The mean Cmin for each L-AmB schedule of intermittent therapy was equal or higher than the minimum inhibitory concentration of amphotericin B against Cryptococcus isolates from 10/12 patients. The Cmin of amphotericin B in patients with cryptococcal meningitis was comparable between those that survived or died. CONCLUSIONS: By evaluating the Cmin of amphotericin B, we demonstrated the therapeutic potential of its intermittent use including in the consolidation phase of neurocryptococcosis treatment, despite the great variability in serum levels among patients.


Subject(s)
Humans , Amphotericin B/blood , Deoxycholic Acid/blood , Antifungal Agents/blood , Paracoccidioidomycosis/drug therapy , Leishmaniasis/drug therapy , Amphotericin B/administration & dosage , Amphotericin B/pharmacokinetics , Chromatography, High Pressure Liquid , Meningitis, Cryptococcal/drug therapy , Deoxycholic Acid/administration & dosage , Deoxycholic Acid/pharmacokinetics , Histoplasmosis/drug therapy , Antifungal Agents/administration & dosage , Antifungal Agents/pharmacokinetics
14.
Caracas; s.n; dic. 2019. 125 p. ^e1 CD-ROM^c30 cmtab.
Thesis in Spanish | LILACS, LIVECS | ID: biblio-1179534

ABSTRACT

La histoplasmosis es una enfermedad granulomatosa, producida por hongos dimorfos del género Histoplasma. Se observa en casi todos los países del mundo. En América Latina, en Venezuela, Colombia, Brasil, Argentina, Ecuador, Perú, Paraguay y Uruguay, entre otros. Datos epidemiológicos recienteshanmostrado un aumento de histoplasmosis en Venezuela y otros países.Los clínicos no están conscientes de su importancia en nuestro medio. Objetivo: Dar a conocer la situación actual de esta enfermedad en el Area Metropolitana de Caracas y en otras áreas endémicas, con la intención de crear la inquietud de investigar su incidencia y otras características relevantes en el resto del país. Métodos: Se analizaron las características de todos los pacientes con diagnóstico de certeza de histoplasmosis registrados y realizados por la Sección de Micología Médica ­Dr. Dante Borelli‖ del Instituto de Medicina Tropical de la UCV, referidos de los diferentes hospitales del Distrito Capital y otros estados del país, con énfasis en los datos epidemiológicos, manifestaciones clínicas, diagnóstico, tratamiento y evolución entre 1994 y 2012. Resultados: se encontraron 553 pacientes. La mayoría estaban entre los 20 y 49 años, relacionado con un alto número de pacientes con VIH/SIDA. Hubo más casos en hombres que en mujeres en todos los grupos etarios, menos en los pacientes mayores de 60 años, posiblemente debido a la disminución de los estrógenos, que son protectores en la mujer. Casi todos los pacientes con VIH/SIDA mostraron la forma diseminada, solo uno presentó una forma pulmonar. De los pacientes VIH negativos, 54,62% presentaron infección diseminada y 44,47%, formas pulmonares. 93 de los de enfermedad diseminada tenían estados de inmunocompromiso. El examen directo fue el método más fácil y eficaz para diagnosticar la histoplasmosis. La anfotericina B (AMB) fue el tratamiento para la histoplasmosis en pacientes con o sin SIDA, que requirieron hospitalización, seguido por itraconazol (ITC). Esta droga se utilizó en pacientes que no se encontraban severamente enfermos o con afectación del sistema nervioso central. Conclusiones: histoplasmosis se encuentra en aumento en nuestro país. Se observa con más frecuencia en pacientes con SIDA, inmunosuprimidos y pacientes que han recibido un inóculo abundante. El examen directo con coloraciones especiales es el método de mayor rendimiento para el diagnóstico. Este debe ser realizado por personal con experiencia.Es conveniente utilizar diferentes técnicas para aumentar la probabilidad de obtener un diagnóstico correcto. AMB e ITC son los tratamientos de elección. Los médicos deben estar alertas de los signos y síntomas, correlacionándolos con los antecedentes epidemiológicos, para evitar el retraso del diagnóstico y mejorar la evolución de los pacientes.


Histoplasmosis is a granulomatous disease, caused by dimorphic fungi from the genus Histoplasma. It is described worldwide.In Latin America, Venezuela, Colombia, Brasil, Argentina, Ecuador, Perú, Paraguay and Uruguay among others are affected. Recent epidemiological data have shown an increase of histoplasmosis in Venezuela and other countries. Clinicians are nor aware of the importance of this mycosis. Objective: analyze the current situation of this disease in the Caracas Metropolitan Area and other endemic areas, with intention to create awareness of its incidence and other relevant characteristics in our country. Methods: characteristics of the patients with diagnosis of histoplasmosis, performed and registered at the Sección de Micología Médica ­Dr. Dante Borelli‖, Instituto de Medicina Tropical, UCV, referred from different hospitals at Distrito Capital and other states of the country, with emphasis on epidemiological data, clinical manifestations, diagnosis, treatment and outcome, between 1994 and 2012 are analized. Results: 553 patients were found. Most of them were between 20 and 49 years old, possibly due to a high number of HIV/AIDS patients. There were more male than female patients in all age groups, except in 60 years and older, possibly due to the lack of estrogenic hormones, which protect women from infection. All HIV/AIDS patients but one, presented with a disseminated form of the disease, and one, a pulmonary form. Of the HIV negative patients, 54,62% showed disseminated infection and 44,47%, pulmonary presentation. 93 of the disseminated infection patients had immunocompromising conditions. Direct examination was the easiest and most efficacious diagnostic method. Amphotericin B (AMB) was the drug of choice for the treatment of hospitalized patients, followed by Itraconazole (ITC). This was the preferred treatment for mild to moderate disease or non CNS infection. Conclusions: Histoplasmosis is rising in our country. It is more frequent in HIV/AIDS patients and immune suppression. It is also seen in patients who have inhaled a large inoculum. Direct examination with special stains is the diagnostic method with better results. It must be performed by experienced personnel in fungal diagnosis. The use of different techniques is recommended to improve early and correct diagnosis. AMB and ITC are drugs of choice for the treatment of histoplasmosis. Clinicians should be aware of suggestive symptoms and signs, correlating them with epidemiological data, to avoid diagnostic delay and improve the outcome of the patients.


Subject(s)
Humans , Male , Female , Child , Adolescent , Adult , Middle Aged , Aged , Aged, 80 and over , Histoplasmosis/diagnosis , Mycoses/therapy , Signs and Symptoms , Epidemiology/statistics & numerical data , Incidence , Probability , Risk Factors , Fungi/pathogenicity , Histoplasma/drug effects , Histoplasmosis/therapy , Histoplasmosis/epidemiology , Infections , Mycoses/drug therapy , Mycoses/epidemiology , Age Groups
15.
Medicina (B.Aires) ; 79(4): 287-290, ago. 2019. ilus
Article in Spanish | LILACS | ID: biblio-1040524

ABSTRACT

La histoplasmosis y la leishmaniasis son enfermedades olvidadas, endémicas en Argentina, y generalmente se asocian a inmunocompromiso. Presentamos el caso de un varón de 16 años, inmunocompetente, con histoplasmosis del sistema nervioso central y leishmaniasis cutánea. Inicialmente, el paciente presentó una lesión en la pierna de un mes de evolución seguida de paraparesia leve, diagnosticada como un proceso de desmielinización mediante estudios de imágenes. El cuadro fue tratado con altas dosis de corticoides y en 72 horas evolucionó a paraparesia grave con lesiones nodulares en las vértebras cervicales, observadas en las imágenes de resonancia magnética nuclear. Se aisló Histoplasma capsulatum de líquido cefalorraquídeo, genotípicamente identificado como perteneciente a la especie filogenética LamB. El paciente recibió tratamiento intravenoso con anfotericina B deoxicolato durante 30 días y posteriormente fluconazol e itraconazol oral durante un año. A los tres meses de iniciado el tratamiento con antifúngicos se reactivó la lesión de la pierna y en el examen directo se observaron amastigotes de Leishmania. La leishmaniasis cutánea fue tratada con antimoniato de meglumina intramuscular. La respuesta clínica al tratamiento de ambas enfermedades fue favorable.


Histoplasmosis and leishmaniasis are neglected and endemic diseases in Argentina, and generally are found associated with immunosuppression. We report the case of an immunocompetent 16-years-old man with simultaneous occurrence of central nervous system histoplasmosis and cutaneous leishmaniasis. Upon admission, the patient showed a one-month old skin lesion in a leg and mild paraparesis. Imaging studies detected thickening and edema in the spinal cord and the cerebrospinal fluid analysis was within normal range. The case was diagnosed as a demyelinating disorder and treated with high-dose short-term steroids. Seventy-two hours later the patient showed severe paraparesis and nuclear magnetic resonance imaging revealed nodular lesions in the spinal cord. Histoplasma capsulatum belonging to the phylogenetic species LamB was isolated from cerebrospinal fluid samples. The patient received intravenous antifungal therapy with amphotericin B for 30 days, followed by oral fluconazole and itraconazole for one year. Three months after initiation of antifungal treatment, the cutaneous lesion recrudesced and Leishmania amastigotes were observed on microscopic examination. The cutaneous leishmaniasis was treated with intramuscular meglumine antimoniate. The patient´s outcome was favorable after treatment for both diseases.


Subject(s)
Humans , Male , Adolescent , Leishmaniasis, Cutaneous/complications , Central Nervous System Fungal Infections/complications , Histoplasmosis/complications , Leishmaniasis, Cutaneous/diagnosis , Leishmaniasis, Cutaneous/drug therapy , Central Nervous System Fungal Infections/diagnosis , Central Nervous System Fungal Infections/drug therapy , Histoplasmosis/diagnosis , Histoplasmosis/drug therapy , Immunocompetence , Anti-Bacterial Agents/administration & dosage , Antifungal Agents/administration & dosage
16.
Autops. Case Rep ; 9(1): e2018046, Jan.-Mar. 2019. ilus
Article in English | LILACS | ID: biblio-987538

ABSTRACT

Oral involvement is rarely found in histoplasmosis, except in its disseminated form, which is mostly observed in the severely immunocompromised host. Herein, we presented the case of a 36-year-old female with a previous history of liver transplant, who was hospitalized due to fever, chills, night sweats, diarrhea, and painful oral lesions over the last 3 days. The oral examination revealed the presence of painful shallow ulcers lined by a pseudomembrane in the gingiva and the soft and hard palate. The initial working diagnosis comprised cytomegalovirus reactivation or herpes simplex virus infection. The diagnostic work-up included incisional biopsies of the gingiva and the sigmoid colon. Both biopsies confirmed the diagnosis of histoplasmosis. Intravenous itraconazole was administered with significant improvement after 7 days. Although oral involvement is rare, histoplasmosis should be included in the differential diagnosis of oral lesions, particularly when the patient is immunosuppressed. This study reports a rare presentation of histoplasmosis involving the mucosa of the oral cavity and the colon.


Subject(s)
Humans , Female , Adult , Diagnosis, Differential , Histoplasmosis/diagnosis , Immunosuppression , Liver Transplantation/adverse effects , Itraconazole/therapeutic use , Oral Ulcer/pathology , Histoplasmosis/pathology
17.
An. bras. dermatol ; 94(1): 96-98, Jan.-Feb. 2019. graf
Article in English | LILACS | ID: biblio-983729

ABSTRACT

Abstract: Histoplasmosis usually presents primarily as lung infection. Occasionally, mainly in immunocompromised hosts, it can spread and cause systemic manifestations. Skin lesions have been reported in 10 to 15 percent of cases of disseminated histoplasmosis, and panniculitis has been described as an unusual form of presentation in affected patients. We present the case of a patient with systemic lupus erythematosus who presented cellulitis due to disseminated histoplasmosis.


Subject(s)
Humans , Female , Middle Aged , Panniculitis/pathology , Histoplasmosis/pathology , Lupus Erythematosus, Systemic/complications , Biopsy , Panniculitis/immunology , Panniculitis/microbiology , Cellulite/immunology , Cellulite/microbiology , Cellulite/pathology , Histoplasma/isolation & purification , Histoplasmosis/immunology , Immunocompetence
18.
Infectio ; 23(1): 22-26, Jan.-Mar. 2019. tab, graf
Article in Spanish | LILACS, COLNAL | ID: biblio-975558

ABSTRACT

Resumen Introducción: La histoplasmosis diseminada es una forma de presentación común en pacientes inmunosuprimidos. La introducción de nuevos métodos diagnós ticos y la mejoría de la sobrevida de los pacientes con VIH pueden hacer cambiar las características clínicas de los pacientes con esta enfermedad. El objetivo de este estudio es describir las características demográficas, clínicas y métodos diagnósticos para esta enfermedad utilizados en una institución de cuarto nivel de complejidad en Colombia durante los últimos cinco años. Métodos: Se realizó un estudio observacional tipo serie de casos, incluyendo pacientes con diagnóstico de histoplasmosis manejados en el Hospital Universitario San Ignacio en Bogotá (Colombia) entre enero de 2012 y diciembre de 2016. Los casos fueron identificados utilizando una herramienta automatizada a partir de las historias clínicas electrónicas (DISEARCH). Resultados: 34 pacientes fueron incluidos, 73,5% con VIH. La enfermedad fue más sintomática en los pacientes con VIH. Los síntomas más frecuentes fueron fiebre y tos (80%), seguidas por diarrea (47%) y manifestaciones cutáneas (35%). El estudio histopatológico fue el método de confirmación más frecuente. El antígeno urinario, fue positivo en el 92.8% de los pacientes a quienes se les realizó la prueba. Las enfermedades autoinmunes fueron la principal causa asociada en pacientes VIH negativos. Conclusiones: Las características clínicas de los pacientes con histoplasmosis son similares a las descritas en estudios previos en colombia, llamando la atención la alta prevalencia de diarrea y manifestaciones cutáneas. El antígeno urinario para histoplasma y las biopsias cutáneas son excelentes métodos diagnósticos, menos invasivos y con resultados rápidamente disponibles.


Abstract Introduction: Disseminated histoplasmosis is a common presentation in immunosuppressed patients. The introduction of new diagnostic methods and the impro vement of the survival of patients with HIV could have changed the clinical characteristics of patients with this disease. The objective of this study is to describe the demographic characteristics, clinical and methods for diagnosis of this disease in a high conplexity institution in Colombia during the last five years. Methods: A serie of cases was conducted, including patients diagnosed with histoplasmosis managed at the San Ignacio University Hospital in Bogotá (Colombia) between January 2012 and December 2016. The cases were selected using an automatic tool for searching in health electronic records (DISEARCH). Results: 34 patients were included, 73.5% with HIV. The disease was more symptomatic in patients with HIV. The most frequent symptoms were fever and cough (80%), followed by diarrhea (47%) and skin manifestations (35%). The histopathological study was the most frequent confirmation method. The urinary antigen was positive in 92.8% of the patients, in whom the test was performed. Autoimmune diseases were the main cause associated in HIV negative patients. Conclusions: The clinical characteristics of patients with histoplasmosis are similar to those described in previous studies in Colombia. It was remarkably the high prevalence of diarrhea and cutaneous manifestations. The urinary antigen for histoplasma and skin biopsies are excellent diagnostic methods, less invasive and with rapidly available results.


Subject(s)
Humans , Male , Female , Middle Aged , Aged , HIV , Histoplasmosis , Antigens , Polymerase Chain Reaction , Colombia , Histoplasma
20.
Article in Korean | WPRIM | ID: wpr-786609

ABSTRACT

The gastrointestinal tract is a vast reservoir for internal microbiota; it is exposed directly to various externally introduced microbes, including bacteria, viruses, parasites and others. In immune-compromised conditions, the gastrointestinal tract is frequently affected by infectious diseases that seldom manifest clinically in immune-competent hosts. Immune-compromised conditions result from a variety of reasons, including human immunodeficiency virus infection, anti-cancer chemo-radiotherapy, immune suppressive therapy for autoimmune diseases, and organ transplantations. The stomach is a relatively rare site for opportunistic infections in immune-compromised patients compared to the esophagus and colon, where esophagitis and colitis develop frequently and cause significant clinical consequences. Helicobacter pylori infection is majorly involved in gastric malfunctioning in immune-compromised patients, followed by cytomegalovirus infection. Infections by Cryptosporidium, Mycobacterium avium complex, histoplasmosis, leishmaniasis, aspergillosis, or treponema, have been reported; however, gastric involvement of these agents is extremely rare. This review discusses the general aspects and recent reports on gastric infection in immune-compromised patients.


Subject(s)
Aspergillosis , Autoimmune Diseases , Bacteria , Colitis , Colon , Communicable Diseases , Cryptosporidium , Cytomegalovirus Infections , Esophagitis , Esophagus , Gastrointestinal Tract , Helicobacter pylori , Histoplasmosis , HIV , Humans , Leishmaniasis , Microbiota , Mycobacterium avium Complex , Opportunistic Infections , Organ Transplantation , Parasites , Stomach , Transplants , Treponema
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