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1.
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.
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
4.
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
5.
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
6.
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
7.
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
8.
Autops. Case Rep ; 8(4): e2018065, Oct.-Dec. 2018. ilus
Article in English | LILACS | ID: biblio-986613

ABSTRACT

Histoplasmosis is a mycosis caused by the dimorphic fungus, Histoplasma capsulatum, which is transmitted via dust and aerosols. Lung involvement is the most common, with a varied clinical presentation. Although it is not the only source of infection, H. capsulatum is frequently found in bat guano, which is the reason why it is highly prevalent among caving practitioners. The solitary histoplasmoma of the lung is an unusual and chronic manifestation of this entity, which mimics, or at least is frequently misconstrued, as a malignancy. Almost invariably, the diagnosis of this type of histoplasmosis presentation is achieved after lung biopsy. The authors present the case of a young woman who sought medical care because of chest pain. The diagnostic work-up revealed the presence of a pulmonary nodule. She was submitted to a thoracotomy and wedge pulmonary resection. The histologic analysis rendered the diagnosis of histoplasmoma. Thisreport aims to call attention to this diagnosis as the differential diagnosis of a pulmonary nodule.


Subject(s)
Humans , Female , Adult , Histoplasmosis/diagnosis , Lung Diseases, Fungal/diagnosis , Diagnosis, Differential , Granulomatous Disease, Chronic , Histoplasmosis/pathology , Lung Diseases, Fungal/pathology
9.
Rev. Soc. Bras. Med. Trop ; 51(4): 479-484, July-Aug. 2018. tab
Article in English | LILACS | ID: biblio-957451

ABSTRACT

Abstract INTRODUCTION: In many settings, the lack of sensitive biomarkers of disseminated histoplasmosis (DH) leads to a clinical reliance on older diagnostic methods and delayed treatment initiation. The early recognition of DH is critical for survival, especially in patients with human immunodeficiency virus (HIV). This study aimed to identify clinical and laboratory findings associated with the definitive diagnosis of DH in low-income HIV patients in endemic areas. METHODS: Febrile AIDS patients with suspected DH who were admitted to a reference hospital in northeastern Brazil from January 2006 to January 2007 were evaluated for clinical and laboratory findings associated with DH diagnosis. RESULTS: One hundred seventeen patients with fever were included, and 48 (41%) cases of DH were determined by Histoplasma capsulatum identification. A higher fever (≥38.5ºC), maculopapular/papular rash, splenomegaly, hepatomegaly, wheezing, hemoglobin ≤9.5g/dL, platelets ≤80,000/µL, CD4 count ≤75/µL, aspartate aminotransferase (AST) level ≥2.5 times the upper limit of normal (ULN), lactate dehydrogenase (LDH) ≥5times the ULN; and international normalized ratio (INR) >2 times the ULN were significantly associated with DH. A multivariable analysis identified hepatomegaly [adjusted (a) prevalence ratio (PR)= 1.96; 95% confidence interval (CI): 1.21-3.16), CD4 count ≤75/µL (aPR = 2.02; 95% CI: 1.06-3.83), LDH ≥5 times the ULN (aPR = 2.23; 95% CI: 1.44-3.48), and maculopapular/papular rash (aPR = 1.70; 95% CI: 1.02-2.83) were independent risk factors for DH. CONCLUSIONS: These easily assessed parameters can facilitate clinical decision-making for febrile AIDS patients with suspected DH in low socioeconomic and Histoplasma-endemic regions.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Young Adult , AIDS-Related Opportunistic Infections/diagnosis , Fever/microbiology , Histoplasma/isolation & purification , Histoplasmosis/diagnosis , Socioeconomic Factors , Brazil/epidemiology , Prevalence , Prospective Studies , Risk Factors , AIDS-Related Opportunistic Infections/epidemiology , CD4 Lymphocyte Count , Histoplasmosis/epidemiology , Middle Aged
10.
J. bras. nefrol ; 40(1): 95-97, Jan.-Mar. 2018. graf
Article in English | LILACS | ID: biblio-893819

ABSTRACT

Abstract Histoplasmosis is a fungus infection that mainly affects immunosuppressed patients. The authors present a case of a kidney transplant recipient who developed sepsis-like histoplasmosis, na atypical but severe manifestation of the disease. The fungus was found in blood and in a skin biopsy, and the treatment with liposomal amphotericin resulted in hepatotoxicity.


Resumo Histoplasmose é uma infecção fúngica que afeta principalmente pacientes imunossuprimidos. Os autores apresentam um caso de uma receptora de transplante de rim que desenvolveu histoplasmose disseminada, uma manifestação atípica, mas grave da doença. O fungo foi encontrado no sangue e na biópsia cutânea, e o tratamento com anfotericina lipossomal resultou em hepatotoxicidade.


Subject(s)
Humans , Female , Middle Aged , Postoperative Complications/diagnosis , Postoperative Complications/drug therapy , Kidney Transplantation , Sepsis/diagnosis , Histoplasmosis/diagnosis , Histoplasmosis/drug therapy , Fatal Outcome , Sepsis/drug therapy
11.
Pesqui. bras. odontopediatria clín. integr ; 18(1): 3846, 15/01/2018. tab, ilus
Article in English | LILACS, BBO | ID: biblio-965614

ABSTRACT

Objective: To determine the frequency and clinical forms of oral manifestations associated to Paracoccidioidomycosis (PCM) and Histoplasmosis. Material and Methods: 481 medical records of outpatients referred to the Medical Mycology Department were reviewed since 2009 to 2016. Data were analyzed using descriptive statistical methods. Results: 47 (9.77%) cases had oral manifestations, 29 (61.70%) were associated to PCM and 18 (38.29%) to histoplasmosis. For PCM, male-female ratio was 8:1 and 1:1 for histoplasmosis. The average age for PCM was 48 years old and 53 for histoplasmosis. All the PCM patients had more than 1 oral structure affected: 44.82% were gingival lesions and 27.58% palate. In patients with histoplasmosis, 6 (33.33%) were lesions affecting palate and 6 (33.33%) involving tongue. For both entities, painful ulcers and granulomatous-like lesions were the most prevalent clinical forms; however, we observed a wide range of other oral manifestations. Regarding PCM patient's comorbidities, 3 (10.34%) cases had HIV/AIDS, 8 (27.58%) histoplasmosis and 2 (6.89%) carcinomas. Whereas the comorbidities of patients with histoplasmosis, 2 (11.11%) had HIV/AIDS and 1 (5.55%) had carcinoma. Conclusion: In endemic countries for both mycoses, dentists must be aware of patients with mouth lesions, take advantage of epidemiologic clues that suggest risk factors and be acquainted with all the current diagnostic tests in order to make a quick diagnosis and treatment in highly suspicious cases.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Oral Manifestations , Paracoccidioidomycosis/diagnosis , Histoplasmosis/diagnosis , Histoplasmosis/etiology , Mycoses/diagnosis , Retrospective Studies , Data Interpretation, Statistical
12.
Rev. chil. infectol ; 35(3): 309-311, 2018. graf
Article in Spanish | LILACS | ID: biblio-959445

ABSTRACT

Resumen En los últimos 11 meses, nuestro laboratorio ha diagnosticado 9 casos de histoplasmosis de presentación clínica en el territorio nacional. Todos los pacientes asociados a los cuadros clínicos son inmigrantes. Por medio del presente trabajo deseamos difundir y alertar a los profesionales de los laboratorios clínicos de nuestro país de la presencia y circulación de cepas de Histoplasma capsulatum en muestras clínicas. Asimismo, deseamos concientizar en el reforzamiento de las medidas de bioseguridad al interior de los laboratorios clínicos.


In the last eleven months, we have diagnosed 9 cases of Histoplasmosis in our country. All patients affected were from endemic areas of South-America. Here, we wish to inform and prevent to all clinical laboratories from Chile about the presence of Histoplasma capsulatum in clinical samples. In the same way we want to prepare and raising awareness of the strengthening of biosecurity measures.


Subject(s)
Humans , Histoplasma/isolation & purification , Histoplasmosis/diagnosis , Chile , Communicable Diseases, Emerging
13.
Rev. chil. infectol ; 35(6): 671-679, 2018. tab
Article in Spanish | LILACS | ID: biblio-990850

ABSTRACT

Resumen La histoplasmosis diseminada es una micosis sistémica endémica, causada por el hongo dimórfico Histoplasma capsulatum. Las manifestaciones clínicas dependen de la carga fúngica inhalada, del estado inmunológico del paciente y de la virulencia de la cepa infectante. La variante diseminada es más frecuente en inmunocomprometidos, registrándose 90% de los casos en pacientes con serología positiva para VIH. En esta serie se evaluaron 37 pacientes con diagnóstico de infección por VIH e histoplasmosis diseminada. El 43,2% de los pacientes no sabía su serología en forma previa a la consulta por histoplasmosis. Las principales manifestaciones clínicas fueron síndrome de impregnación (67,6%), fiebre (64,9%), síntomas respiratorios (62,2%) y manifestaciones muco-cutáneas (67,6%), entre otras. El 94,6% de los pacientes presentó anemia, 75,7% tenía bicitopenia y 32,4% pancitopenia. La sensibilidad de los hemocultivos fue de 70,4%. El 86,5% no tuvo otra infección oportunista concomitante al momento del diagnóstico. En 83,8% de los pacientes la histoplasmosis diseminada fue la primera enfermedad marcadora de SIDA. Se registró una mortalidad de 14,7%.


Disseminated histoplasmosis is an endemic systemic mycosis, caused by the dimorphic fungus Histoplasma capsulatum. The clinical manifestations depend on the inhaled fungal load, the immunological state of the patient and the virulence of the infecting fungal strain. The disseminated variant is most frequent in immunocompromised patients, with 90% of cases in patients with positive serology for HIV, In this series, 37 patients with diagnosis of HIV and disseminated histoplasmosis were evaluated. The 43.2% of the patients did not know their serology prior to the consultation due to histoplasmosis. The main clinical causes were impregnation syndrome (67.6%), fever (64.9%), respiratory symptoms (62.2%) and mucocutaneous manifestations (67.6%), among others. The 94.6% of the patients presented anemia, 75.7% had bicytopenia and 32.4% pancytopenia. The sensitivity of the blood cultures was 70.4%. The 86.5% of the patients did not have another opportunistic infection concomitant at the time of diagnosis. In 83.8% of patients, disseminated histoplasmosis was the first AIDS disease. A mortality of 14.7% was recorded.


Subject(s)
Humans , Male , Female , Adult , AIDS-Related Opportunistic Infections/diagnosis , Histoplasmosis/diagnosis , Retrospective Studies , Immunocompromised Host , AIDS-Related Opportunistic Infections/drug therapy , Histoplasmosis/drug therapy
14.
Rev. chil. infectol ; 35(5): 560-565, 2018. tab, graf
Article in Spanish | LILACS | ID: biblio-978070

ABSTRACT

Resumen Antecedentes: La histoplasmosis es una micosis de gran relevancia en pacientes con SIDA. El cuadro clínico puede ser muy variado y, en enfermos que no desarrollan lesiones cutáneas, el diagnóstico suele demorar varias semanas. Objetivo: Establecer pautas que permitan emplear un tratamiento empírico y precoz en pacientes con histoplasmosis asociada al SIDA sin manifestaciones tegumentarias y determinar las características clínicas, microbiológicas y algunos parámetros bioquímicos en los casos de difícil diagnóstico. Métodos: Se analizaron las historias clínicas de 86 pacientes con histoplasmosis. Fueron seleccionados 31 enfermos con histoplasmosis asociada con SIDA sin lesiones cutáneas. Resultados: La fiebre fue el síntoma más frecuente (96,7%), el compromiso pulmonar se comprobó en 22 enfermos (70,9%). El patrón radiológico más frecuentemente hallado en las radiografías de tórax fue el miliar o micronodulillar bilateral [(12/22), 54,5%]. Diecinueve enfermos presentaron esplenomegalia. Los hemocultivos demostraron una sensibilidad de 93,3% (28/30) y la serología fue positiva en 23,5% de los casos. Fallecieron ocho pacientes (25,8%). Los pacientes con recuentos de linfocitos T CD4+ menores a 50 céls/μl, albúmina menor a 2,5 g/dl y pancitopenia evidenciaron un pronóstico desfavorable. Conclusiones: En los pacientes con infección por VIH, fiebre asociada a esplenomegalia y lesiones micronodulillares bilaterales en la radiografía de tórax debe considerarse el tratamiento empírico con anfotericina B cuando existan signos o síntomas de mal pronóstico, debido al tiempo de demora hasta el diagnóstico definitivo. Previo a iniciar el tratamiento deben tomarse todas las muestras para los estudios microbiológicos que permitan confirmar luego la presunción diagnóstica.


Background: Histoplasmosis is a mycosis with a high prevalence in HIV/AIDS patients. Clinical presentation includes a wide spectrum of manifestations and diagnosis usually takes up to several weeks in patients who do not present cutaneous lesions. Aim: To determine the clinical and microbiological characteristics as well as some biochemical parameters in patients with AIDS-associated histoplasmosis without tegumentary lesions, in order to develop a guideline which enables an early empiric treatment in cases of difficult diagnosis. Methods: Medical records of 86 patients with histoplasmosis were reviewed; 31 patients with diagnosis of AIDS-associated histoplasmosis without cutaneous lesions were analyzed. Results: Fever was the most frequent symptom (96.7%), lung involvement was observed in 22 patients (70.9%), the most commonly radiological pattern was miliary pattern [(12/22), 54.5%]. Nineteen patients presented with splenomegaly. Blood culture sensitivity was 93.3% (28/30) and serology was positive only in 23.5% of the cases. Eight patients died (25.8%). Patients in which CD4+ T cell lymphocytes count was < 50 cells/μl, albumin levels < 2.5 g/dl and who presented with pancytopenia had an unfavorable outcome. Conclusions: In HIV seropositive patients with fever associated to splenomegaly and bilateral miliar pattern in chest radiography, the empiric treatment with amphotericin B must be considered if signs and symptoms of unfavorable outcome are present and due to the time that it takes to arrive at an accurate diagnosis. In order to confirm the diagnosis, all microbiological samples should be collected prior to initiating therapy.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Young Adult , AIDS-Related Opportunistic Infections/diagnosis , Dermatomycoses/diagnosis , Histoplasmosis/diagnosis , Acute Disease , Retrospective Studies
17.
Rev. chil. infectol ; 34(4): 365-369, ago. 2017. tab
Article in Spanish | LILACS | ID: biblio-899725

ABSTRACT

Resumen Introducción: La histoplasmosis es una infección fúngica endémica en Perú, y la co-infección con VIH conlleva dificultades diagnósticas y alta mortalidad asociada. Objetivo: Describir las características clínicas, epidemiológicas y desenlace clínico en pacientes con infección por VIH con diagnóstico de histoplasmosis diseminada (HD) en el Hospital Nacional Guillermo Almenara Irigoyen, Lima-Perú. Material y Métodos: Estudio retrospectivo, descriptivo; se obtuvo información del registro informático de pacientes con infección por VIH con diagnóstico de HD, durante el período 1996-2014. Se describieron características clínicas, epidemiológicas, tratamiento y desenlace. Resultados: Se encontraron 27 pacientes, 25 (92,6%) fueron varones, con edad media de 36,7 años (± 9,4 años) y 22 (81,5%) tuvieron antecedente epidemiológico. Dieciséis (59,3%) tuvieron HD como enfermedad indicadora de SIDA. El recuento medio de LT CD4+ fue de 65 céls/mm3 (RIQ 15-92). Sólo siete (25,9%) recibían al momento del diagnóstico terapia anti-retroviral combinada. La presentación clínica más frecuente fue con fiebre (66,7%), diarrea crónica (40,7%) y linfoadenopatías (33,3%); el diagnóstico fue realizado principalmente mediante histopatología. Seis (22,2%) fallecieron en la etapa aguda de la enfermedad. Siete (25,9%) fueron tratados inicialmente de forma empírica como tuberculosis. Conclusiones: Se describen las características clínicas de un grupo de pacientes que tuvieron HD como co-infección de VIH, siendo esto aún una realidad cuasi endémica en los pacientes que sufren esta patología.


Background: Histoplasmosis is an endemic fungal infection in Peru and HIV coinfection leads to difficult diagnoses and high associated mortality. Aim: To describe clinical, epidemiological and clinical outcomes in patients with HIV infection with diagnosis of disseminated histoplasmosis (DH) at Guillermo Almenara Irigoyen National Hospital, Lima, Peru. Methods: Retrospective, descriptive study; information was obtained from the computer registry of patients with HIV infection diagnosed with DH, during the period 1996-2014. Clinical, epidemiological, treatment and outcome characteristics were described. Results: We found 27 patients, 25 (92.6%) were male, with a mean age of 36.7 years (± 9.4 years) and 22 (81.5%) had an epidemiological history contact. Sixteen patients (59.3%) had DH as an AIDS defining disease. The median CD4 count was 65 cells/mm3 (IQR 15-92). Only 7 (25.9%) received combination antiretroviral therapy at diagnosis. The most common clinical presentation was fever (66.7%), chronic diarrhea (40.7%) and lymphadenopathy (33.3%). The diagnosis was made mainly by histopathology. Six (22.2%) patiens died in the acute stage of the disease. Seven (25.9%) were initially treated empirically as tuberculosis. Conclusion: We describe the clinical characteristics of a group of patients who had DH as HIV coinfection and this is still a quasi endemic reality in patients suffering from this pathology.


Subject(s)
Humans , Male , Female , Adult , AIDS-Related Opportunistic Infections/diagnosis , Histoplasmosis/diagnosis , Peru , Retrospective Studies , AIDS-Related Opportunistic Infections/drug therapy , Coinfection , Histoplasmosis/drug therapy
18.
Rev. habanera cienc. méd ; 16(3): 395-401, may.-jun. 2017. ilus
Article in Spanish | LILACS, CUMED | ID: biblio-901733

ABSTRACT

Introducción: La Histoplasmosis es una enfermedad endémica, que presenta un comportamiento oportunista cuyo germen causal es el Histoplasma capsulatum (HC), considerado un hongo dimórfico. Objetivo: Presentar un caso con el diagnóstico de Histoplasmosis generalizada, cuyas manifestaciones faríngeas fueron el inicio de la enfermedad. Presentación del caso: Se presenta el caso de un paciente, con los síntomas faríngeos que fueron la primera manifestación de la enfermedad, en el que la biopsia permitió llegar al diagnóstico nosológico. Posteriormente presentó otras manifestaciones con aspectos clínicos-microbiológicos de diseminación progresiva. Conclusiones: La Histoplasmosis faríngea es una micosis sistémica infrecuente y de difícil diagnóstico, es preciso un buen interrogatorio y examen físico, en aquellos pacientes con factores de riesgo de enfermedades infecciosas sin diagnóstico aparente y deterioro progresivo de su estado general(AU)


Introduction: The Histoplasmosis is an endemic illness that presents an opportunist behavior in which causal germ is the Histoplasma capsulatum (HC), considered a dimorphic mushroom. Objective: To present a case with the diagnosis of Generalized Histoplasmosis in which pharyngeal manifestations were the beginning of the illness. Presentation of the case: The case of a patient is presented with the pharyngeal symptoms that were the first manifestation of the illness, in which the biopsy allowed to arrive to the diagnostic. Later the patient presented other manifestations with clinical-microbiologic aspects of progressive dissemination. Conclusions: The pharyngeal Histoplasmosis is an uncommon systemic mycosis and with a difficult diagnostic, it is necessary a good interrogation and physical exam, in those patients with factors of risk of infectious illnesses without apparent diagnosis and progressive deterioration of their general state(AU)


Subject(s)
Humans , Male , Aged , Pharyngeal Diseases/complications , Histoplasmosis/diagnosis , Histoplasmosis/etiology , Histoplasmosis/pathology
19.
Braz. j. infect. dis ; 21(1): 7-11, Jan.-Feb. 2017. tab, graf
Article in English | LILACS | ID: biblio-839182

ABSTRACT

Abstract The diagnosis of progressive disseminated histoplasmosis is often a challenge to clinicians, especially due to the low sensitivity and long turnaround time of the classic diagnostic methods. In recent years, studies involving a variety of non-culture-based diagnostic tests have been published in the literature. We performed a systematic review by selecting studies evaluating non-culture-based diagnostic methods for progressive disseminated histoplasmosis. We searched for articles evaluating detection of antibody, antigens, as well as DNA-based diagnostic methods. A comprehensive PUBMED, Web of Science, and Cochrane Library search was performed between the years 1956 and 2016. Case reports, review articles, non-human models and series involving less than 10 patients were excluded. We found 278 articles and after initial review 18 articles were included: (12) involved antigen detection methods, (4) molecular methods, and (2) antibody detection methods. Here we demonstrate that the pursuit of new technologies is ultimately required for the early and accurate diagnosis of disseminated histoplasmosis. In particular, urinary antigen detection was the most accurate tool when compared with other diagnostic techniques.


Subject(s)
Humans , Serologic Tests/methods , Immunoenzyme Techniques/methods , Histoplasmosis/diagnosis , Polymerase Chain Reaction/methods , Sensitivity and Specificity
20.
An. bras. dermatol ; 91(3): 362-364, graf
Article in English | LILACS | ID: lil-787298

ABSTRACT

Abstract: A patient with systemic involvement, initially treated as tuberculosis, is presented in this report. There were only two painful subcutaneous nodules, from which we arrived at the correct diagnosis of histoplasmosis. The patient was attended by several experts in the fields of infectious diseases, nephrology and internal medicine, but the diagnosis was only possible after dermatological examination and skin biopsy. This case values multidisciplinary interaction between dermatologists and other medical areas for diagnosis of cases with atypical manifestations.


Subject(s)
Humans , Male , Subcutaneous Tissue/microbiology , Dermatomycoses/diagnosis , Histoplasmosis/diagnosis , Arm , Biopsy , Interdisciplinary Communication , Diagnosis, Differential , Diagnostic Errors/prevention & control
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