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Micoses sistêmicas: fatores associados ao óbito em pacientes com infecção pelo vírus da imunodeficiência humana, Cuiabá, Estado de Mato Grosso, 2005-2008 / Systemic mycosis: factors associated with death among patients infected with the human immunodeficiency virus, Cuiabá, State of Mato Grosso, Brazil, 2005-2008
Ribeiro, Luciano Correa; Hahn, Rosane Christine; Favalessa, Olivia Cometi; Tadano, Tomoko; Fontes, Cor Jesus Fernandes.
  • Ribeiro, Luciano Correa; Universidade Federal do Mato Grosso. Hospital Universitário Júlio Müller. Cuiabá. BR
  • Hahn, Rosane Christine; Universidade Federal do Mato Grosso. Hospital Universitário Júlio Müller. Cuiabá. BR
  • Favalessa, Olivia Cometi; Universidade Federal do Mato Grosso. Hospital Universitário Júlio Müller. Cuiabá. BR
  • Tadano, Tomoko; Universidade Federal do Mato Grosso. Hospital Universitário Júlio Müller. Cuiabá. BR
  • Fontes, Cor Jesus Fernandes; Universidade Federal do Mato Grosso. Hospital Universitário Júlio Müller. Cuiabá. BR
Rev. Soc. Bras. Med. Trop ; 42(6): 698-705, Dec. 2009. tab
Article in Portuguese | LILACS | ID: lil-539521
RESUMO
A prevalência de micose sistêmica entre 1.300 pacientes portadores de HIV/Aids de Cuiabá, Mato Grosso foi de 4,6 por cento, no período de 2005-2008. As espécies de fungos isoladas foram o Cryptococcus neoformans (50 por cento), Cryptococcus gattii (1,6 por cento), Cryptococcus spp (6,6 por cento), Histoplasma capsulatum (38,3 por cento) e Paracoccidioides brasiliensis (3,3 por cento). Óbito foi registrado em 32 (53,3 por cento) pacientes, sendo a criptococose a principal causa. A contagem de linfócitos T CD4+ foi baixa e semelhante entre os pacientes que sobreviveram ou faleceram por micose sistêmica. O etilismo (OR8,2; IC95 por cento 1,4-62,1; p=0,005) e o nível médio de desidrogenase lática [758 (182) U/L vs 416 (268) U/L; p<0,001] foram as características independentemente associadas ao óbito dos pacientes do estudo. Os resultados mostram alta letalidade por micoses sistêmicas em pacientes portadores de HIV/Aids de Cuiabá e sugerem que características clínico-laboratoriais tais como o etilismo e a elevação precoce da desidrogenase lática podem ser fatores relacionados ao pior prognóstico nessas condições.
ABSTRACT
Between 2005 and 2008, the prevalence of systemic mycosis among 1,300 HIV/AIDS patients in Cuiabá, Mato Grosso, was 4.6 percent. The fungus species isolated were Cryptococcus neoformans in 50 percent, Cryptococcus gattii in 1.6 percent, Cryptococcus spp in 6.6 percent, Histoplasma capsulatum in 38.3 percent and Paracoccidioides brasiliensis in 3.3 percent. Death was recorded in the cases of 32 patients (53.3 percent), and cryptococcosis was the main cause. The CD4+ T lymphocyte count was low and similar among patients who survived or died due to systemic mycosis. The factors independently associated with the deaths of these patients were alcoholism (OR 8.2; 95 percent CI 1.4-62.1; p = 0005) and the mean level of lactate dehydrogenase [758 (182) U/l vs. 416 (268) U/l; p < 0001]. The findings showed that systemic mycosis was highly lethal among the patients with HIV/AIDS in Cuiabá and suggested that clinical-laboratory characteristics such as alcoholism and early elevation of lactate dehydrogenase may be factors relating to worse prognosis under these conditions.
Subject(s)

Full text: Available Index: LILACS (Americas) Main subject: Paracoccidioidomycosis / AIDS-Related Opportunistic Infections / Cryptococcosis / Histoplasmosis Type of study: Etiology study / Observational study / Prevalence study / Prognostic study / Risk factors Limits: Adolescent / Adult / Child / Female / Humans / Male Country/Region as subject: South America / Brazil Language: Portuguese Journal: Rev. Soc. Bras. Med. Trop Journal subject: Tropical Medicine Year: 2009 Type: Article Affiliation country: Brazil Institution/Affiliation country: Universidade Federal do Mato Grosso/BR

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Full text: Available Index: LILACS (Americas) Main subject: Paracoccidioidomycosis / AIDS-Related Opportunistic Infections / Cryptococcosis / Histoplasmosis Type of study: Etiology study / Observational study / Prevalence study / Prognostic study / Risk factors Limits: Adolescent / Adult / Child / Female / Humans / Male Country/Region as subject: South America / Brazil Language: Portuguese Journal: Rev. Soc. Bras. Med. Trop Journal subject: Tropical Medicine Year: 2009 Type: Article Affiliation country: Brazil Institution/Affiliation country: Universidade Federal do Mato Grosso/BR