Messina Fernando A, Corti Marcelo, Negroni Ricardo, Arechavala Alicia, Bianchi Mario, Santiso Gabriela
Unidad de Micología, Hospital de Enfermedades Infecciosas, Buenos Aires, Argentina.
Departamento de Medicina, Orientación Enfermedades Infecciosas, Universidad de Buenos Aires, Argentina.
Rev Chilena Infectol. 2018;35(5):560-565. doi: 10.4067/s0716-10182018000500560.
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.
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.
Medical records of 86 patients with histoplasmosis were reviewed; 31 patients with diagnosis of AIDS-associated histoplasmosis without cutaneous lesions were analyzed.
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.
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.
组织胞浆菌病是一种在艾滋病病毒/艾滋病患者中高发的真菌病。临床表现多种多样，对于无皮肤损害的患者，诊断通常需要数周时间。
确定无皮肤损害的艾滋病相关组织胞浆菌病患者的临床和微生物学特征以及一些生化参数，以便制定一项指南，使在诊断困难的情况下能够早期进行经验性治疗。
回顾了86例组织胞浆菌病患者的病历；分析了31例诊断为艾滋病相关组织胞浆菌病且无皮肤损害的患者。
发热是最常见的症状（96.7%），22例患者（70.9%）有肺部受累，最常见的放射学表现是粟粒样改变[（12/22），54.5%]。19例患者出现脾肿大。血培养敏感性为93.3%（28/30），血清学仅在23.5%的病例中呈阳性。8例患者死亡（25.8%）。CD4+T淋巴细胞计数<50个细胞/μl、白蛋白水平<2.5g/dl且出现全血细胞减少的患者预后不良。
对于艾滋病病毒血清学阳性、伴有发热、脾肿大且胸部X线表现为双侧粟粒样改变的患者，如果出现预后不良的体征和症状，且由于准确诊断需要时间，必须考虑使用两性霉素B进行经验性治疗。为了确诊，所有微生物学样本应在开始治疗前采集。
