Infectious Diseases Unit, Internal Medicine Department, Triângulo Mineiro Federal University, Mailbox 118, Uberaba, Minas Gerais, 38001-170, Brazil.
Special Pathology Unit, Triângulo Mineiro Federal University, Uberaba, Minas Gerais, Brazil.
Mycopathologia. 2020 Apr;185(2):339-346. doi: 10.1007/s11046-020-00435-y. Epub 2020 Feb 20.
Histoplasmosis occurs in 5-10% of HIV-infected patients in endemic areas and evolves to severe and disseminated infection with mortality rates over 50% in some regions. This report presents epidemiological, clinical and outcome data from HIV-infected patients with histoplasmosis confirmed by culture and/or at necropsy who were admitted to a Brazilian teaching hospital. Data from 65 patients were obtained from their respective medical and necropsy records. From 2005 to 2018, 36 HIV-infected patients were diagnosed with histoplasmosis confirmed by culture. At admission, most of these patients presented disseminated fungal infection, whereas 15 (41.7%) were simultaneously diagnosed with both HIV infection and histoplasmosis. Fever, weight loss, hepatosplenomegaly, respiratory and digestive symptoms were present in 86.2%, 50%, 44.4% and 41.7% of the patients, respectively. At admission, 24 patients had low CD4 T-cell count and high viral load values. Among the 30 patients who received antifungals, 16 (53.3%) were cured, 13 (43.3%) died, and one was lost to follow-up. Six patients died prior to therapy. From 1990 to 2018, 63 necropsies of patients with Histoplasma capsulatum infection were performed. Of these patients, 29 (46.0%) were HIV-infected individuals, including 21 (72.4%) who presented disseminated histoplasmosis and 21 (72.4%) who were diagnosed with histoplasmosis at necropsy. The epidemiological, clinical and outcome profiles presented herein are similar to those described elsewhere and reinforce the difficulties that are still present in limited-resource settings where advanced immunodeficiency, combined with severe fungal infection and late patient admissions, is related to poor outcomes.
组织胞浆菌病发生在流行地区的 5-10%HIV 感染患者中，在某些地区会发展为严重和播散性感染，死亡率超过 50%。本报告介绍了在一家巴西教学医院住院的 HIV 感染患者中，通过培养和/或尸检确诊的组织胞浆菌病的流行病学、临床和预后数据。从 2005 年到 2018 年，通过培养确诊了 36 例 HIV 感染合并组织胞浆菌病患者，从他们各自的病历和尸检记录中获得了这些患者的数据。入院时，这些患者大多患有播散性真菌感染，而同时诊断为 HIV 感染和组织胞浆菌病的有 15 例（41.7%）。发热、体重减轻、肝脾肿大、呼吸道和消化道症状分别出现在 86.2%、50%、44.4%和 41.7%的患者中。入院时，24 例患者的 CD4T 细胞计数低，病毒载量高。在接受抗真菌治疗的 30 例患者中，16 例（53.3%）治愈，13 例（43.3%）死亡，1 例失访。有 6 例患者在治疗前死亡。1990 年至 2018 年，对 63 例感染荚膜组织胞浆菌的患者进行了尸检。这些患者中，29 例（46.0%）为 HIV 感染者，其中 21 例（72.4%）为播散性组织胞浆菌病，21 例（72.4%）在尸检时被诊断为组织胞浆菌病。本文所描述的流行病学、临床和预后特征与其他地方描述的相似，这再次强调了在资源有限的环境中仍然存在的困难，在这种环境中，高级别的免疫缺陷，加上严重的真菌感染和晚期患者入院，与不良预后有关。
