Cruz-Quezada Arlen, Moreno Joaquín, Solís-Bravo Miguel Ángel, López Chávez Claudia Andrea, Santos Tiburcio, Fonseca-Mata Juan José, Araiza Javier, Bonifaz Alexandro
Department of Infectious Diseases, Hospital Regional San Juan de Dios, Estelí, Nicaragua.
Department of Infectious Diseases, Hospital General de México "Dr. Eduardo Liceaga," Ciudad de México.
Open Forum Infect Dis. 2024 Jul 8;11(7):ofae385. doi: 10.1093/ofid/ofae385. eCollection 2024 Jul.
Hemophagocytic lymphohistiocytosis (HLH) is considered a rare disease with high morbidity and mortality risks. Most research on this disease is conducted in pediatric settings. Therefore, this study aimed to describe the clinical characteristics, laboratory findings, and outcomes related to HLH in people living with human immunodeficiency virus (HIV)/AIDS) and disseminated histoplasmosis.
A retrospective and descriptive study was conducted in a tertiary hospital in México City from January 2018 to December 2022, including people living with HIV who had disseminated histoplasmosis confirmed through direct microbiological or immunological methods with an HScore ≥169 or who met 5 of the 8 HLH-2004 criteria.
HLH occurred in 36.1% (n = 26) of patients with HIV and disseminated histoplasmosis; the majority were men (84.9%), and their mean age (standard deviation) was 30.19 (5.6) years. The most frequent clinical manifestations were hepatomegaly (100%), fever (96.2%), and dyspnea (84.6%). The most common biochemical changes were hyperferritinemia (100%), elevated lactate dehydrogenase (100%), and bicytopenia (61.5%). Partial thromboplastin time ( = .012) and prothrombin time ( = .004) were associated with the 30-day mortality rate, and the 30-day survival rate was 65.4%.
We detected a high frequency of HLH; therefore, we encourage physicians to use diagnostic prediction tools (HLH-2004 and HScore criteria) in each reassessment for timely detection.
噬血细胞性淋巴组织细胞增生症（HLH）被认为是一种发病率和死亡率风险较高的罕见疾病。关于这种疾病的大多数研究是在儿科环境中进行的。因此，本研究旨在描述人类免疫缺陷病毒（HIV）/获得性免疫缺陷综合征（AIDS）患者合并播散性组织胞浆菌病时HLH的临床特征、实验室检查结果及预后。
2018年1月至2022年12月在墨西哥城一家三级医院进行了一项回顾性描述性研究，纳入通过直接微生物学或免疫学方法确诊为播散性组织胞浆菌病且HScore≥169或符合8条HLH - 2004标准中5条的HIV感染者。
HIV合并播散性组织胞浆菌病患者中36.1%（n = 26）发生HLH；大多数为男性（84.9%），平均年龄（标准差）为30.19（5.6）岁。最常见的临床表现为肝肿大（100%）、发热（96.2%）和呼吸困难（憨84.6%）。最常见的生化改变为高铁蛋白血症（100%）、乳酸脱氢酶升高（100%）和双血细胞减少（61.5%）。部分凝血活酶时间（= 0.012）和凝血酶原时间（= 0.004）与30天死亡率相关，30天生存率为65.4%。
我们检测到HLH的高发生率；因此，我们鼓励医生在每次重新评估时使用诊断预测工具（HLH - 2004和HScore标准）以便及时发现。
