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[晚期艾滋病合并皮肤表现的播散性组织胞浆菌病:病例报告]

[Disseminated histoplasmosis with skin manifestations in advanced HIV: Case report].

作者信息

Arreola-Banda Francisco, López-Lachica Olivia, García-Maldonado Guillermo, Alcázar-Quiñones Carlos Salvador, Rodríguez-Alejandro Pedro, Castillo-Meraz Jorge Arturo

机构信息

Instituto Mexicano del Seguro Social, Hospital General de Zona No. 33, Servicio de Medicina Interna. Monterrey, Nuevo León, México.

Instituto Mexicano del Seguro Social, Hospital General de Zona No. 33, Departamento de Investigación y Educación en Salud. Monterrey, Nuevo León, México.

出版信息

Rev Med Inst Mex Seguro Soc. 2024 Mar 4;62(2):1-6. doi: 10.5281/zenodo.10712236.

Abstract

BACKGROUND

Histoplasmosis is a systemic mycosis caused by the agent Histoplasma capsulatum. Its clinical manifestations depend on the inhaled fungal load and can vary from an asymptomatic infection (90%) to a disseminated disease, especially in HIV infections and a CD4 T lymphocyte count of less than 150 cells. Its initial symptoms are nonspecific, including fever, weight loss, dry cough, and chest pain. It spreads to other organs, with the skin being a rare site where lesions of wide polymorphism are observed. The disseminated form requires a high index of suspicion and must be differentiated from other common pathologies in patients with advanced HIV infection such as pulmonary tuberculosis.

CLINIC CASE

A 33-year-old male with a diagnosis of HIV/AIDS C3, pulmonary tuberculosis and dermatosis of 9 months' evolution, with poor adherence to treatment who died of complications secondary to disseminated histoplasmosis.

CONCLUSION

Histoplasmosis is a common opportunistic mycosis in patients with advanced HIV disease, especially in endemic areas, so it's recommended to start an early diagnostic protocol and raise awareness of the importance of adherence to treatment, due to the rapid progression of the disseminated variant and its high mortality.

摘要

背景

组织胞浆菌病是由荚膜组织胞浆菌引起的一种全身性真菌病。其临床表现取决于吸入的真菌负荷,可从无症状感染(90%)到播散性疾病不等,尤其是在HIV感染且CD4 T淋巴细胞计数低于150个细胞的情况下。其初始症状不具特异性,包括发热、体重减轻、干咳和胸痛。它会扩散到其他器官,皮肤是观察到广泛多形性病变的罕见部位。播散型需要高度怀疑,必须与晚期HIV感染患者的其他常见病症如肺结核相鉴别。

临床病例

一名33岁男性,诊断为HIV/AIDS C3、肺结核和病程9个月的皮肤病,治疗依从性差,死于播散性组织胞浆菌病继发的并发症。

结论

组织胞浆菌病是晚期HIV疾病患者常见的机会性真菌病,尤其是在流行地区,因此建议启动早期诊断方案,并提高对坚持治疗重要性的认识,因为播散型进展迅速且死亡率高。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ecfc/12140800/8cac52fe002c/04435117-62-2-e5646-f001.jpg

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