BACKGROUND: Histoplasmosis is a frequent systemic mycosis in immunocompromised patients. The clinic is variable and is considered the most common respiratory mycosis worldwide, presenting a higher prevalence in tropical areas including South America. It is estimated that there are forty million patients, calculating two hundred thousand new cases annually. In Ecuador, the epidemiology of the disease is unknown, but it is estimated that 11.1% of patients with AIDS have histoplasmosis. CASE REPORT: Male patient of 23 years old, from Oro - Ecuador, with a history of AIDS diagnosed four years ago, with poor adherence to antiretroviral treatment and pulmonary tuberculosis, is admitted for presenting fever of two weeks evolution, asthenia, productive cough, weight loss, scaly erythematous-violaceous papules spread throughout the integument, with mucosal involvement. The risk factors presented by the patient for histoplasmosis were the lack of compliance with antiretroviral treatment and living in a rural area with exposure to poultry excrement. EVOLUTION: The patient was hospitalized with diagnosis of disseminated cutaneous histoplasmosis, AIDS, pulmonary tuberculosis, oral candidiasis and anal herpes. Antiretroviral, antituberculous treatment was continued and Amphotericin-B and itraconazole were started; later the patient was discharged with clinical improvement. CONCLUSION: Dermatoses play an important role in the early diagnosis of histoplasmosis. When there are comorbidities associated with the disease, such as AIDS and pulmonary tuberculosis. It is necessary to rethink the treatment, due to the drug interaction that may exist between Itraconazole and Rifampicin. The patient received Amphotericin-B until clinical improvement. For the prevention of opportunistic diseases, a correct adherence to the antiretroviral treatment, avoid the habitat of the fungus as bird or cave farms and before the risk of exposure, the adequate use of a mask.

BACKGROUND: Levobupivacaine is currently the anesthetic of choice in subarachnoid anesthesia; reducing the risk of cardiotoxicity, it provides a shorter time of motor and sensory block compared to bupivacaine, allowing faster recovery of motility. The aim of this study was to characterize subarachnoid anesthesia with levobupivacaine, in a study of patients aged 18 to 65 years, undergoing lower abdominal and lower limb surgery, at the Hospital Vicente Corral Moscoso and Hospital de Especialidades José Carrasco Arteaga in Cuenca, Ecuador. METHODS: Observational, descriptive study. 276 patients who met the inclusion criteria were included. The anesthesiologist monitored the latency time, duration, level of block, and side effects of levobupivacaine. For qualitative variables, we presented frequencies and percentages, for quantitative variables we applied mean and standard deviation. Statistical associations between the variables were sought with Chi-square test, accepting statistical significance with a p value < 0.05. RESULTS: Most of patients were male, between 30 and 39 years old. The majority of patients were overweight, most classified as ASA II, and underwent emergency surgery. Sensory block latency time was 1 to 5 minutes in 57.2% of the sample. Regarding motor block, 8 out of 10 patients had the anesthetic effect in the range of 11 to 15 minutes. In more than half of the patients the duration of the sensitive block was > 200 minutes; most of participants reached a sensory block at T6. The duration of motor block varied between 81 and 160 minutes for 80.4% of the sample. One out of 10 patients had side effects. CONCLUSION: The average sensory latency time is 5.89 minutes and the average motor latency time is 12.69 minutes. The duration of sensory block is greater than 200 minutes in most patients. The higher the dose of levobupivacaine, the longer the sensory block lasted. Motor block duration was 131 ± 31.31 minutes on average. The differences in the sensitive latency time in relation to the use of fentanyl are not significant; on the contrary, there is a significant association between the duration of sensory block and fentanyl administration.

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