Histoplasmosis in HIV-infected patients in a southern regional medical center: poor prognosis in the era of highly active antiretroviral therapy

Baddley, John W.; Sankara, Ishwara R.; Rodriquez, J. Martin; Pappas, Peter G.; Many, Wickliffe J.

doi:10.1016/j.diagmicrobio.2008.05.006

Cited by 80 publications

(73 citation statements)

References 13 publications

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“…It is important to note that individuals presenting comorbidities with hepatitis B and C viruses and drug interactions were not observed in the study. Similar findings have also been reported in other studies, 9,14,18,28,30 and high AST and ALT levels frequently correlate with hepatomegaly. Splenomegaly and hepatomegaly have been reported frequently among PDH patients (10-93%) in similar cohorts from Europe, United States, Panama, French Guyana, Brazil, and Argentina.…”

Section: Discussionsupporting

confidence: 78%

“…Splenomegaly and hepatomegaly have been reported frequently among PDH patients (10-93%) in similar cohorts from Europe, United States, Panama, French Guyana, Brazil, and Argentina. 9,10,12,13,18,28,30,31 The signs of hepatomegaly and/ or splenomegaly are often nonspecific and are frequently present in PLWHA having other opportunistic coinfections, especially TB.…”

Section: Discussionmentioning

confidence: 99%

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Clinical and Laboratory Profile of Persons Living with Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome and Histoplasmosis from a Colombian Hospital

Cáceres

Tobón

Cleveland

et al. 2016

The American Society of Tropical Medicine and Hygiene

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Abstract. Histoplasmosis is common among persons living with human immunodeficiency virus/acquired immune deficiency syndrome (PLWHA) in Latin America, but its diagnosis is difficult and often nonspecific. We conducted prospective screening for histoplasmosis among PLWHA with signs or symptoms suggesting progressive disseminated histoplasmosis (PDH) and hospitalized in Hospital La María in Medellín, Colombia. The study's aim was to obtain a clinical and laboratory profile of PLWHA with PDH. During 3 years (May 2008 to August 2011), we identified 89 PLWHA hospitalized with symptoms suggestive of PDH, of whom 45 (51%) had histoplasmosis. We observed tuberculosis (TB) coinfection in a large proportion of patients with PDH (35%), so all analyses were performed adjusting for this coinfection and, alternatively, excluding histoplasmosis patients with TB. Results showed that the patients with PDH were more likely to have Karnofsky score ≤ 30 (prevalence ratio [PR] = 1.98, 95% confidence interval [CI] = 0.97-4.06), liver compromised with hepatomegaly and/or splenomegaly (PR = 1.77, CI = 1.03-3.06) and elevation in serum of alanine aminotransferase and aspartate aminotransferase to values > 40 mU/mL (PR = 2.06, CI = 1.09-3.88 and PR = 1.53, CI = 0.99-2.35, respectively). Using multiple correspondence analyses, we identified in patients with PDH a profile characterized by the presence of constitutional symptoms, namely weight loss and Karnofsky classification ≤ 30, gastrointestinal manifestations with alteration of liver enzymes and hepatosplenomegaly and/or splenomegaly, skin lesions, and hematological alterations. Study of the profiles is no substitute for laboratory diagnostics, but identifying clinical and laboratory indicators of PLWHA with PDH should allow development of strategies for reducing the time to diagnosis and thus mortality caused by Histoplasma capsulatum.

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Section: Discussionsupporting

confidence: 78%

Section: Discussionmentioning

confidence: 99%

Clinical and Laboratory Profile of Persons Living with Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome and Histoplasmosis from a Colombian Hospital

Cáceres

Tobón

Cleveland

et al. 2016

The American Society of Tropical Medicine and Hygiene

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“…A significant difference, p=0.01, was found between AIDS and non-AIDS patients, a difference already noticed in other reports and considered to be connected to the seriousness of the disease course in HIV patients (2,4,5,31,(37)(38)(39). The advanced stage of the latter infection in this series explains the clinical behavior of the mycosis, as observed by the lesser age found in this group as compared with those in the other risk factor groups; it may also explain, partially at least, the observed sex differences although here a more intense environmental exposure is also attributed to males.…”

Section: Diagnostic Methodssupporting

confidence: 55%

“…Besides presenting a more rapid course, the clinical course of the AIDS patients was also more aggressive and exhibited peculiar characteristics rarely informed in other patients groups, such as indicated by hematologic abnormalities and frequency and severity of skin lesions, as described earlier (2,4,5,31,(37)(38)(39). It should be noticed that skin lesions are seldom observed in North American patients (8,9).…”

Section: Diagnostic Methodsmentioning

confidence: 70%

“…As expected, the patients' T CD4+ mean counts were low, 66.5 (±82.1) cells/μl, as only 27.6% of them had been receiving HAART at time of diagnosis. Late diagnosis was also important as indicated by the proportion of patients (29.3%) in whom full-blown AIDS was defined by clinically apparent histoplasmosis The coincidence of HIV and histoplasmosis has been noticed in most of the series reported (6-9,16-18,21,24,26-28,29,31,37-39), but the role played by the mycosis as the AIDS defining opportunistic infection varies according to the country of report (37).…”

Section: Diagnostic Methodsmentioning

confidence: 99%

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Histoplasmosis en Colombia: resultados de la encuesta nacional, 1992-2008

et al. 2011

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Introduction. Histoplasmosis, a fungal disorder characterized by a wide spectrum of manifestations that range from subclinical infections to disseminated processes, affects both immunocompetent and immunosuppressed individuals. Histoplasmosis is not a reportable disease in Colombia and consequently, a survey was designed to collect histoplasmosis cases diagnosed in the country. Objective. The aim of this work was to analyze the data collected from 1992 to 2008. Materials and methods. The survey included demographic data, risk factors, clinical manifestations, imaging data, diagnostic methods and antifungal treatment. Patients were grouped according to risk factors and comparisons of the various findings were done. Results. A total of 434 surveys were gathered from 20 of the country's Departments. Most patients (96.1%) were adults, 77% were males with a mean age of 38.4 years. Only 3.9% were children less than 15 years of age. In the adult population, AIDS was reported in 70.5% of the cases; additionally, in 7.0% patients other immunosuppressive conditions were informed. The most frequent clinical manifestations were fever (76.1%), cough (54.8%) and constitutional symptoms (56.8%). X rays abnormalities were represented mainly by infiltrates (65.9%) and nodules (17.1%). Diagnosis was made by microscopic observation of H. capsulatum in 49.6% patients, by culture in 58.0% and by serological test in 14.6% cases. Antifungal use was recorded in 52.5% cases. Conclusions. Histoplasmosis is frequent in Colombia, especially in certain risk factor groups such as the HIV-infected population. Data collected from this large number of cases has allowed valid comparisons on various aspects of histoplasmosis in Colombia.Key words: histoplasmosis, surveillance, acquired immunodeficiency syndrome, children, disseminated histoplasmosis, Colombia. Author contributions:Myrtha Arango played an important role in the development of the project, revised the questionnaires and ascertained their completeness, participated in the analysis of the data and in the writing process. Elizabeth Castañeda conceived the plan for the surveillance program, orchestrated connections with hospitals, diagnostic centers and worked all along the development of the study, including writing and analyzing the manuscript. Clara Inés Agudelo worked all along in the surveillance study, played an important role in preparation of the manuscript and in analysis of the data, including statistical tests. Catalina De Bedout was in charge of the mycologic diagnosis for all CIB cases, established links with physicians in charge of patients, and controlled receipt of questionnaires. Carlos A. Agudelo was the physician in charge of most of the CIB patients, checked the questionnaire's contents for medical accuracy, and analyzed the data statistics. Ángela María Tobón examined many of the CIB patients, filled in the corresponding questionnaires, supervised the clinical aspects of most patients, and served as a consultant for other physicians in charge of histoplasmosis patie...

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