2011, Number 2
Rev Med MD 2011; 2.3 (2)
Campos-Loza AE, Arellano-Contreras D, López-Iñiguez A, González-Landeros M, González-Hernández LA, Andrade-Villanueva JF
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ABSTRACTBackground: Histoplasma captulatum is the main dimorphic fungus responsible of significant morbidity and mortality on patients with AIDS living on the western hemisphere tropical regions. The clinical characteristics typically reflect a disseminated disease including fever as a cardinal sign. However, there are cases of histoplasmosis with an atypical presentation in which clinical characteristics have been rarely determined.
Objective: To describe a series of cases of patients diagnosed with subclinical histoplasmosis (SCH) of a cohort of patients with HIV/AIDS.
Methods: A Retrospective review was done in the definitive cases of histoplasmosis that were diagnosed between the years of 2004 and 2011; Cases that clearly excluded the presence of fever, were included. Their pertinent demographic, clinical, immunological, and laboratorial data, as well as their history of antiretroviral therapy (ART), antifungal treatment administrated and survival were analyzed.
Results: 14 cases (12, males) were identified, diagnosed with (SCH) through a histopathological study during the period of study representing 7% of the definitive cases of histoplasmosis. The age of presentation was 29 (RIC 24-40 years). No patient had control of the infection by HIV: 7 patients (50%) with suboptimum adherence to ART and 7 (50%) had never received ART. The T CD4+ lymphocytes level was 129 cells/mm3 (RIC 64-299). The anatomic locations of SCH were ganglionic (12 cases, 85.7%), and cutaneous (2 cases, 14.3%).The history of weight loss (9 cases, 64%) and lymphadenopathy through physical exploration were the most common clinical characteristics (12 cases, 86%). None of the patients had a significant biochemical disorder. All, except one patient, were treated with itraconazole and no relapse or deaths were registered during the period of 203 days to follow. After receiving ART, 10/14 (71%) patients managed to suppress the CV-VIH with a favorable immunological reconstitution of T CD4+ lymphocytes in 9/14 (64%) of +120 cells/mm3 (RIC -119 - +292).
Conclusions: In a cohort of mexican patients with HIV, the SCH was observed exclusively on patients with AIDS with no plasmatic viremia control, with a history of weight loss, adenopathies or dermatosis and the absence of significant biochemical abnormalities. With a treatment based on itraconazole and active ART, the prognosis of infection by Histoplasma capsulatum was favorable.