Histoplasmosis at a reference center for infectious diseases in Southeast Brazil: Comparison between HIV-positive and HIV-negative individuals

• Published in: Tropical medicine and infectious disease Vol. 8; no. 5; pp. 1 - S1
• Main Authors: Paixão, Ariane Gomes, Almeida, Marcos Abreu, Correia, Roberta Espírito Santo, Kamiensky, Beatriz Brittes, Zancopé-Oliveira, Rosely Maria, Lazera, Márcia Dos Santos, Wanke, Bodo, Lamas, Cristiane da Cruz
• Format: Journal Article
• Language: English
• Published: Basel, Switzerland MDPI 10.05.2023; MDPI AG
• Subjects: AIDS; Anemia; Blood; Brazil; Care; Communicable diseases; Dehydrogenases; Development and progression; Disease; Drug therapy; Efavirenz; epidemiology; Fungal infections; Health aspects; Hemoglobin; Histopathology; Histoplasmosis; HIV; HIV (Viruses); HIV infections; HIV patients; HIV-positive; Human immunodeficiency virus; immunosuppression; Laboratories; Medical examination; Medical laboratories; Medical records; Medical research; Medicine, Experimental; Patients; Prevention; Risk factors; Statistical significance; Tuberculosis; Brazil; Rio de Janeiro Brazil; epidemiology; HIV-positive; culture; serology; Brazil; mortality; AIDS; immunosuppression; histoplasmosis
• ISSN: 2414-6366; 2414-6366
• DOI: 10.3390/tropicalmed8050271

Objectives: Histoplasmosis is a systemic mycosis, present globally. We aimed to describe cases of histoplasmosis (Hc) and to establish a risk profile associated with Hc in HIV-infected patients (HIV+). Methods: This was a retrospective study of patients with a clinical laboratory diagnosis of Hc. Data were fed into REDCap, and statistical analysis was performed with R. Results: We included 99 records, 65 HIV+ and 34 HIV+. Average age was 39 years. Median time from onset to diagnosis was 8 weeks in HIV+ and 22 weeks in HIV+. Disseminated histoplasmosis occurred in 79.4% of HIV+, vs. 36.4% of HIV+ patients. Median CD4 count was 70. Co-infection with tuberculosis was present in 20% of HIV+ patients. Blood cultures were positive in 32.3% of HIV+ vs. 11.8% of HIV+ ('p' = 0.025) patients; bone marrow culture was positive in 36.9% vs. 8.8% ('p' = 0.003). Most HIV+ patients (71.4%) were hospitalized. On univariate analysis, anemia, leukopenia, intensive care, use of vasopressors and mechanical ventilation were associated with death in HIV+ patients. Conclusions: Most of our patients with histoplasmosis were HIV+, presenting advanced AIDS. Diagnosis was late in HIV+ patients, and they frequently presented disseminated Hc, required hospitalization, and died. Early screening for Hc in HIV+ and drug-induced immunosuppressed patients is crucial.