Resumen Durante , en nuestro hospital fueron diagnosticados casos de histoplasmosis en pacientes con HIV/sida: 64 en , y en. Abstract. FERNANDEZ ANDREU, CARLOS MANUEL et al. Histoplasmosis diseminada progresiva en pacientes con SIDA. Rev Cubana Med Trop [online]. Download PDF. 1 / 4 Pages. Previous article. Go back to website. Next article.

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Skip to main content. Log In Sign Up. He presented with prolonged fever and cough, was diagnosed with hemophagocytic syndrome and multiple organ failure and died 18 days after admission. Histoplasma capsulatum was isolated post-mortem from bone marrow biopsy and blood culture.

In a literature review we found 22 published cases of disseminated histoplasmosis in patients with AIDS in Spain since All but two were men under 50 years old. Nineteen had been born or had lived in endemic areas. The uistoplasmosis of histoplasmosis was established by culture of bone marrow biopsy in 10 cases.

Itraconazole was introduced as a second drug after amphotericin B in ten of the thirteen patients who survived. Campanar 21, Valencia, Spain Te. This fungus has nema pallidum, Cryptococcus neoformans and Brucella been isolated from eiseminada containing bird and bat feces melitensis were also negative. It The bone marrow biopsy specimens demonstrated has been classified into three varieties, two of which are hemophagocytosis and, in one bone marrow sample, stai- pathogenic to humans: Having been Infection results from the inhalation of the fungal microco- diagnosed of hemophagocytic syndrome with multiple nidia.

The development hiistoplasmosis disease depends on the size of organ failure, the patient was admitted to the intensive care the inoculum and the immune status of the host. Around unit on day 13, where histoplawmosis died 5 days later. When left at room temperature, the yeasts HAART has reduced fiseminada number of infected patients, it turned into a white cottony mould.

Microscopic observa- remains a significant opportunistic infection in Central and tion of the septate fungi hyphae and tuberculate macroco- South America. The number of cases, both in endemic and nidia allowed the identification of Histoplasma capsula- in non-endemic areas, has grown since the first case tum. The diagnosis was then confirmed morphologically reports in the US around [28].

Microbiology Department, Rovira i Virgili University, Reactive hemophagocytic syndrome has multiple Reus and by PCR assay of three serum samples Mico- etiologies infectious, malignant or autoimmune and is, diseminaad logy Department, National Microbiology Laboratory, Ma- many cases, associated with organ failure [30].

It has also jadahonda.

In a We present a new case of disseminated histoplas- review of the literature using Medline and Google websi- mosis with reactive hemophagocytosis in an immigrant tes, we found 22 reported cases of this disease in patients patient from Ecuador infected by HIV and a review of the infected with HIV in our country since [, Spanish literature. The characteristics of these cases, together with those of the current patient, are pre- sented in table 1.

Case report A year-old man was admitted to our hospital in Discussion February for evaluation of a 2-week intermittent fever. Born in Ecuador, he had been living in Spain for Infection with H. He was heterosexual and was employed as a truck caves and old buildings with guano [17]. In November fungus [38].

Other possible methods of transmission thathe presented at our hospital with fever and hae- have been proposed are through inhalation of contamina- moptysis and was diagnosed of microbiologically proven ted cocaine from South America [5], parenteral transmis- disseminated tuberculosis TB and AIDS, starting anti-TB sion after organ transplantation [20] or by sharing needles therapy and prophylaxis with co-trimoxazol.


He had an with an infected patient [35]. In the series revie- intermittent haemoptysis, but no chest pain, dyspnea, diar- wed, all patients but two were men under 50 years old, and rhea or weight loss. Findings on a physical examination only one case corresponded to disemiada infant.

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The occupational exposure risk rent response. One of them had inhaled cocaine. Chest radio- In patients with disseminated histoplasmosis, fever graphy was normal, but chest computed tomography sho- is the most common symptom.

They may present with dieeminada extensive paratracheal, periaortic and histoplassmosis weight loss, anorexia, cough, nausea, vomiting, diarrhea adenopathy. Bacterial and mycobacterial smears and cultu- and abdominal pain. Shared needles with him. Died of disseminated histoplasmosis. Clinically, histoplasmosis can mimic of the skin lesions, bronchoalveolar lavage, bone marrow TB [19], as was appreciated in our patient when he presen- or blood.

The 4-week incubation period required for culture is plasm, in a histoplasmsis with symptoms compatible with TB not practical in severe cases, so other diagnostic techni- that does not respond to correct anti-TB treatment. Furthermore, skin tests histoplasmosia not use- Chest radiography findings may be normal or show ful; fungal staining of tissue or blood has lower sensitivity a diffuse nodular infiltrate or cavitary lesions [14].

Labo- than culture, and serum antibody tests can yield false-posi- ratory evaluation may reveal abnormal liver function test tive and false-negative results.

Histoplasmosis diseminada e infección por VIH: serie de casos en un hospital peruano

The detection of antigen in results and pancytopenia due to involvement of the liver urine sample is rapid, sensitive and can be useful in moni- and bone marrow. Reactive hemophagocytic syndrome in toring therapy, but should be confirmed with other serolo- patients with severe forms of histoplasmosis has also been gic and culture data [17]. Even though no PCR assay for described, and the presence of fever and cytopenia in routine use is commercially available, real-time and semi- patients with AIDS can be a clue to its diagnosis [18].

He- nested PCR assays have adequately identified H. A new real-time PCR-based as a result of multiple etiologies viral, bacterial, parasitic, assay which detects up to 1 fg of H. In some serumhas recently been described [6]. These findings areas of South America, disseminated histoplasmosis is demonstrate that PCR techniques could be useful as rapid the most frequent opportunistic infection in severely diagnostic and confirmation methods.

In the series revie- immunosuppressed HIV infected patients with fever and wed, the diagnosis was established mainly by culture of cytopenia [24]. Hemophagocytosis in these patients is fre- bone marrow biopsy 11 casesskin lesions 7 casesquent, although not specific of diagnosis, and disseminated blood culture 5 cases and respiratory specimens 4 cases. To our knowledge, of the patient in six cases, with the disease not being sus- the case we report is the first case of hemophagocytosis in pected while the patients were alive.

Both patients died in a short period of time disease is often fatal if untreated [17]. Intravenous ampho- after admission to the hospital. However, it should not be disregarded in of treatment depends on the severity of the disease and intravenous drug users or patients with tuberculosis-like the immune status of the patient.


Patients with AIDS and symptoms who do not respond to anti-TB therapy, inde- disseminated disease typically need 12 months of initial pendently of travel history. In HIV positive patients with therapy followed by lifelong maintenance using itraco- low CD4 lymphocyte count and fever, any new or unspe- nazole therapy to prevent relapse, although some studies cific skin lesion, bone marrow biopsy and blood samples suggest that it is possible to interrupt secondary prophyla- should be cultured since this procedure can lead to the xis when the patient has responded to HAART, is clini- diagnosis of the disease.

Other treatment options in- mation methods. Since the diagnosis of the disease can be clude fluconazole as a second-line antifungal in patients delayed, antifungal therapy should be initiated as soon as who are intolerant to both itraconazole and amphotericin B, possible in these patients.

Disseminated histoplasmosis and posaconazole, which has proven to be effective for pa- should be included in the causes of pancytopenia in tients in whom therapy with amphotericin B, fluconazole patients with AIDS, where the presence of hemophagocy- or itraconazole has failed [39]. In the series reviewed, the tosis correlates with poor prognosis.

The clinical situation of the patient allowed the introduction of a second drug in eleven of the thirteen patients that survi- Agradecemos a J. Gene Microbiology Department, ved. Cuenca-Estrella treated surgically by resection of the small bowel and had Micology Department, National Microbiology then received itraconazole. Of the 5 patients whose CD4 Laboratory y a M. Montagud Hematology lymphocyte count is unknown, only the three who were Department, Vinaroz Hospital treated survived, one of them having received itraconazole therapy alone.

This data shows the importance of starting therapy with amphotericin B as soon as possible and then continuing with itraconazole, since all the patients who did not receive any antifungal therapy, or were treated with amphotericin B alone, died.

Histoplasmosis diseminada by Laura Marcela Aguirre on Prezi

Moreover, all those who recei- ved itraconazole survived and did not present relapse in at least 6 months of secondary prophylaxis. The mortality observed in the series reviewed was Pasternak J, Bolivar R. Arch Intern Med ; Owens S, Aberg JA. Acquired inmunodeficiency patients in Spain.

Eur J Clin Microbiol immunologic response to antiretroviral syndrome and disseminated Infect Dis ; Clin Infect Dis ; J Infec ; Mayo Clin Proc ; B for induction therapy of histoplasmosis Med Clin Bar ; Ann Med ; Histoplasmosis diseminada en pacientes con SIDA. Enferm Infecc Reactive hemophagocytic syndrome: Microbiol Clin ; Successful discontinuation of Clin ; Diag Cytopathol ; Transmission of Histoplasma capsulatum by organ transplantation.

New Eng J Med Rev Clin Esp comunicacion. Linfadenitis cervical, pancitopenia y fiebre en paciente con Study of Yebra-Bango M. Enferm Infecc Microbiol Clin ; Rev Clin Esp ; Hemophagocytic syndrome associated Registro Nacional de casos de Dolor abdominal en paciente con with histoplasmosis in the acquired immunodeficiency syndrome: Rev Esp Enferm Dig Available from the URL: Sangre Barc ; Identification of Histoplasma capsulatum Israel KS.

Disseminated histoplasmosis in bacteriemia caused by Mycobacterium the acquired immunodeficiency avium intracellulare.