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Clinical outcomes and risk factors for death from disseminated histoplasmosis in patients with AIDS who visited a high-complexity hospital in Campo Grande, MS, Brazil.

Abstract Disseminated histoplasmosis (DH) is a systemic mycosis caused by Histoplasma capsulatum (H. capsulatum) and is characterized by progressive and fatal evolution in immunocompromised patients. Moreover, it is considered an AIDS-defining disease.
PMID
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Authors

Mayor MeshTerms
Keywords
Journal Title revista da sociedade brasileira de medicina tropical
Publication Year Start




PMID- 29768547
OWN - NLM
STAT- MEDLINE
DCOM- 20180524
LR  - 20180524
IS  - 1678-9849 (Electronic)
IS  - 0037-8682 (Linking)
VI  - 51
IP  - 2
DP  - 2018 Mar-Apr
TI  - Clinical outcomes and risk factors for death from disseminated histoplasmosis in 
      patients with AIDS who visited a high-complexity hospital in Campo Grande, MS,
      Brazil.
PG  - 155-161
LID - S0037-86822018000200155 [pii]
LID - 10.1590/0037-8682-0369-2017 [doi]
AB  - INTRODUCTION: Disseminated histoplasmosis (DH) is a systemic mycosis caused by
      Histoplasma capsulatum (H. capsulatum) and is characterized by progressive and
      fatal evolution in immunocompromised patients. Moreover, it is considered an
      AIDS-defining disease. METHODS: We performed an observational, analytical,
      retrospective study to identify the clinical outcomes and risk factors for death 
      from DH in patients with AIDS at an infectious diseases service facility in
      Brazil between September 2011 and July 2016. Patients with a positive serology
      for HIV and DH were diagnosed via direct examination and/or positive cultures for
      H. capsulatum. RESULTS: Twenty-three patients were included in this study.
      Approximately, 82.6% were men, with a mean age of 41.0+/-11.5 years, and 52.2%
      had a concomitant diagnosis of AIDS and DH. The median CD4+ T cell count was 19
      cells/mm3, and 56.5% of the patients died. The most frequently observed symptoms 
      were fever, dyspnea, and skin lesions. On the basis of a comparative analysis of 
      those who died and survived, the absence of splenomegaly and hepatomegaly and the
      presence of H. capsulatum in the peripheral blood were considered as risk factors
      for death. Those who died had a higher leukocyte count; CRP, urea, and lactate
      dehydrogenase levels; AST index; and international normalized ratio prothrombin
      time. The serum total protein and albumin levels of the patients were lower.
      CONCLUSIONS: The mortality rate for DH is high among severely immunocompromised
      patients with AIDS. The risk factors for death were those traditionally
      associated with blood dyscrasia, inflammatory activity, as well as increased
      renal and nutritional impairment.
FAU - Boigues, Barbara Cristina Scarcelli
AU  - Boigues BCS
AD  - Divisao de Doencas Infecciosas, Universidade Federal de Mato Grosso do Sul, Campo
      Grande, MS, Brasil.
FAU - Paniago, Anamaria Mello Miranda
AU  - Paniago AMM
AD  - Divisao de Doencas Infecciosas, Universidade Federal de Mato Grosso do Sul, Campo
      Grande, MS, Brasil.
FAU - Lima, Glaucia Moreira Espindola
AU  - Lima GME
AD  - Laboratorio de Micologia Medica, Universidade Federal de Mato Grosso do Sul,
      Campo Grande, MS, Brasil.
FAU - Nunes, Maina de Oliveira
AU  - Nunes MO
AD  - Laboratorio de Micologia Medica, Universidade Federal de Mato Grosso do Sul,
      Campo Grande, MS, Brasil.
FAU - Uehara, Silvia Naomi de Oliveira
AU  - Uehara SNO
AD  - Divisao de Doencas Infecciosas, Universidade Federal de Mato Grosso do Sul, Campo
      Grande, MS, Brasil.
LA  - eng
PT  - Journal Article
PT  - Observational Study
PL  - Brazil
TA  - Rev Soc Bras Med Trop
JT  - Revista da Sociedade Brasileira de Medicina Tropical
JID - 7507456
SB  - IM
MH  - AIDS-Related Opportunistic Infections/*mortality
MH  - Adult
MH  - Brazil/epidemiology
MH  - Female
MH  - Histoplasmosis/*mortality
MH  - Humans
MH  - Immunocompromised Host
MH  - Male
MH  - Retrospective Studies
MH  - Risk Factors
EDAT- 2018/05/17 06:00
MHDA- 2018/05/25 06:00
CRDT- 2018/05/17 06:00
PHST- 2017/10/11 00:00 [received]
PHST- 2018/03/20 00:00 [accepted]
PHST- 2018/05/17 06:00 [entrez]
PHST- 2018/05/17 06:00 [pubmed]
PHST- 2018/05/25 06:00 [medline]
AID - S0037-86822018000200155 [pii]
AID - 10.1590/0037-8682-0369-2017 [doi]
PST - ppublish
SO  - Rev Soc Bras Med Trop. 2018 Mar-Apr;51(2):155-161. doi:
      10.1590/0037-8682-0369-2017.