Histoplasmosis diseminada y síndrome hemofagocítico en pacientes VIH: serie de casos en un hospital peruano

Juan José Montenegro-Idrogo, Alfredo Chiappe-Gonzalez, Renzo Vargas-Gonzales, Jorge Arévalo, Marcos Angel Ñavincopa Flores, Eduardo Ticona

Resultado de la investigación: Contribución a una revistaArtículorevisión exhaustiva

Resumen

Background: Disseminated histoplasmosis (DH) is an opportunistic fungal infection in severely immunocompromised patients with HIV infection. Haemophagocytic syndrome (HFS), which can occur in these co-infected patients when the immune response is significantly altered, is often associated with high mortality. Aims: To describe the epidemiological, clinical, analytical and microbiological characteristics, along with studying the presence of HFS, in patients with DH-HIV. Methods: A retrospective study was conducted on a case series using data from the clinical records of patients diagnosed with DH and HIV infection during the years 2014 and 2015. Results: DH was diagnosed in 8 (1.3%) of 597 HIV patients. All patients were in stage C3, and 75% (6/8) were not receiving combined antiretroviral therapy (CART). The remaining two patients had recently begun CART (possible immune reconstitution syndrome). Five (62.5%) of the 8 patients met criteria for HFS. The most frequent clinical symptoms were lymphoproliferative and consumptive syndrome, respiratory compromise, and cytopenia. Histoplasma was isolated in lymph nodes of 75% (6/8) of the patients, in blood samples in 25% (2/8), and also in intestinal tissue in one patient. The antifungal therapy was amphotericin B deoxycholate, without adjuvants. The overall mortality was 50%. Conclusions: In this case series, DH-HIV co-infection frequently progressed to HFS with high mortality. The clinical picture may resemble that of other systemic opportunistic infections, such as tuberculosis, or can take place simultaneously with other infections. Clinical suspicion is important in patients with severe cytopenia and lymphoproliferative and consumptive syndrome in order to establish an early diagnosis and prescribing a timely specific therapy.

Título traducido de la contribuciónDisseminated histoplasmosis and haemophagocytic syndrome in HIV patients: A case series in a Peruvian hospital
Idioma originalEspañol
Páginas (desde-hasta)28-33
Número de páginas6
PublicaciónRevista Iberoamericana de Micologia
Volumen37
N.º1
DOI
EstadoPublicada - 1 ene 2020

Nota bibliográfica

Publisher Copyright:
© 2019 Asociación Española de Micología

Palabras clave

  • Aids
  • Disseminated histoplasmosis
  • HIV
  • Haemophagocytic lymphohistiocytosis
  • Haemophagocytic syndrome

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