title: Oropharyngeal histoplasmosis: report of eleven cases and review of the literature.
abstract: BACKGROUND
  Histoplasmosis is a systemic mycosis endemic in Brazil, especially in the State of Rio Grande do Sul, where Histoplasma capsulatum was isolated from the soil. H. capsulatum may compromise unusual areas, including the oropharynx, particularly in patients presenting disseminated histoplasmosis; which is associated with a state of immunosuppression, such as AIDS.
  
  
  METHODS
  During database analysis of a total of 265 cases of histoplasmosis, the medical records of 11 patients with histological or microbiological diagnoses of oral histoplasmosis (OH) between 1987 and 2008 were retrospectively reviewed.
  
  
  RESULTS
  This work reports 11 cases of OH, the majority presenting histopathological or microbiological evidence of disseminated histoplasmosis (DH). In the patients with DH, OH was the first manifestation of histoplasmosis. Five of the 11 patients discussed were HIV-seropositive with clinical and laboratory findings of AIDS. Four patients presented active pulmonary tuberculosis concomitant with histoplasmosis. Treatment was based on the use of itraconazole and amphotericin B deoxycholate. Eight patients responded successfully to therapy after one year, two did not come back for reevaluation and one died despite adequate therapy.
  
  
  CONCLUSIONS
  Oral histoplasmosis is closely associated with immunosuppression status, especially in patients presenting AIDS; moreover, in many cases, OH is the first sign of disseminated histoplasmosis.
authors.affiliation: Department of Infectious Diseases, Hospital Nossa Senhora da Conceição, Porto Alegre, RS, Brazil. vicente_antonello@hotmail.com
authors.forename: Vicente Sperb
authors.initials: VS
authors.lastname: Antonello
authors.forename: Vanice Ferrazza
authors.initials: VF
authors.lastname: Zaltron
authors.forename: Marcela
authors.initials: M
authors.lastname: Vial
authors.forename: Flávio Mattos de
authors.initials: FM
authors.lastname: Oliveira
authors.forename: Luiz Carlos
authors.initials: LC
authors.lastname: Severo
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D000328:Adult; D000368:Aged; D000666:Amphotericin B / Q000627:therapeutic use; D000935:Antifungal Agents / Q000627:therapeutic use; D003840:Deoxycholic Acid / Q000627:therapeutic use; D004338:Drug Combinations; D005260:Female; D006660:Histoplasmosis / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D006801:Humans; D017964:Itraconazole / Q000627:therapeutic use; D007654:Ketoconazole / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009960:Oropharynx / Q000382:microbiology*; D010608:Pharyngeal Diseases / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D000935:Antifungal Agents; D004338:Drug Combinations; D003840:Deoxycholic Acid; D017964:Itraconazole; D000666:Amphotericin B; C059765:amphotericin B, deoxycholate drug combination; D007654:Ketoconazole