Histoplasmosis in HIV-positive patients in Ceará, Brazil: clinical-laboratory aspects and in vitro antifungal susceptibility of Histoplasma capsulatum isolates.
This study contains a descriptive analysis of histoplasmosis in AIDS patients between 2006 and 2010 in the state of Ceará, Brazil. Additionally, the in vitro susceptibility of Histoplasma capsulatum isolates obtained during this period was assessed. We report 208 cases of patients with histoplasmosis and AIDS, describing the epidemiological, clinical, laboratory and therapeutic aspects. The in vitro antifungal susceptibility test was carried out by the microdilution method, according to Clinical and Laboratory Standards Institute, with H. capsulatum in the filamentous and yeast phases, against the antifungals amphotericin B, fluconazole, itraconazole, voriconazole and caspofungin. In 38.9% of the cases, histoplasmosis was the first indicator of AIDS and in 85.8% of the patients the CD4 cell count was lower than 100 cells/mm(3). The lactate dehydrogenase levels were high in all the patients evaluated, with impairment of hepatic and renal function and evolution to death in 42.3% of the cases. The in vitro susceptibility profile demonstrated there was no antifungal resistance among the isolates evaluated. There was a significant increase in the number of histoplasmosis cases in HIV-positive patients during the period surveyed in the state of Ceará, northeastern Brazil, but no antifungal resistance among the recovered isolates of H. capsulatum.
Specialized Medical Mycology Center, Federal University of Ceará, Fortaleza, Ceará, Brazil. brilhante@ufc.br
Raimunda S N
RS
Brilhante
Maria A B
MA
Fechine
Jacó R L
JR
Mesquita
Rossana A
RA
Cordeiro
Marcos F G
MF
Rocha
André J
AJ
Monteiro
Rita A C
RA
Lima
Érica P
ÉP
Caetano
Juliana F
JF
Pereira
Débora S C M
DS
Castelo-Branco
Zoilo P
ZP
Camargo
José J C
JJ
Sidrim
D017088:AIDS-Related Opportunistic Infections / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology*; D000328:Adult; D000666:Amphotericin B / Q000627:therapeutic use; D000935:Antifungal Agents / Q000627:therapeutic use*; D001938:Brazil / Q000453:epidemiology; D018791:CD4 Lymphocyte Count; D000077336:Caspofungin; D054714:Echinocandins / Q000627:therapeutic use; D005260:Female; D015725:Fluconazole / Q000627:therapeutic use; D006658:Histoplasma / Q000302:isolation & purification / Q000472:pathogenicity*; D006660:Histoplasmosis / Q000175:diagnosis* / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology; D006801:Humans; D017964:Itraconazole / Q000627:therapeutic use; D007770:L-Lactate Dehydrogenase / Q000097:blood*; D055666:Lipopeptides; D008297:Male; D008826:Microbial Sensitivity Tests; D011743:Pyrimidines / Q000627:therapeutic use; D014230:Triazoles / Q000627:therapeutic use; D065819:Voriconazole
D000935:Antifungal Agents; D054714:Echinocandins; D055666:Lipopeptides; D011743:Pyrimidines; D014230:Triazoles; D017964:Itraconazole; D000666:Amphotericin B; D015725:Fluconazole; D007770:L-Lactate Dehydrogenase; D000077336:Caspofungin; D065819:Voriconazole