title: Disseminated histoplasmosis and aids: relapse and late mortality in endemic area in North-Eastern Brazil.
abstract: The State of Ceará in north-eastern Brazil has one of the highest rates in the world of relapse and death due to disseminated histoplasmosis (DH) in acquired immunodeficiency syndrome (AIDS) patients. The objective of this study is to characterise the relapse and mortality of DH in AIDS cases residents in Ceará. We performed a retrospective analysis of the medical records of AIDS patients who had a first episode of DH from 2002 to 2008. We analysed the outcomes until December 31, 2010. A total of 145 patients participated in the study. The mean clinical follow-up duration was 3.38 years (SD = 2.2; 95% CI = 3.01-3.75). The majority of the subjects were male with a mean age of 35 years (SD = 2.2; 95% CI = 3.01-3.75) and were born in the capital of Ceará. DH was the first manifestation of AIDS in 59% of the patients. The relapse rate was 23.3%, with a disseminated presentation in 90% of these patients. The overall mortality during the study period was 30.2%. The majority of patients who relapsed or died had irregular treatment with antifungals or highly active antiretroviral therapy and did not have active clinical follow-up. High rates of recurrence and mortality were found in AIDS-associated DH in this area of the country.
authors.affiliation: Department of Community Health, School of Medicine, Federal University of Ceará, Fortaleza, CE, Brazil. lisandraserra@yahoo.com.br
authors.forename: Lisandra Serra
authors.initials: LS
authors.lastname: Dasmasceno
authors.forename: Alberto Ramos
authors.initials: AR
authors.lastname: Novaes
authors.forename: Carlos Henrique Morais
authors.initials: CH
authors.lastname: Alencar
authors.forename: Daniel Teixeira
authors.initials: DT
authors.lastname: Lima
authors.forename: José Júlio Costa
authors.initials: JJ
authors.lastname: Sidrim
authors.forename: Maria Vânia Freitas
authors.initials: MV
authors.lastname: Gonçalves
authors.forename: Jacó Ricarte Lima
authors.initials: JR
authors.lastname: de Mesquita
authors.forename: Terezinha do Menino Jesus Silva
authors.initials: Tdo M
authors.lastname: Leitão
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000150:complications; D000328:Adult; D001938:Brazil / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006660:Histoplasmosis / Q000453:epidemiology* / Q000401:mortality*; D006801:Humans; D008297:Male; D012008:Recurrence; D012189:Retrospective Studies; D016019:Survival Analysis
keywords: AIDS; disseminated histoplasmosis; mortality; mycoses