Clinical and Laboratory Profile of Persons Living with Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome and Histoplasmosis from a Colombian Hospital
| Autor: | Angela A. Cleveland, Beatriz L. Gómez, Ángela M. Tobón, Mary E. Brandt, Angela Restrepo, Dedsy Y. Berbesi, Diego H. Cáceres, Christina M. Scheel, Jesús Ochoa, Tom Chiller |
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| Rok vydání: | 2016 |
| Předmět: |
Male
0301 basic medicine Constitutional symptoms Hepatosplenomegaly Lymphadenopathy HIV Infections Gastroenterology 0302 clinical medicine Weight loss Medicine Sida Histoplasmosis biology SIDA Coinfection Liver enzyme Headache Alanine Transaminase Nausea Progressive disseminated histoplasmosis Articles Infectious Diseases Acquired immune deficiency syndrome Female medicine.symptom Hepatomegaly Adult Diarrhea medicine.medical_specialty Tuberculosis Vomiting 030106 microbiology 030231 tropical medicine Colombia Aspartate aminotransferase 03 medical and health sciences Virology Internal medicine Skin Ulcer Weight Loss Humans Aspartate Aminotransferases Karnofsky Performance Status Acquired Immunodeficiency Syndrome business.industry VIH Leukopenia medicine.disease biology.organism_classification Enfermedades Thrombocytopenia Abdominal Pain Dyspnea Cough Splenomegaly Immunology Alanine aminotransferase Parasitology business |
| Zdroj: | Repositorio EdocUR-U. Rosario Universidad del Rosario instacron:Universidad del Rosario |
| ISSN: | 1476-1645 0002-9637 |
| DOI: | 10.4269/ajtmh.15-0837 |
| Popis: | Histoplasmosis is common among persons living with human immunodeficiency virus/acquired immune deficiency syndrome (PLWHA) in Latin America, but its diagnosis is difficult and often nonspecific. We conducted prospective screening for histoplasmosis among PLWHA with signs or symptoms suggesting progressive disseminated histoplasmosis (PDH) and hospitalized in Hospital La María in Medellín, Colombia. The study's aim was to obtain a clinical and laboratory profile of PLWHA with PDH. During 3 years (May 2008 to August 2011), we identified 89 PLWHA hospitalized with symptoms suggestive of PDH, of whom 45 (51%) had histoplasmosis. We observed tuberculosis (TB) coinfection in a large proportion of patients with PDH (35%), so all analyses were performed adjusting for this coinfection and, alternatively, excluding histoplasmosis patients with TB. Results showed that the patients with PDH were more likely to have Karnofsky score ≤ 30 (prevalence ratio [PR] = 1.98, 95% confidence interval [CI] = 0.97-4.06), liver compromised with hepatomegaly and/or splenomegaly (PR = 1.77, CI = 1.03-3.06) and elevation in serum of alanine aminotransferase and aspartate aminotransferase to values > 40 mU/mL (PR = 2.06, CI = 1.09-3.88 and PR = 1.53, CI = 0.99-2.35, respectively). Using multiple correspondence analyses, we identified in patients with PDH a profile characterized by the presence of constitutional symptoms, namely weight loss and Karnofsky classification ≤ 30, gastrointestinal manifestations with alteration of liver enzymes and hepatosplenomegaly and/or splenomegaly, skin lesions, and hematological alterations. Study of the profiles is no substitute for laboratory diagnostics, but identifying clinical and laboratory indicators of PLWHAwith PDH should allow development of strategies for reducing the time to diagnosis and thus mortality caused by Histoplasma capsulatum. Copyright © 2016 by The American Society of Tropical Medicine and Hygiene. |
| Databáze: | OpenAIRE |
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