Central Nervous System Histoplasmosis in HIV/AIDS Patients in Endemic Region of Brazil

Abstract

Introduction: Histoplasmosis is a fungal disease, caused by Histoplasma capsulatum. Goal: To report 13 cases of Central nervous system of histoplasmosis in a endemic region in Brazil. Case report: Of the 13 patients included, only 1 was on regular ART on admission. The viral load was detected at high values in 9 of the 10 patients who had the viral load recorded, with an average of 419,168 copies/ml. The 11 patients who had CD4 available had values below 150 cells/mm³ with a mean of 47.6 cells/mm³. No patient was treated according to the standard recommended by the IDSA, which recommends the use of AMB-L 5mg/kg (max 175mg/day) for 4-6 weeks, followed by the use of itraconazole 200mg 12h/12 for 1 year. Of the patients included, 8 (62%) evolved with death and the other 5 (38%) evolved with discharge. Discussion: CNS histoplasmosis is an entity that constitutes a real diagnostic challenge, especially in the context of local laboratory limitations. Since we are dealing with an endemic pathogen in our region it seems certain that we are underdiagnosing one of the most lethal forms of histoplasmosis. In this context, routine cerebrospinal fluid collection in cases of disseminated histoplasmosis becomes essential. In addition, fight for the acquisition of new diagnostic tools. In the same vein, there is a need to make accessible the AMB-L to our AIDS patients. Restricting access to it implies considerably reducing the chances of cure and survival. It is necessary to fight for better knowledge, diagnosis and treatment of known neglected diseases.