Doença fúngica negligenciada: história da histoplasmose em unidade de referência em infectologia do estado de Goiás, um recorte de 2017 a 2022

Abstract

OBJECTIVE: To evaluate clinical, epidemiological and laboratory characteristcs of histoplasmosis in State of Goiás, diagnosed at the Hospital Estadual de Doençãs Tropicais Dr. Anuar Auad (HDT), from 2018 to 2022.

METHODS: This is an retrospective epidemiological study based on medical records. The collection systems used were the Soul MV, the Gerenciamento de Ambiente Laboratorial (GAL) and the Laboratory Test Control System of the National Network for CD4+/CD8+ Lymphocyte Counting and HIV Viral Load (SISCEL), tabled in a Microsoft Excel® platform. Data from the medical records were collected in compliance with the Research Ethics Committee of the Hospital Estadual de Doençãs Tropicais Dr. Anuar Auad, according to CAAE 09015419.2.2005.0034 and 56007216.9.2009.0034.

RESULTS: During the study period, 107 patients were analyzed. Two cases were excluded due to lack of relevant information in the medical records and negative laboratory results. Thus, 92.5% of the sample (99) had disseminated Histoplasmosis, of which 0.95% (1) was HIV negative. 69.8% (74 cases) of patients were diagnosed with HIV during the Histoplasmosis approach, while 28.3% (30 cases) had a previous diagnosis of HIV and 1.9% (1 case) was HIV negative. Among the positives, in the diagnosis of Histoplasmosis, the average number of CD4+ T lymphocytes was 33.42 cells/𝜇�L and the viral load was 971434.42 copies/mL. In that study, 55.3% (57) were not using any antiretroviral therapy (ART), 30.1% (31) had abandoned treatment, and 14.6% (15) had been on regular treatment for more than 90 days at the time of the diagnosis. For diagnosis, 102 patients underwent blood cultures, with 85 positive results. Of those who did not undergo a blood culture, the diagnosis was given by serology or lesion culture. The antigenuria test was performed in 14 patients, with diagnostic confirmation in 13 patients. 38 patients had some coinfection or opportunistic disease (OD), with emphasis on Cytomegalovirus (28.9%), Non-Tuberculous Mycobacteria (26.3%), Candida sp. (21%) and Mycobacterium tuberculosis (18.4%). For treatment, the most used combination was Amphotericin B Desoxycholate with Itraconazole, 22 patients (20,9%), with an average duration of 198 days of treatment. In addition to this combination, the most used isolated form was Amphotericin B Desoxycholate, 24 patients (22,8%), with an average duration of 12 days. Of the total, 19% (20) patients did not use any antifungal therapy. The total number of patients who died was 32.4% (34), with an average time between admission and death of 52 days. These patients had a mean age of 45 ± 12.5 years. Of the patients who died, 58.8% (20) had their diagnosis defined after death.

CONCLUSION: The study showed that Histoplasmosis behaves like a OD that is linked to immunosuppression, with results of an intense relationship with HIV, even with a synchronous diagnosis at admission. It is possible to understand that there is an important worsening of AIDS in Brazil with Histoplasmosis as the DO. Thus, epidemiological studies are important to show the reality that the country faces and the dichotomy of health services provided in Brazil.