Coinfecção tuberculose x histoplasmose, um recorte temporal de 5 anos em unidade de referência especializada em infectologia

Abstract

Introduction: Histoplasmosis, an endemic opportunistic disease caused by the fungus Histoplasma capsulatum, can affect individuals of both sexes and age groups. However, in Brazil its real prevalence rate is not well characterized. Immunosuppressed patients are at greater risk of severe disease and, as clinical manifestations are variable, it can mimic other diseases, particularly tuberculosis (TB), which makes diagnosis and initiation of treatment difficult. Objective: To evaluate the clinical-epidemiological and laboratory characteristics of histoplasmosis associated with tuberculosis that are neglected and emerging in the state of Goiás, diagnosed at the Dr. Anuar Auad State Hospital for Tropical Diseases (HDT), from 2017 to 2021. Methods: Treats This is an observational, retrospective study, with analysis of medical records of patients diagnosed with histoplasmosis associated with tuberculosis, analyzed according to age, gender, drug use, smoking, alcohol consumption, presence of co-infection with HIV, taking into account CD4 and initial viral load, comorbidities, initial symptoms, treatment and outcome. Results: Of the 32 patients analyzed with co-infection of histoplasmosis and tuberculosis, all were positive for HIV, with fever being the most common initial symptom. A predominance of males was observed, with an average age of 40.75 years and a median of 40 years. Regarding smoking and alcohol consumption, 6 patients were smokers and alcohol drinkers (31.25% (10). The use of illicit drugs was reported by 31.25% (10) of the patients included. Regarding CD4+ T numbers, the majority of patients had a value indicative of very serious immunosuppression, in addition to a very high viral load and the minority of patients used antiretroviral therapy regularly. In the treatment of histoplasmosis, the majority of patients were treated with amphotericin B, with the others being treated with combinations between itraconazole and liposomal amphotericin B and 25% (08) did not receive antifungal treatment. Regarding TB treatment, the majority (46.875%) underwent treatment with RIPE therapy (rifampicin, isoniazid, pyrazinamide and ethambutol) and 43.75% did not undergo treatment. Many patients presented comorbidities, the most frequent being oral and esophageal moniliasis. Regarding the outcome, 56.25% (18) were discharged, 40.63% (13) died and only one patient evaded treatment. Conclusion: Histoplasmosis is a neglected fungal infection, whose epidemiological data in the country are not reliable. This fact reinforces the need for prevention, rapid diagnosis and appropriate therapy, in addition to surveillance and more epidemiological studies to understand the real burden of this disease and its associated co-infections.​