Predictive factors for disseminated histoplasmosis in AIDS patients with fever admitted to a reference hospital in Brazil
Abstract INTRODUCTION: In many settings, the lack of sensitive biomarkers of disseminated histoplasmosis (DH) leads to a clinical reliance on older diagnostic methods and delayed treatment initiation. The early recognition of DH is critical for survival, especially in patients with human immunodefic...
Published in: | Revista da Sociedade Brasileira de Medicina Tropical |
---|---|
Main Authors: | , , , , , , , |
Format: | Article in Journal/Newspaper |
Language: | English |
Published: |
Sociedade Brasileira de Medicina Tropical (SBMT)
|
Subjects: | |
Online Access: | https://doi.org/10.1590/0037-8682-0425-2017 https://doaj.org/article/19065780b5364991bfee3384738eeb9e |
id |
ftdoajarticles:oai:doaj.org/article:19065780b5364991bfee3384738eeb9e |
---|---|
record_format |
openpolar |
spelling |
ftdoajarticles:oai:doaj.org/article:19065780b5364991bfee3384738eeb9e 2023-05-15T15:12:18+02:00 Predictive factors for disseminated histoplasmosis in AIDS patients with fever admitted to a reference hospital in Brazil Isadora Cavalcanti Ramos Yuri Coelho Soares Lisandra Serra Damasceno Mariana Pitombeira Libório Luís Arthur Brasil Gadelha Farias Jorg Heukelbach Carlos Henrique Morais de Alencar Terezinha do Menino Jesus Silva Leitão https://doi.org/10.1590/0037-8682-0425-2017 https://doaj.org/article/19065780b5364991bfee3384738eeb9e EN eng Sociedade Brasileira de Medicina Tropical (SBMT) http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0037-86822018000400479&lng=en&tlng=en https://doaj.org/toc/1678-9849 1678-9849 doi:10.1590/0037-8682-0425-2017 https://doaj.org/article/19065780b5364991bfee3384738eeb9e Revista da Sociedade Brasileira de Medicina Tropical, Vol 51, Iss 4, Pp 479-484 Histoplasma Diagnosis AIDS HIV Arctic medicine. Tropical medicine RC955-962 article ftdoajarticles https://doi.org/10.1590/0037-8682-0425-2017 2022-12-31T02:57:25Z Abstract INTRODUCTION: In many settings, the lack of sensitive biomarkers of disseminated histoplasmosis (DH) leads to a clinical reliance on older diagnostic methods and delayed treatment initiation. The early recognition of DH is critical for survival, especially in patients with human immunodeficiency virus (HIV). This study aimed to identify clinical and laboratory findings associated with the definitive diagnosis of DH in low-income HIV patients in endemic areas. METHODS: Febrile AIDS patients with suspected DH who were admitted to a reference hospital in northeastern Brazil from January 2006 to January 2007 were evaluated for clinical and laboratory findings associated with DH diagnosis. RESULTS: One hundred seventeen patients with fever were included, and 48 (41%) cases of DH were determined by Histoplasma capsulatum identification. A higher fever (≥38.5ºC), maculopapular/papular rash, splenomegaly, hepatomegaly, wheezing, hemoglobin ≤9.5g/dL, platelets ≤80,000/µL, CD4 count ≤75/µL, aspartate aminotransferase (AST) level ≥2.5 times the upper limit of normal (ULN), lactate dehydrogenase (LDH) ≥5times the ULN; and international normalized ratio (INR) >2 times the ULN were significantly associated with DH. A multivariable analysis identified hepatomegaly [adjusted (a) prevalence ratio (PR)= 1.96; 95% confidence interval (CI): 1.21-3.16), CD4 count ≤75/µL (aPR = 2.02; 95% CI: 1.06-3.83), LDH ≥5 times the ULN (aPR = 2.23; 95% CI: 1.44-3.48), and maculopapular/papular rash (aPR = 1.70; 95% CI: 1.02-2.83) were independent risk factors for DH. CONCLUSIONS: These easily assessed parameters can facilitate clinical decision-making for febrile AIDS patients with suspected DH in low socioeconomic and Histoplasma-endemic regions. Article in Journal/Newspaper Arctic Directory of Open Access Journals: DOAJ Articles Arctic Revista da Sociedade Brasileira de Medicina Tropical 51 4 479 484 |
institution |
Open Polar |
collection |
Directory of Open Access Journals: DOAJ Articles |
op_collection_id |
ftdoajarticles |
language |
English |
topic |
Histoplasma Diagnosis AIDS HIV Arctic medicine. Tropical medicine RC955-962 |
spellingShingle |
Histoplasma Diagnosis AIDS HIV Arctic medicine. Tropical medicine RC955-962 Isadora Cavalcanti Ramos Yuri Coelho Soares Lisandra Serra Damasceno Mariana Pitombeira Libório Luís Arthur Brasil Gadelha Farias Jorg Heukelbach Carlos Henrique Morais de Alencar Terezinha do Menino Jesus Silva Leitão Predictive factors for disseminated histoplasmosis in AIDS patients with fever admitted to a reference hospital in Brazil |
topic_facet |
Histoplasma Diagnosis AIDS HIV Arctic medicine. Tropical medicine RC955-962 |
description |
Abstract INTRODUCTION: In many settings, the lack of sensitive biomarkers of disseminated histoplasmosis (DH) leads to a clinical reliance on older diagnostic methods and delayed treatment initiation. The early recognition of DH is critical for survival, especially in patients with human immunodeficiency virus (HIV). This study aimed to identify clinical and laboratory findings associated with the definitive diagnosis of DH in low-income HIV patients in endemic areas. METHODS: Febrile AIDS patients with suspected DH who were admitted to a reference hospital in northeastern Brazil from January 2006 to January 2007 were evaluated for clinical and laboratory findings associated with DH diagnosis. RESULTS: One hundred seventeen patients with fever were included, and 48 (41%) cases of DH were determined by Histoplasma capsulatum identification. A higher fever (≥38.5ºC), maculopapular/papular rash, splenomegaly, hepatomegaly, wheezing, hemoglobin ≤9.5g/dL, platelets ≤80,000/µL, CD4 count ≤75/µL, aspartate aminotransferase (AST) level ≥2.5 times the upper limit of normal (ULN), lactate dehydrogenase (LDH) ≥5times the ULN; and international normalized ratio (INR) >2 times the ULN were significantly associated with DH. A multivariable analysis identified hepatomegaly [adjusted (a) prevalence ratio (PR)= 1.96; 95% confidence interval (CI): 1.21-3.16), CD4 count ≤75/µL (aPR = 2.02; 95% CI: 1.06-3.83), LDH ≥5 times the ULN (aPR = 2.23; 95% CI: 1.44-3.48), and maculopapular/papular rash (aPR = 1.70; 95% CI: 1.02-2.83) were independent risk factors for DH. CONCLUSIONS: These easily assessed parameters can facilitate clinical decision-making for febrile AIDS patients with suspected DH in low socioeconomic and Histoplasma-endemic regions. |
format |
Article in Journal/Newspaper |
author |
Isadora Cavalcanti Ramos Yuri Coelho Soares Lisandra Serra Damasceno Mariana Pitombeira Libório Luís Arthur Brasil Gadelha Farias Jorg Heukelbach Carlos Henrique Morais de Alencar Terezinha do Menino Jesus Silva Leitão |
author_facet |
Isadora Cavalcanti Ramos Yuri Coelho Soares Lisandra Serra Damasceno Mariana Pitombeira Libório Luís Arthur Brasil Gadelha Farias Jorg Heukelbach Carlos Henrique Morais de Alencar Terezinha do Menino Jesus Silva Leitão |
author_sort |
Isadora Cavalcanti Ramos |
title |
Predictive factors for disseminated histoplasmosis in AIDS patients with fever admitted to a reference hospital in Brazil |
title_short |
Predictive factors for disseminated histoplasmosis in AIDS patients with fever admitted to a reference hospital in Brazil |
title_full |
Predictive factors for disseminated histoplasmosis in AIDS patients with fever admitted to a reference hospital in Brazil |
title_fullStr |
Predictive factors for disseminated histoplasmosis in AIDS patients with fever admitted to a reference hospital in Brazil |
title_full_unstemmed |
Predictive factors for disseminated histoplasmosis in AIDS patients with fever admitted to a reference hospital in Brazil |
title_sort |
predictive factors for disseminated histoplasmosis in aids patients with fever admitted to a reference hospital in brazil |
publisher |
Sociedade Brasileira de Medicina Tropical (SBMT) |
url |
https://doi.org/10.1590/0037-8682-0425-2017 https://doaj.org/article/19065780b5364991bfee3384738eeb9e |
geographic |
Arctic |
geographic_facet |
Arctic |
genre |
Arctic |
genre_facet |
Arctic |
op_source |
Revista da Sociedade Brasileira de Medicina Tropical, Vol 51, Iss 4, Pp 479-484 |
op_relation |
http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0037-86822018000400479&lng=en&tlng=en https://doaj.org/toc/1678-9849 1678-9849 doi:10.1590/0037-8682-0425-2017 https://doaj.org/article/19065780b5364991bfee3384738eeb9e |
op_doi |
https://doi.org/10.1590/0037-8682-0425-2017 |
container_title |
Revista da Sociedade Brasileira de Medicina Tropical |
container_volume |
51 |
container_issue |
4 |
container_start_page |
479 |
op_container_end_page |
484 |
_version_ |
1766342999767252992 |