Histoplasmosis and AIDS co-infection

Abstracts

Apresenta-se um caso de coinfecção histoplasmose e Aids, com lesões cutâneas predominantemente papulosas e comprometimento sistêmico. O exame histopatológico e micológico de lesão cutânea confirmou o diagnóstico. Em doentes com Aids, a histoplasmose surge, principalmente, quando a contagem de células T-CD4-positivas é inferior a 50 células/mm³. Nesses casos, a histoplasmose pode ser grave e, se não tratada adequadamente, levar ao êxito letal, como no paciente relatado.

HIV; Histoplasma; Histoplasmose; Infecções oportunistas relacionadas com a Aids; Síndrome de imunodeficiência adquirida

IMAGENS EM DERMATOLOGIA TROPICAL

Histoplasmosis and AIDS co-infection^*

Ana Tereza Orsi^I; Lisiane Nogueira^II; Anette Chrusciak-Talhari^III; Monica Santos^III; Luiz Carlos de Lima Ferreira^IV; Sinesio Talhari^V; Carolina Talhari^VI

^IDermatologist at the Amazonas Tropical Medicine Foundation (FMTAM), Manaus (AM), Brazil

^IIDermatology Resident at the Amazonas Tropical Medicine Foundation (FMTAM), Manaus (AM), Brazil

^IIIPhD in Tropical Medicine, Dermatologist at the Amazonas Tropical Medicine Foundation (FMTAM), Manaus (AM), Brazil

^IVPhD in Pathology, Pathologist at the Amazonas Tropical Medicine Foundation (FMTAM), Manaus (AM), Brazil

^VPh.D. in Dermatology, Director of the Amazonas Tropical Medicine Foundation (FMTAM), Manaus (AM), Brazil

^VIPh.D., Professor of Dermatology at the State University of Amazonas

Mailing address

ABSTRACT

This report concerns an AIDS patient presenting systemic and cutaneous manifestations of histoplasmosis. A histopathological and mycological examination of the skin lesion confirmed the diagnosis. In AIDS patients histoplasmosis arises mainly when the T-CD4+ cell count is less than 50 cells/mm3. In such cases, histoplasmosis can be severe and if left untreated can lead to death, as occurred with this patient.

Keywords: AIDS-Related Opportunistic infections; Acquired immunodeficiency syndrome; HIV; Histoplasma; Histoplasmosis

Histoplasmosis is caused by Histoplasma capsulatum var. Capsulatum. In patients with AIDS it occurs mainly when the T-CD4-positive cell count is less than 50 cells/ mm³. In such cases,this mycosis can be severe and if left untreated can lead to a lethal outcome, as in the patient reported here. ^2.3 Clinical symptoms may include fever, hepatosplenomegaly, lymphadenopathy, pulmonary manifestations, skin and mucosal lesions and central nervous system involvement. ^3.4 Macular, purpuric, papular lesions (occasionally acneiform or molluscum contagiosum-like), plaques and ulcers can occur together or in isolation (Figures 1 and 2). Erosive lesions or ulcers can occur in the oral mucosa. ^4-7 Diagnosis is made by direct examination, culture and histopathology (Figures 3 and 4). The treatment of severe cases (T-CD4+ counts of below 100 cells/ mm³ and/or general state of health compromised) consists of amphotericin B (1mg/kg) until complete regression of clinical symptoms, followed by maintenance with fluconazole or itraconazole (200-300 mg/day) until the T-CD4+ count reach es 150 cells/mm³.^1,4-7

REFERENCES

• 1. Bonifaz A, Chang P, Moreno K, Fernández-Fernández V, Montes de Oca G, Araiza J, Ponce RM. Disseminated cutaneous histoplasmosis in acquired immunodeficiency syndrome: report of 23 cases. Clin Exp Dermatol. 2009;34:481-6.
• 2. Souza SL, Feitoza PV, Araújo JR, Andrade RV, Ferreira LC. Causes of death among patients with acquired immunodeficiency syndrome autopsied at the Tropical Medicine Foundation of Amazonas. Rev Soc Bras Med Trop. 2008;41:247-51.
• 3. Gon AS, Franco C, Maia IL, Rodrigues VSM, Pozzeti EMO, Antônio JR. Histoplasmose cutânea na síndrome de imunodeficiência adquirida - relato de 4 casos. An Bras Dermatol. 1992;67:221-6.
• 4. Talhari C, Braga A, Chrusciak-Talhari A, Niedermeier A, Carlos Ferreira L, Talhari S. Cutaneous ulcer due to histoplasmosis and HIV infection. Hautarzt. 2009;60:992-4.
• 5. Cunha VS, Zampese MS, Aquino VR, Cestari TF, Goldani LZ. Mucocutaneous manifestations of disseminated histoplasmosis in patients with acquired immunodeficiency síndrome: particular aspects in a Latin- American population. Clin Exp Dermatol. 2007;32:250-5.
• 6. Talhari C, Talhari S, Massone C. Widespread crusted lesions in a patient with HIV-quiz case. Arch Dermatol. 2009;145:1447-52.
• 7. Porro AM, Yoshioka MCN. Manifestações dermatológicas da infecção pelo HIV. An Bras Dermatol. 2000;75:665-91.

*

Trabalho realizado na Fundação de Medicina Tropical do Amazonas (FMTAM) - Manaus (AM), Brasil.

Publication Dates

• Publication in this collection
  01 Dec 2011
• Date of issue
  Oct 2011

History

• Accepted
  16 July 2010
• Received
  31 Jan 2010