5 research outputs found
HISTOPLASMIN SURVEY IN HIV-POSITIVE PATIENTS: RESULTS FROM AN ENDEMIC AREA IN NORTHEASTERN BRAZIL
SUMMARY Background. Disseminated histoplasmosis is common in AIDS patients with advanced immunosuppression in CearĂĄ, Northeastern Brazil. The goal of this study was to determine the prevalence of Histoplasma infection in patients with HIV/AIDS living in Fortaleza, the capital of CearĂĄ. Methods. Intradermal tests with histoplasmin (mycelial phase) were performed in 161 HIV patients with CD4 â„ 350 cells/mm 3 . Evidence of recent illness was evaluated with immunodiffusion (ID) tests in 76 of these individuals. Results. A total of 11.8% of patients reacted to histoplasmin and 2.63% had ID test positive to Histoplasma. The presence of mango trees (Mangifera indica) in the patient neighborhood (OR = 2.870; 95% CI = 1.081-7.617; p = 0.040) and past activity involving soil (OR = 2.834; 95% CI = 1.045-7.687; p = 0.045) or visits to a farm (OR = 3.869; 95% CI = 1.189-12.591; p = 0.033) were significantly associated with Histoplasma infection. Conclusions. Patients with HIV living in Fortaleza have an expressive prevalence of infection with Histoplasma.RESUMO Introdução: Histoplasmose disseminada ocorre com grande frequĂȘncia em pacientes com aids e imunossupressĂŁo avançada no CearĂĄ, Brasil. O objetivo deste artigo Ă© determinar a prevalĂȘncia da infecção por Histoplasma em pacientes com HIV/aids residentes em Fortaleza capital. MĂ©todos. Testes intradĂ©rmicos com histoplasmina (fase micelial), foram realizados em 161 pacientes com CD4 â„ 350 cĂ©lulas/mm 3 . Doença recente foi estudada por imunodifusĂŁo em 76 desses indivĂduos. Resultados. Reagiram Ă histoplasmina, 11,8% dos pacientes e Ă imunodifusĂŁo para Histoplasma: 2,63%. A presença da ĂĄrvore mangueira (Mangifera indica) na vizinhança (OR = 2,870; IC 95% = 1,081-7,617; p = 0,040), atividade com o solo no passado (OR = 2,834; IC 95% = 1,045-7,687, p = 0,045) e visitar sĂtio no passado (OR = 3,869; IC 95% = 1,189-12,591; p = 0,033); foram significativamente associados com positividade para o teste. ConclusĂ”es. Pacientes com HIV que vivem em Fortaleza apresentam uma prevalĂȘncia expressiva de infecção por Histoplasma
HISTOPLASMIN SURVEY IN HIV-POSITIVE PATIENTS: RESULTS FROM AN ENDEMIC AREA IN NORTHEASTERN BRAZIL
Histoplasmosis infection in patients HIV / AIDS in the city of Fortaleza, CearĂ
A histoplasmose Ă uma doenĂa causada por Histoplasma capsulatum var. capsulatum, nos seres humanos e em vĂrias outras espĂcies de animais. Trata-se de um fungo encontrado na natureza, principalmente em locais ricos em fezes de aves e morcegos: galinheiros sujos e abandonados, ambiente de cavernas, construĂĂes antigas, cĂpula de prĂdios e Ărvores ocas. A infecĂĂo em humanos ocorre atravĂs das vias aĂreas superiores. Desde o inicio da epidemia de HIV na dĂcada de 80 Ă notada uma detecĂĂo crescente de histoplasmose disseminada em pacientes com aids de serviĂos de referĂncia em Fortaleza, sugerindo ser o Estado do CearĂ uma Ărea com elevada endemicidade para esse fungo. Este estudo teve o intuito de identificar a prevalĂncia de histoplasmose infecĂĂo em pacientes com HIV/aids, residentes na cidade de Fortaleza, CearĂ. Trata-se de um estudo transversal, descritivo e analĂtico, com uma amostra composta por 161 pacientes, acompanhados no ambulatĂrio de HIV/aids do Centro de Especialidades MĂdicas JosĂ de Alencar e que ao serem abordados, aceitaram participar do estudo. Para tanto, foi preenchido um formulĂrio, realizou-se teste intradĂrmico com histoplasmina (fase miceliana, fornecido pela Fiocruz-RJ) e coleta sanguĂnea para sorologia por imunodifusĂo (antĂgenos e anticorpos comerciais de Histoplasma capsulatum e Coccidioides immitis fornecidos pelo Centro Especializado em Micologia MĂdica-CEMM). A caracterizaĂĂo geral dos pacientes revelou que a maioria tinha, em mĂdia 35,11 anos, era do sexo masculino (76,40%; n=123), solteiros (67,70%, n=109), com renda familiar de no mĂximo trĂs salĂrios mĂnimos (81,99%; n=132) e com mais de 10 anos de estudo (44,10%; n=71). O tipo de ocupaĂĂo no passado obteve distribuiĂĂo variĂvel e atualmente parte do grupo (20,5%; n=33) encontrava-se desempregada. Um nĂmero de 137 pacientes (85,10%) relatou residir em casas, sendo Messejana o bairro de moradia mais citado pelos participantes (8,7%; n=14). Prevaleceram na amostra os pacientes com diagnĂstico recente de infecĂĂo por HIV, (66,46% identificados no ano de 2008). A prevalĂncia de histoplasmose infecĂĂo em pacientes com HIV/aids em Fortaleza foi de 12,42%. PresenĂa de galinheiro na vizinhanĂa atual do paciente (p=0,031); presenĂa de mangueira na residĂncia atual (p=0,023); atividade com terra no passado (p=0,021) e visitar sĂtio no passado (p=0,009), mostraram-se significantes para a infecĂĂo por Histoplasma capsulatum; jĂ o uso de medicaĂĂo anti-retroviral e o fato do paciente ter ou nĂo aids, nĂo influenciaram na reatividade Ă histoplasmina (ambos p=1,00). Pode-se concluir que Fortaleza constitui-se Ărea com significativa prevalĂncia de histoplasmose infecĂĂo, levando-se em conta que a populaĂĂo estudada se referia a pacientes com supressĂo da resposta imune. O valor obtido aponta para a necessidade de identificaĂĂo dessas pessoas em risco para histoplasmose doenĂa e a implementaĂĂo de medidas profilĂticas naqueles susceptĂveis Ăs formas graves desta infecĂĂo.Histoplasmosis is an infection disease caused by the fungus Histoplasma capsulatum var. capsulatum that can affect humans and several other animal. This fungus can be found in nature, mainly in places rich in bat and bird droppings: dirty and abandoned chicken coops, cave environments, old constructions, building domes and hollow trees. The infection in humans occurs through the upper airways. Since the HIV outbreak in the 1980s, it is noticed an increasing detection of disseminated histoplasmosis among aids patients assisted in reference clinics of Fortaleza, suggesting the Brazilian State of CearĂ as an area with high endemicity related to this fungus. The purpose of this study is to identify histoplasmosis infection prevalence among HIV/aids-infected patients, who live in the city of Fortaleza, CearĂ. It is a transverse, descriptive and analytic study, with a sample of 161 patients observed at the HIV/aids ambulatory from JosĂ de Alencar Center of Medical Specialties, and when invited, agreed to participate. For this, they filled in a form, took an intradermal test with histoplasmin (mycelial phase, provided by Fiocruz Ăą RJ), and had their blood collected to serology via immunodiffusion (commercial antigens and antibodies from Histoplasma capsulatum and Coccidioides immitis were provided by Immy Immunodiagnostics laboratory). The general characterization of patients revealed that, on average, most participants were 35,11 years old, men (76,40%; n=123), single (67,70%, n=109), with a maximum family income of three minimum salaries (81,99%; n=132), and having more than 10 years of education (44,10%; n=71). Their previous employment situation had a variable distribution, although the majority of the group is currently unemployed. A number of 137 patients (85,10%) live in houses, and Messejana was the most informed quarter by the participants (8,7%; n=14). The year of 2008 had the most frequent HIV diagnoses among patients, with 66,46% (n=107). The prevalence of histoplasmosis infection among HIV/aids-infected patients, who live in the city of Fortaleza, was 12,42%. Some variables, such as the presence of chicken coops in the patientĂąs current neighborhood (p=0,031), the presence of mango trees in the current residence (p=0,023), dealing with soil in the past (p=0,021) and visiting small farms in the past (p=0,009) proved to be significant to the Histoplasma infection. However, the use of antiretroviral medication and having or not AIDS did not influence the reactivity to histoplasmin (both p=1,000). It can be concluded that Fortaleza constitutes an area with significant prevalence of histoplasmosis infection, considering that the analyzed population referred to people with suppression of the immune response. This result points out the necessity of identifying patients at risk for histoplasmosis, and also of implementing prophylactic measures on those susceptible to the severe forms of this disease