Histoplasmosis, An Underdiagnosed Disease Affecting People Living With HIV/AIDS in Brazil: Results of a Multicenter Prospective Cohort Study Using Both Classical Mycology Tests and Histoplasma Urine Antigen Detection
Histoplasmosis, An Underdiagnosed Disease Affecting People Living With HIV/AIDS in Brazil: Results of a Multicenter Prospective Cohort Study Using Both Classical Mycology Tests and Histoplasma Urine Antigen Detection
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DOI：
10.1093/ofid/ofz073
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发表时间：
2019-04-01
影响因子：
4.2
通讯作者：
Pasgualotto, Alessandro C.
中科院分区：
文献类型：
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作者：
Falci, Diego R.;Monteiro, Alexandre A.;Pasgualotto, Alessandro C.
背景组织胞浆菌病是美洲大陆的高度地方病。这种情况与高死亡率有关，特别是在艾滋病毒/艾滋病感染者中。在南美洲，组织胞浆菌病的诊断通常较晚，因为组织胞浆菌抗原检测很少可用。在这里，我们确定了巴西医院中组织胞浆菌病在PLWHA中的患病率、危险因素和预后。这是一项前瞻性队列研究（2016-2018），涉及巴西的14家三级医疗中心。我们纳入了因发热和其他临床表现住院的PLWHA。在每个参与中心用经典真菌学方法对患者进行调查。此外，在尿液样本中进行组织胞浆菌抗原检测（IMMY）。根据欧洲癌症研究和治疗组织/侵袭性真菌感染合作组/国家过敏和传染病研究所真菌病研究组标准定义可能/已证实的组织胞浆菌病。从616例合格患者中，纳入了570例。在21.6%（123/570）的患者中发现了组织胞浆菌病。与标准真菌学方法相比，尿抗原检测的诊断率提高了53.8%。与组织胞浆菌病独立相关的变量为CD 4+计数
Background. Histoplasmosis is highly endemic in the American continent. This condition is associated with a high mortality, particularly in people living with HIV/AIDS (PLWHA). Diagnosis of histoplasmosis is usually late in South America, as Histoplasma antigen detection is rarely available. Here we determined the prevalence, risk factors, and outcome of histoplasmosis in PLWHA in Brazilian hospitals.Methods. This was a prospective cohort study (2016-2018) involving 14 tertiary medical centers in Brazil. We included hospitalized PLWHA presenting with fever and additional clinical findings. Patients were investigated at each participant center with classical mycology methods. Also, Histoplasma antigen detection was performed in urine samples (IMMY). Probable/proven histoplasmosis was defined according to European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group/National Institute of Allergy and Infectious Diseases Mycoses Study Group criteria.Results. From 616 eligible patients, 570 were included. Histoplasmosis was identified in 21.6% (123/570) of patients. Urine antigen testing increased the diagnostic yield in 53.8%, in comparison with standard mycology methods. Variables independently associated with histoplasmosis were CD4+ count