Oropharyngeal histoplasmosis: report of eleven cases and review of the literature
Oropharyngeal histoplasmosis: report of eleven cases and review of the literature
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DOI：
10.1590/s0037-86822011000100007
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发表时间：
2011-02-01
影响因子：
2
通讯作者：
Severo, Luiz Carlos
中科院分区：
文献类型：
--
作者：
Antonello, Vicente Sperb;Zaltron, Vanice Ferrazza;Severo, Luiz Carlos
组织浆体病是巴西的一种全身性真菌病，特别是在南巴西大德州，在那里从土壤中分离到了荚膜组织浆体。荚膜荚膜胞杆菌可损害异常区域，包括口咽部，特别是在出现播散性组织胞浆菌病的患者中；这与免疫抑制状态有关，比如艾滋病。方法：对265例口腔组织胞浆菌病进行数据库分析，回顾性分析1987 ~ 2008年间11例经组织学或微生物学诊断为口腔组织胞浆菌病（OH）患者的病历。结果：本研究报告了11例OH，大多数表现为弥散性组织胞浆菌病（DH）的组织病理学或微生物学证据。在DH患者中，OH是组织浆菌病的首要表现。讨论的11名患者中有5名hiv血清阳性，临床和实验室结果为艾滋病。4例伴有组织浆菌病的活动性肺结核。治疗基于伊曲康唑和两性霉素B去氧胆酸盐。8名患者在一年后对治疗成功反应，2名患者没有回来重新评估，1名患者在充分治疗后死亡。结论：口腔组织胞浆菌病与免疫抑制状态密切相关，尤其是AIDS患者；此外，在许多病例中，OH是播散性组织胞浆菌病的第一个征象。
INTRODUCTION: Histoplasmosis is a systemic mycosis endemic in Brazil, especially in the State of Rio Grande do Sul, where Histoplasma capsulatum was isolated from the soil. H. capsulatum may compromise unusual areas, including the oropharynx, particularly in patients presenting disseminated histoplasmosis; which is associated with a state of immunosuppression, such as AIDS.METHODS: During database analysis of a total of 265 cases of histoplasmosis, the medical records of 11 patients with histological or microbiological diagnoses of oral histoplasmosis (OH) between 1987 and 2008 were retrospectively reviewed.RESULTS: This work reports 11 cases of OH, the majority presenting histopathological or microbiological evidence of disseminated histoplasmosis (DH). In the patients with DH, OH was the first manifestation of histoplasmosis. Five of the 11 patients discussed were HIV-seropositive with clinical and laboratory findings of AIDS. Four patients presented active pulmonary tuberculosis concomitant with histoplasmosis. Treatment was based on the use of itraconazole and amphotericin B deoxycholate. Eight patients responded successfully to therapy after one year, two did not come back for reevaluation and one died despite adequate therapy.CONCLUSIONS: Oral histoplasmosis is closely associated with immunosuppression status, especially in patients presenting AIDS; moreover, in many cases, OH is the first sign of disseminated histoplasmosis.