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Free Content Clinical and laboratory features of disseminated histoplasmosis in HIV patients from Brazil

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Abstract:

Summary Objectives  To identify the main clinical and laboratory features of disseminated histoplasmosis (DH) in human immunodeficiency virus (HIV) patients and compare them with those of HIV patients with other opportunistic diseases. Methods  Retrospective study of HIV patients comparing the clinical and laboratory data of patients with and without DH. Univariate and multivariate analyses were performed to verify the risk factors related to DH. Results  In total, 378 HIV patients were included, 164 with DH and 214 with other opportunistic diseases. Acute renal failure, respiratory insufficiency and septic shock were more frequent in DH patients, who also had a higher mortality (32%. 14%, <0.001). Independent risk factors for DH were: acute renal failure [odds ratio (OR) 5.2; 95% confidence interval (CI) 3.2–8.5; <0.001], splenomegaly (OR 3.4; 95% CI 1.19–9.9; <0.001), respiratory insufficiency (OR 2.7 95% CI 1.5–5.0; <0.001), proteinuria (OR 2.7; 95% CI 1.3–5.2; =0.03), hypotension (OR 2.5; 95% CI 1.2–5.0; =0.008), hepatomegaly (OR 2.4; 95% CI 1.2–4.8; =0.01), cutaneous lesions (OR, 1.9; 95% CI 1.0–3.3; =0.02) and weight loss (OR 1.8; 95% CI 1.0–3.1; =0.03). Conclusion  Our results suggest that DH is a severe opportunistic disease with high mortality rate, which should be promptly recognized in order to provide early specific treatment.

French
Objectifs 

Identifier les principales caractéristiques cliniques et de laboratoire de l’histoplasmose disséminée (HD) chez les patients VIH et les comparer à celles de patients VIH présentant d’autres maladies opportunistes. Méthodes 

Étude rétrospective de patients VIH comparant les données cliniques et de laboratoire de patients avec et sans histoplasmose disséminée. Les analyses univariées et multivariées ont été effectuées pour vérifier les facteurs de risque liés à l’HD. Résultats 

378 patients VIH ont été inclus, 164 avec histoplasmose disséminée et 214 ans avec d’autres maladies opportunistes. La défaillance rénale aiguë, l’insuffisance respiratoire et le choc septique étaient plus fréquents chez les patients avec histoplasmose disséminée, qui également avaient une mortalité plus élevée (32% contre 14%; P < 0,001). Les facteurs de risque indépendants pour l’histoplasmose disséminée étaient: défaillance rénale aiguë (OR: 5,2 [3,2 – 8,5]; P < 0,001), splénomégalie (OR: 3,4 [1,19 – 9,9]; P < 0,001), insuffisance respiratoire (OR: 2,7 [1,5 – 5,0]; P < 0,001), protéinurie (OR: 2,7 [1,3 – 5,2]; P = 0,03), hypotension (OR: 2,5 [1,2 – 5,0]; P = 0,008), hépatomégalie (OR: 2,4 [1,2 – 4,8]; P = 0,01), lésions cutanées (OR: 1,9 [1,0 – 3,3]; P = 0,02) et perte de poids (OR: 1,8 [1,0 – 3,1]; P = 0,03). Conclusion 

Nos résultats suggèrent que l’histoplasmose disséminée est une maladie opportuniste grave avec un taux élevé de mortalité, qui devrait être promptement reconnue afin d’administrer très tôt le traitement spécifique.

Keywords: AIDS; HIV; SIDA; VIH; acute renal failure; défaillance rénale; enfermedades oportunistas; fallo renal agudo; histoplasma capsulatum; histoplasmose; histoplasmosis; maladies opportunistes; opportunistic diseases

Document Type: Research Article

DOI: http://dx.doi.org/10.1111/j.1365-3156.2007.01894.x

Affiliations: 1:  Department of Internal Medicine, Faculdade de Medicina, Universidade Federal do Ceará, Fortaleza, Ceará, Brazil 2:  Hospital São José de Doenças Infecciosas, Fortaleza, Ceará, Brazil 3:  Department of Statistics, Universidade Federal do Ceará, Fortaleza, Ceará, Brazil

Publication date: September 1, 2007

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