Histoplasmosis: results of the Colombian National Survey, 1992-2008
Keywords:
histoplasmosis, surveillance, acquired immunodeficiency syndrome, children, disseminated histoplasmosis, Colombia
Abstract
Introduction. Histoplasmosis, a fungal disorder characterized by a wide spectrum of manifestations that range from subclinical infections to disseminated processes, affects both immunocompetent and immunosuppressed individuals. Histoplasmosis is not a reportable disease in Colombia and consequently, a survey was designed to collect histoplasmosis cases diagnosed in the country.
Objective. The aim of this work was to analyze the data collected from 1992 to 2008.
Materials and methods. The survey included demographic data, risk factors, clinical manifestations, imaging data, diagnostic methods and antifungal treatment. Patients were grouped according to risk factors and comparisons of the various findings were done.
Results. A total of 434 surveys were gathered from 20 of the country's Departments. Most patients (96.1%) were adults, 77% were males with a mean age of 38.4 years. Only 3.9% were children less than 15 years of age. In the adult population, AIDS was reported in 70.5% of the cases; additionally, in 7.0% patients other immunosuppressive conditions were informed. The most frequent clinical manifestations were fever (76.1%), cough (54.8%) and constitutional symptoms (56.8%). X rays abnormalities were represented mainly by infiltrates (65.9%) and nodules (17.1%). Diagnosis was made by microscopic observation of H. capsulatum in 49.6% patients, by culture in 58.0% and by serological test in 14.6% cases. Antifungal use was recorded in 52.5% cases.
Conclusions. Histoplasmosis is frequent in Colombia, especially in certain risk factor groups such as the HIV-infected population. Data collected from this large number of cases has allowed valid comparisons on various aspects of histoplasmosis in Colombia.
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References
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11. Arango M, Bedout C, Tobón AM, Restrepo A, Torrado E, Castañeda E, et al. Histoplasmosis en Colombia: estudio interinstitucional. Inf Quinc Epidemiol Nac. 2000;5:119-23.
12. Chinchilla M, Kogson MC, Insignares R, Rodríguez MC, Vargas M, Torrado E, et al. Valor de las pruebas inmunológicas en el diagnóstico de las enfermedades micóticas. Biomédica. 1998;18:179-84.
13. Dawson B, Trapp R. Bioestadística Médica. 4° edición México DF: Editorial Manual Moderno; 2005.
14. Wheat LJ. Approach to the diagnosis of the endemic mycoses. Clin Chest Med. 2009;30:379-89.
15. Assi MA, Sandid MS, Baddour LM, Roberts GD, Walker RC. Systemic histoplasmosis: A 15-year retrospective institutional review of 111 patients. Medicine (Baltimore). 2007;86:162-9.
16. Reyes-Montes MR, Bobadilla-Del Valle M, Martínez-Rivera MA, Rodríguez-Arellanes G, Maravilla E, Sifuentes-Osornio J, et al. Relatedness analyses of Histoplasma capsulatum isolates from Mexican patients with AIDS-associated histoplasmosis by using histoplasmin electrophoretic profiles and randomly amplified polymorphic DNA patterns. J Clin Microbiol. 1999;37:1404-8.
17. Bonifaz A, Chang P, Moreno K, Fernández-Fernández V, Montes de Oca G, Araiza J, et al. Disseminated cutaneous histoplasmosis in acquired immunodeficiency syndrome: Report of 23 cases. Clin Exp Dermatol. 2009;34:481-6.
18. Gutiérrez ME, Canton A, Sosa N, Puga E, Talavera L. Disseminated histoplasmosis in patients with AIDS in Panamá: A review of 104 cases. Clin Infect Dis. 2005;40:1199-202.
19. Mata-Essayag S, Colella MT, Roselló A, de Capriles CH, Landaeta ME, de Salazar CP, et al. Histoplasmosis: A study of 158 cases in Venezuela, 2000-2005. Medicine (Baltimore). 2008;87:193-202.
20. Cermeño J, Cermeño J, Godoy G, Hernández I, Orellán Y, Blanco Y, et al. Epidemiological study of paracoccidioidomycosis and histoplasmosis in a suburb of San Félix City, Bolívar State, Venezuela. Invest Clin. 2009;50:213-20.
21. Huber F, Nacher M, Aznar C, Pierre-Demar M, El Guedj M, Vaz T, et al. AIDS-related Histoplasma capsulatum var. capsulatum infection: 25 years experience of French Guiana. AIDS. 2008;22:1047-53.
22. Severo LC, Oliveira FM, Irion K, Porto NS, Londero AT. Histoplasmosis in Rio Grande do Sul, Brazil: A 21-year experience. Rev Inst Med Trop Sao Paulo. 2001;43:183-7.
23. Rodrigues M, Ledesma C, Melo AM, Ledesma D, Venâncio R, Wanke B. Study of 30 cases of histoplasmosis observed in Mato Grosso do Sul Stae, Brazil. Rev Inst Med Trop Sao Paulo. 2007;49:37-9.
24. Mora DJ, dos Santos CT, Silva-Vergara ML. Disseminated histoplasmosis in acquired immunodeficiency syndrome patients in Uberaba, MG, Brazil. Mycoses. 2008;51:136-40.
25. Goldman LZ, Aquino VR, Lunardi LW, Cunha VS, Santos RP. Two specific strains of Histoplasma capsulatum causing mucocutaneous manifestations of histoplasmosis: Preliminary analysis of a frequent manifestation of histoplasmosis in southern Brazil. Mycopathologia. 2009;167:181-6.
26. Prado M, Silva MB, Laurenti R, Travassos LR, Taborda CP. Mortality due to systemic mycoses as a primary cause of death or in association with AIDS in Brazil: A review from 1996 to 2006. Mem Inst Oswaldo Cruz. 2009;104:513-21.
27. Negroni R, Taborda A, Robles AM, Arechevala A. Itraconazole in the treatment of histoplasmosis associated with AIDS. Mycoses. 1992;35:281-7.
28. Pietrobon D, Negro-Marquinez L, Kilstein J, Galíndez J, Greca A, Battagliotti C. Disseminated histoplasmosis and AIDS in an Argentine hospital: Clinical manifestations, diagnosis and treatment. Enferm Infecc Microbiol Clin. 2004;22:156-9.
29. Arango M, Cano LE, De Bedout C, Estrada S, Gómez I, Restrepo A, et al. Histoplasmosis y criptococosis diseminadas en pacientes con el síndrome de inmunodeficiencia adquirida (SIDA). Acta Med Colomb. 1990;15:84-91.
30. Tobón A, Franco L, Correa AL, Bedoya F, Ortega J, Soto M. et al. La Histoplasmosis en el adulto, pasos para su diagnóstico. Acta Med Colomb. 1997;22:277-84.
31. Tobón AM, Agudelo CA, Rosero DS, Ochoa JE, De Bedout C, Zuluaga A, et al. Disseminated histoplasmosis: A comparative study between patients with acquired immunodeficiency syndrome and non-human immunodeficiency virus-infected individuals. Am J Trop Med Hyg. 2005;73:576-82.
32. Ordoñéz N, Tobón A, Arango M, Tabares A, De Bedout C, Gómez B, et al. Brotes de histoplasmosis registrados en el área andina colombiana. Biomédica. 1997;17:105-11.
33. Jiménez R, Urán M, De Bedout C, Arango M, Tobón AM, Cano LE, et al. Brote de histoplasmosis aguda en un grupo familiar: identificación de la fuente de infección. Biomédica. 2002;22:155-9.
34. Ashbee HR, Evans EG, Viviani MA, Dupont B, Chryssanthou E, Surmont I, et al. Histoplasmosis in Europe: Report on an epidemiological survey from the European Confederation of Medical Mycology Working Group. Med Mycol. 2008;46:57-65.
35. Carmona J. Análisis estadístico y ecológico-epidemiológico de la sensibilidad a la histoplasmina en Colombia 1950-1968. Antioquia Med. 1971;21:109-54.
36. Ministerio de la Protección Social, Instituto Nacional de Salud. Manual de Referencia. Observatorio Nacional de la Gestión en VIH-SIDA. 2006. [Fecha de consulta: 7 de abril de 2011]. Disponible en: http://www.minproteccionsocial.gov.co/salud/Documents/INS.pdf
37. Baddley JW, Sankara IR, Rodriquez JM, Pappas PG, Many WJ Jr. Histoplasmosis in HIV-infected patients in a southern regional medical center: Poor prognosis in the era of highly active antiretroviral therapy. Diagn Microbiol Infect Dis. 2008;62:151-6.
38. Ferreira MS, Borges AS. Histoplasmosis. Rev Soc Bras Med Trop. 2009;42:192-8.
39. McKinsey DS, Spiegel RA, Hutwagner L, Stanford J, Driks MR, Brewer J, et al. Prospective study of histoplasmosis in patients infected with human immunodeficiency virus: Incidence, risk factors, and pathophysiology. Clin Infect Dis. 1997;24:1195-203.
40. Cuellar-Rodríguez J, Avery RK, Lard M, Budev M, Gordon SM, Shrestha NK, et al. Histoplasmosis in solid organ transplant recipients: 10 years of experience at a large transplant center in an endemic area. Clin Infect Dis. 2009;49:710-6.
41. CDC. Histoplasmosis: Protecting workers at risk. Revised edition. Cincinnati, OH: US Department of Health and Human Services, CDC, National Institute for Occupational Safety and Health (2004). Fecha de consulta: 12 de agosto de 2009. Disponible en: http://www.cdc.gov/niosh/docs/2005-109.
42. Scheel CM, Samayoa B, Herrera A, Lindsley MD, Benjamin L, Reed Y, et al. Development and evaluation of an enzyme-linked immunosorbent assay to detect Histoplasma capsulatum antigenuria in immunocompromised patients. Clin Vaccine Immunol. 2009;16:852-8.
43. Wheat LJ, Freifeld AG, Kleiman MB, Baddley JW, McKinsey DS, Loyd JE, et al. Clinical practice guidelines for the management of patients with histoplasmosis: 2007 update by the Infectious Diseases Society of America. Clin Infect Dis.2007;45:807-25.
2. Kauffman CA. Histoplasmosis. Clin Chest Med. 2009; 30:217-25.
3. Couppie P, Aznarb C, Carme B, Nacher. American histoplasmosis in developing countries with a special focus on patients with HIV: Diagnosis, treatment, and prognosis. Curr Opin Infect Dis. 2006;19:443-9.
4. Kauffman CA. Histoplasmosis: A clinical and laboratory update. Clin Microb Rev. 2007;20:115-32.
5. Hage CA, Wheat LJ, Lloyd J, Allen SD, Blue D, Knox KS. Pulmonary histoplasmosis. Semin Respir Crit Care Med. 2008;29:151-65.
6. Chu JH, Feudtner C, Heydon K, Walsh TJ, Zaoutis TE. Hospitalizations for endemic mycoses: A population-based national study. Clin Infect Dis. 2006;42:822-5.
7. Kauffman CA. Diagnosis of histoplasmosis in immunosuppressed patients. Curr Opin Infect Dis. 2008;21:421-5.
8. Karimi K, Wheat LJ, Conolly P, Cloud G, Hajjeh R, Wheat E, et al. Differences in histoplasmosis in patients with acquired immunodeficiency syndrome in the United States and Brazil. J Infect Dis. 2002;186:1655-60.
9. Hajjeh RA, Pappas PG, Henderson HD, Lancaster DM, Bamberger KJ, Skahan KJ, et al. Multicenter case-control study of risk factors for histoplasmosis in human immunodeficiency virus-infected people. Clin Infect Dis. 2001;32:1215-20.
10. Ashbee HR. European Committee Medical Mycology (ECMM) Newsletter, 1997.
11. Arango M, Bedout C, Tobón AM, Restrepo A, Torrado E, Castañeda E, et al. Histoplasmosis en Colombia: estudio interinstitucional. Inf Quinc Epidemiol Nac. 2000;5:119-23.
12. Chinchilla M, Kogson MC, Insignares R, Rodríguez MC, Vargas M, Torrado E, et al. Valor de las pruebas inmunológicas en el diagnóstico de las enfermedades micóticas. Biomédica. 1998;18:179-84.
13. Dawson B, Trapp R. Bioestadística Médica. 4° edición México DF: Editorial Manual Moderno; 2005.
14. Wheat LJ. Approach to the diagnosis of the endemic mycoses. Clin Chest Med. 2009;30:379-89.
15. Assi MA, Sandid MS, Baddour LM, Roberts GD, Walker RC. Systemic histoplasmosis: A 15-year retrospective institutional review of 111 patients. Medicine (Baltimore). 2007;86:162-9.
16. Reyes-Montes MR, Bobadilla-Del Valle M, Martínez-Rivera MA, Rodríguez-Arellanes G, Maravilla E, Sifuentes-Osornio J, et al. Relatedness analyses of Histoplasma capsulatum isolates from Mexican patients with AIDS-associated histoplasmosis by using histoplasmin electrophoretic profiles and randomly amplified polymorphic DNA patterns. J Clin Microbiol. 1999;37:1404-8.
17. Bonifaz A, Chang P, Moreno K, Fernández-Fernández V, Montes de Oca G, Araiza J, et al. Disseminated cutaneous histoplasmosis in acquired immunodeficiency syndrome: Report of 23 cases. Clin Exp Dermatol. 2009;34:481-6.
18. Gutiérrez ME, Canton A, Sosa N, Puga E, Talavera L. Disseminated histoplasmosis in patients with AIDS in Panamá: A review of 104 cases. Clin Infect Dis. 2005;40:1199-202.
19. Mata-Essayag S, Colella MT, Roselló A, de Capriles CH, Landaeta ME, de Salazar CP, et al. Histoplasmosis: A study of 158 cases in Venezuela, 2000-2005. Medicine (Baltimore). 2008;87:193-202.
20. Cermeño J, Cermeño J, Godoy G, Hernández I, Orellán Y, Blanco Y, et al. Epidemiological study of paracoccidioidomycosis and histoplasmosis in a suburb of San Félix City, Bolívar State, Venezuela. Invest Clin. 2009;50:213-20.
21. Huber F, Nacher M, Aznar C, Pierre-Demar M, El Guedj M, Vaz T, et al. AIDS-related Histoplasma capsulatum var. capsulatum infection: 25 years experience of French Guiana. AIDS. 2008;22:1047-53.
22. Severo LC, Oliveira FM, Irion K, Porto NS, Londero AT. Histoplasmosis in Rio Grande do Sul, Brazil: A 21-year experience. Rev Inst Med Trop Sao Paulo. 2001;43:183-7.
23. Rodrigues M, Ledesma C, Melo AM, Ledesma D, Venâncio R, Wanke B. Study of 30 cases of histoplasmosis observed in Mato Grosso do Sul Stae, Brazil. Rev Inst Med Trop Sao Paulo. 2007;49:37-9.
24. Mora DJ, dos Santos CT, Silva-Vergara ML. Disseminated histoplasmosis in acquired immunodeficiency syndrome patients in Uberaba, MG, Brazil. Mycoses. 2008;51:136-40.
25. Goldman LZ, Aquino VR, Lunardi LW, Cunha VS, Santos RP. Two specific strains of Histoplasma capsulatum causing mucocutaneous manifestations of histoplasmosis: Preliminary analysis of a frequent manifestation of histoplasmosis in southern Brazil. Mycopathologia. 2009;167:181-6.
26. Prado M, Silva MB, Laurenti R, Travassos LR, Taborda CP. Mortality due to systemic mycoses as a primary cause of death or in association with AIDS in Brazil: A review from 1996 to 2006. Mem Inst Oswaldo Cruz. 2009;104:513-21.
27. Negroni R, Taborda A, Robles AM, Arechevala A. Itraconazole in the treatment of histoplasmosis associated with AIDS. Mycoses. 1992;35:281-7.
28. Pietrobon D, Negro-Marquinez L, Kilstein J, Galíndez J, Greca A, Battagliotti C. Disseminated histoplasmosis and AIDS in an Argentine hospital: Clinical manifestations, diagnosis and treatment. Enferm Infecc Microbiol Clin. 2004;22:156-9.
29. Arango M, Cano LE, De Bedout C, Estrada S, Gómez I, Restrepo A, et al. Histoplasmosis y criptococosis diseminadas en pacientes con el síndrome de inmunodeficiencia adquirida (SIDA). Acta Med Colomb. 1990;15:84-91.
30. Tobón A, Franco L, Correa AL, Bedoya F, Ortega J, Soto M. et al. La Histoplasmosis en el adulto, pasos para su diagnóstico. Acta Med Colomb. 1997;22:277-84.
31. Tobón AM, Agudelo CA, Rosero DS, Ochoa JE, De Bedout C, Zuluaga A, et al. Disseminated histoplasmosis: A comparative study between patients with acquired immunodeficiency syndrome and non-human immunodeficiency virus-infected individuals. Am J Trop Med Hyg. 2005;73:576-82.
32. Ordoñéz N, Tobón A, Arango M, Tabares A, De Bedout C, Gómez B, et al. Brotes de histoplasmosis registrados en el área andina colombiana. Biomédica. 1997;17:105-11.
33. Jiménez R, Urán M, De Bedout C, Arango M, Tobón AM, Cano LE, et al. Brote de histoplasmosis aguda en un grupo familiar: identificación de la fuente de infección. Biomédica. 2002;22:155-9.
34. Ashbee HR, Evans EG, Viviani MA, Dupont B, Chryssanthou E, Surmont I, et al. Histoplasmosis in Europe: Report on an epidemiological survey from the European Confederation of Medical Mycology Working Group. Med Mycol. 2008;46:57-65.
35. Carmona J. Análisis estadístico y ecológico-epidemiológico de la sensibilidad a la histoplasmina en Colombia 1950-1968. Antioquia Med. 1971;21:109-54.
36. Ministerio de la Protección Social, Instituto Nacional de Salud. Manual de Referencia. Observatorio Nacional de la Gestión en VIH-SIDA. 2006. [Fecha de consulta: 7 de abril de 2011]. Disponible en: http://www.minproteccionsocial.gov.co/salud/Documents/INS.pdf
37. Baddley JW, Sankara IR, Rodriquez JM, Pappas PG, Many WJ Jr. Histoplasmosis in HIV-infected patients in a southern regional medical center: Poor prognosis in the era of highly active antiretroviral therapy. Diagn Microbiol Infect Dis. 2008;62:151-6.
38. Ferreira MS, Borges AS. Histoplasmosis. Rev Soc Bras Med Trop. 2009;42:192-8.
39. McKinsey DS, Spiegel RA, Hutwagner L, Stanford J, Driks MR, Brewer J, et al. Prospective study of histoplasmosis in patients infected with human immunodeficiency virus: Incidence, risk factors, and pathophysiology. Clin Infect Dis. 1997;24:1195-203.
40. Cuellar-Rodríguez J, Avery RK, Lard M, Budev M, Gordon SM, Shrestha NK, et al. Histoplasmosis in solid organ transplant recipients: 10 years of experience at a large transplant center in an endemic area. Clin Infect Dis. 2009;49:710-6.
41. CDC. Histoplasmosis: Protecting workers at risk. Revised edition. Cincinnati, OH: US Department of Health and Human Services, CDC, National Institute for Occupational Safety and Health (2004). Fecha de consulta: 12 de agosto de 2009. Disponible en: http://www.cdc.gov/niosh/docs/2005-109.
42. Scheel CM, Samayoa B, Herrera A, Lindsley MD, Benjamin L, Reed Y, et al. Development and evaluation of an enzyme-linked immunosorbent assay to detect Histoplasma capsulatum antigenuria in immunocompromised patients. Clin Vaccine Immunol. 2009;16:852-8.
43. Wheat LJ, Freifeld AG, Kleiman MB, Baddley JW, McKinsey DS, Loyd JE, et al. Clinical practice guidelines for the management of patients with histoplasmosis: 2007 update by the Infectious Diseases Society of America. Clin Infect Dis.2007;45:807-25.
How to Cite
1.
Arango M, Castañeda E, Agudelo CI, De Bedout C, Agudelo CA, Tobón A, et al. Histoplasmosis: results of the Colombian National Survey, 1992-2008. biomedica [Internet]. 2011 Mar. 31 [cited 2024 May 16];31(3):344-56. Available from: https://revistabiomedica.org/index.php/biomedica/article/view/348
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