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DISSEMINATED HISTOPLASMOSIS: A COMPARATIVE STUDY BETWEEN PATIENTS WITH ACQUIRED IMMUNODEFICIENCY SYNDROME AND NON-HUMAN IMMUNODEFICIENCY VIRUS–INFECTED INDIVIDUALS

We studied 52 patients with disseminated histoplasmosis, 30 with the acquired immunodeficiency syndrome (AIDS) (cohort 1) and 22 not co-infected with the human immunodeficiency virus (cohort 2). Demographic, clinical, laboratory, mycologic findings, as well as antifungal therapy and highly active antiretroviral (HAART), were analyzed. Skin lesions were significantly higher in cohort 1 than in cohort 2 (P = 0.001). Anemia, leukopenia, and an elevated erythrocyte sedimentation rate were also more pronounced in cohort 1 than in cohort 2 (P < 0.001). Histoplasma capsulatum was isolated more often in cohort 1 than in cohort 2 (P < 0.05) patients, but antibodies to H. capsulatum were detected more frequently in cohort 2 than in cohort 1 (P < 0.05). Itraconazole treatment was less effective in cohort 1 than in cohort 2 (P = 0.012). In cohort 1 patients, HAART improved response to antifungals when compared with individuals not given HAART (P = 0.003), who exhibited higher mortality rates (P = 0.025). Cohort 1 patients who were given dual antifungal and anti-retroviral therapies responded as well as the non-HIV patients in cohort 2, who were treated only with itraconazole. These results indicate the need to promote restoration of the immune system in patients with AIDS and histoplasmosis.

Received February 24, 2005. Accepted for publication May 17, 2005.

Acknowledgments: We thank the patients for participating in the study and the physicians for referring their cases to our institution. We also thank Dr. Elizabeth Castañeda (Instituto Nacional de Salud, Bogotá, Colombia) for cooperation.

Financial support: This study was supported by the Corporación para Investigaciones Biológicas (Medellín, Colombia).

Disclosure: None of the authors have any conflicts of interest.

^* Address correspondence to Angela Restrepo, Corporación para Investigaciones Biológicas, Carrera 72A # 78B-141, Medellín, Colombia. E-mail: angelares{at}geo.net.co

Authors’ addresses: Angela M. Tobón, Catalina de Bedout, Alejandra Zuluaga, and Angela Restrepo, Corporación para Investigaciones Biológicas, Carrera 72A # 78B-141, Medellín, Colombia and Hospital La Maria, Medellín, Colombia, Fax: 57-4-441-0855, E-mails: atobon{at}cib.org.co, cbedout{at}cib.org.co, azuluaga{at}cib.org.co, and angelares{at}geo.net.co. Carlos A. Agudelo and Juan E. Ochoa, Universidad Pontificia Bolivariana, Calle 78B # 72A-109, Medellín, Colombia, Fax: 57-4-257-2428, E-mails: carlosaguedelo{at}yahoo.com and clio{at}geo.net.co. David S. Rosero, Policlínica Villarrobledo, c/o Senda Molinera 02600, Villarobledo, Albacete, Spain, Fax: 34-96-714-5959, E-mail: roserocuesta{at}hotmail.com. Myrtha Arango, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia and Corporación para Investigaciones Biológicas, Carrera 72A # 78B-141, Medellín, Colombia, Fax: 57-4-441-0855, E-mail: myrtaa{at}geo.net.co. Luz E. Cano, Escuela de Bacteriología, Universidad de Antioquia, Medellín, Colombia and Corporación para Investigaciones Biológicas, Carrera 72A # 78B-141, Medellín, Colombia, Fax: 57-4-441-0855, E-mail: lcano{at}cib.org.co. Jaime Sampedro, Hospital La María, Calle 92 EE # 67-61, Medellín, Colombia, Fax 57-4-237-1963.

Reprint requests: Angela Restrepo, Corporación para Investigaciones Biológicas, Carrera 72A # 78B-141, Medellín, Colombia.

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