Disseminated histoplasmosis and aids: relapse and late mortality in endemic area in north-eastern Brazil

Authors

  • Lisandra Serra Dasmasceno,

    Corresponding author
    1. Hospital São José of Infectious Diseases, Health Department of Ceará, Fortaleza, CE, Brazil
    • Department of Community Health, School of Medicine, Federal University of Ceará, Fortaleza, CE, Brazil
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  • Alberto Ramos Novaes Jr,

    1. Department of Community Health, School of Medicine, Federal University of Ceará, Fortaleza, CE, Brazil
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  • Carlos Henrique Morais Alencar,

    1. Department of Community Health, School of Medicine, Federal University of Ceará, Fortaleza, CE, Brazil
    2. Swiss Tropical and Public Health Institute, University of Basel, Basel, Switzerland
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  • Daniel Teixeira Lima,

    1. Specialized Medical Mycology Center, Federal University of Ceará, Fortaleza, CE, Brazil
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  • José Júlio Costa Sidrim,

    1. Specialized Medical Mycology Center, Federal University of Ceará, Fortaleza, CE, Brazil
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  • Maria Vânia Freitas Gonçalves,

    1. Hospital São José of Infectious Diseases, Health Department of Ceará, Fortaleza, CE, Brazil
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  • Jacó Ricarte Lima de Mesquita,

    1. Hospital São José of Infectious Diseases, Health Department of Ceará, Fortaleza, CE, Brazil
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  • Terezinha do Menino Jesus Silva Leitão

    1. Department of Community Health, School of Medicine, Federal University of Ceará, Fortaleza, CE, Brazil
    2. Hospital São José of Infectious Diseases, Health Department of Ceará, Fortaleza, CE, Brazil
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Correspondence: Ms. Lisandra Serra Damasceno Department of Community Health, School of Medicine, Federal University of Ceará, Rua Professor Costa Mendes, 1608, Bloco Didático – 5° andar. Rodolfo Teófilo. CEP: 60430-140. Fortaleza, Ceará, Brazil Tel: 55-85-33668044. Fax: 55-85-33668050 Email: lisandraserra@yahoo.com.br

Summary

The State of Ceará in north-eastern Brazil has one of the highest rates in the world of relapse and death due to disseminated histoplasmosis (DH) in acquired immunodeficiency syndrome (AIDS) patients. The objective of this study is to characterise the relapse and mortality of DH in AIDS cases residents in Ceará. We performed a retrospective analysis of the medical records of AIDS patients who had a first episode of DH from 2002 to 2008. We analysed the outcomes until December 31, 2010. A total of 145 patients participated in the study. The mean clinical follow-up duration was 3.38 years (SD = 2.2; 95% CI = 3.01–3.75). The majority of the subjects were male with a mean age of 35 years (SD = 2.2; 95% CI = 3.01–3.75) and were born in the capital of Ceará. DH was the first manifestation of AIDS in 59% of the patients. The relapse rate was 23.3%, with a disseminated presentation in 90% of these patients. The overall mortality during the study period was 30.2%. The majority of patients who relapsed or died had irregular treatment with antifungals or highly active antiretroviral therapy and did not have active clinical follow-up. High rates of recurrence and mortality were found in AIDS-associated DH in this area of the country.

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