Disseminated histoplasmosis in AIDS patients: an urban disease. Experience in a metropolis in the middle east of Brazil

Abstract

Histoplasmosis is a fungal disease commonly ob served as an opportunistic disease in AIDS patients. It is a neglected disease in many countries, particularly Latin America, including Brazil. It is related with en vironmental factors, even in urban areas, where the incidence has increased. Implementing a descriptive ecological study, we performed a retrospective chart review for data collected between January 2003 and July 2014 for AIDS patients with histoplasmosis who lived in Goiânia. The selected cases were georefer enced to analyse the incidence of histoplasmosis in AIDS patients in the metropolitan area of Goiânia. In all, 166 patients (130 men) met the criteria for AIDS and histoplasmosis coinfection. Almost half of the patients (41%) had simultaneous histoplasmosis and AIDS diagnoses. The general mortality was 53% (88 patients). The main symptoms involved the respi ratory, gastrointestinal, and cutaneous systems. The distribution of cases included almost all regions of the urban areas, with some predominance in the eastern and western regions close to areas of environmental degradation, contaminated water sources and un planned urbanisation. In conclusion, coinfection with HIV and disseminated histoplasmosis is common and associated with high mortality rates in our referral hos pital for infectious diseases. Despite being considered as having a predominantly rural epidemiology, many patients reported living in urban areas such as Goiânia and Aparecida de Goiânia. Our findings suggest the need for environmental studies to evaluate environ mental contamination and possible local risk factors for H. capsulatum infection in addition to serological surveys to determine the prevalence of this infection in the studied cities.