Factores relacionados con histoplasmosis diseminada en los pacientes admitidos con VIH-SIDA y fiebre, CHDrAAM, 2017 - 2019
[Factors related to disseminated histoplasmosis in patients admitted with HIV-AIDS and fever: CHDrAAM, 2017 - 2019]José Anel González Rodriguéz1, Elam Chérigo1, Nathan Gundacker2, José Antonio Suárez3
1. Departamento de Infectología, Complejo Hospitalario Dr. Arnulfo Arias Madrid. Panamá, Panamá.; 2. División de Enfermedades Infecciosas, Medical College of Wisconsin, USA; 3. Instituto Conmemorativo Gorgas de Estudios de la Salud, SNI Senacyt. Panamá..
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Resumen
Introducción: el diagnóstico de histoplasmosis diseminada (HD) es un desafío debido a la similitud del cuadro clínico con otras enfermedades infecciosas y no infecciosas. Confirmar un caso de HD requiere realizar procedimientos poco sensibles como hemocultivos, mielocultivos y biopsias de tejidos, o costosos como el antígeno urinario de Histoplasma capsulatum. Conocer los factores clínicos y de laboratorios relacionados con el diagnóstico de HD es de vital importancia en especial en sitios con recursos limitados. Metodología: se realizó un estudio de cohorte retrospectivo donde los expedientes clínicos de los pacientes con fiebre y VIH-SIDA, admitidos con sospecha de histoplasmosis diseminada del 1 de enero de 2017 al 31 de diciembre de 2019 en el Complejo Hospitalario Dr. Arnulfo Arias Madrid (CHDrAAM) de Panamá, fueron evaluados por características demográficas, clínicas y de laboratorio relacionadas con el diagnóstico de HD. Resultados: 63 pacientes cumplieron los criterios de inclusión, 14 con diagnóstico confirmado de HD y 49 con diagnóstico no confirmado de HD. Los niveles de lactato deshidrogenasa (LDH) y aspartato transaminasa (AST) se relacionaron con el diagnóstico de HD en el análisis univariado. Luego de realizar regresión logística ni AST ni LDH fueron estadísticamente significativas. (p= 0.22 y P = 0.92). Conclusión: Ninguna característica clínica ni de laboratorio se relacionó de forma independiente con el diagnóstico de HD, en pacientes con VIH-SIDA admitidos con sospecha de histoplasmosis diseminada.
Abstract
Introduction: The diagnosis of disseminated histoplasmosis (HD) is a challenge due to the similarity of the clinical picture with other infectious and non-infectious diseases. Confirming a case of HD requires performing insensitive procedures such as blood cultures, myelocultures and tissue biopsies, or expensive procedures such as urinary Histoplasma capsulatum antigen. Knowing the clinical and laboratory factors related to the diagnosis of HD is of vital importance, especially in places with limited resources. Methodology: a retrospective cohort study was conducted where clinical records of patients with fever and HIV-AIDS, admitted with suspected disseminated histoplasmosis from January 1, 2017, to December 31, 2019, at the Complejo Hospitalario Dr. Arnulfo Arias Madrid (CHDrAAM) in Panama, were evaluated for demographic, clinical and laboratory characteristics related to the diagnosis of HD. Results: 63 patients met the inclusion criteria, 14 with confirmed diagnosis of HD and 49 with unconfirmed diagnosis of HD. Lactate dehydrogenase (LDH) and aspartate transaminase (AST) levels were related to HD diagnosis in univariate analysis. After logistic regression neither AST nor LDH were statistically significant. (p= 0.22 and P = 0.92). Conclusion: No clinical or laboratory characteristics were independently related to the diagnosis of HD in HIV-AIDS patients admitted with suspected disseminated histoplasmosis.
Citas
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