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Oral histoplasmosis in HIV-infected patients. A report of two cases
H Chinn1, D N Chernoff, C A Migliorati
1Division of Oral Medicine, UCSF, USA.
Abstract:
Histoplasmosis is a fungal infection caused by the organism Histoplasma capsulatum. Disseminated disease usually occurs in immunosuppressed patients or in patients with chronic illnesses. Although relatively uncommon, histoplasmosis has been reported in patients with AIDS, and oral lesions have been noted on multiple sites and in various clinical presentations. We present two HIV-positive cases with oral lesions as the initial signs of histoplasmosis. Both patients responded well to IV amphotericin B but later suffered recurrences despite being maintained on systemic antifungal therapy.
Insights
Histoplasmosis, a fungal infection, can manifest as initial oral lesions in individuals with HIV/AIDS. Despite successful treatment with amphotericin B, recurrences highlight the challenges in managing this opportunistic infection.
Area of Science:
- Mycology
- Infectious Diseases
- Immunocompromised Hosts
Background:
- Histoplasmosis is a fungal infection caused by Histoplasma capsulatum, typically affecting immunocompromised individuals.
- Disseminated histoplasmosis is uncommon but documented in patients with Acquired Immunodeficiency Syndrome (AIDS).
- Oral manifestations of histoplasmosis in HIV-positive patients present with diverse clinical features.
Observation:
- Two cases of Human Immunodeficiency Virus (HIV)-positive patients presented with oral lesions as the primary sign of histoplasmosis.
- These oral lesions appeared in various locations and exhibited different clinical presentations.
- Both patients initially responded positively to intravenous amphotericin B treatment.
Findings:
- Recurrence of histoplasmosis was observed in both patients.
- Recurrences occurred even while patients were undergoing systemic antifungal maintenance therapy.
- This suggests potential challenges in achieving sustained remission for disseminated histoplasmosis in this population.
Implications:
- Oral lesions can be an early indicator of disseminated histoplasmosis in HIV-positive individuals.
- Aggressive antifungal therapy is crucial, but long-term management strategies may need further investigation.
- Understanding recurrence patterns is vital for optimizing treatment protocols for opportunistic fungal infections in immunocompromised patients.