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Histoplasmosis diseminada en pacientes tratados con corticosteroides. Informe de cinco casos reportados
JAMA
|September 29, 1978
Resumen
La terapia con corticosteroides puede conducir a la histoplasmosis diseminada (DH) en pacientes que presentan fiebre persistente. El diagnóstico y el tratamiento tempranos son cruciales para mejorar los resultados en estos individuos inmunocomprometidos.
Área de la Ciencia:
- La micología médica La micología médica.
- Enfermedades infecciosas Enfermedades infecciosas.
- Investigación de anfitriones inmunocomprometidos.
Sus antecedentes:
- Por lo general, el Histoplasma capsulatum no se considera oportunista.
- El uso de corticosteroides puede alterar las respuestas inmunes, aumentando potencialmente la susceptibilidad a las infecciones.
Objetivo del estudio:
- Para investigar la ocurrencia de histoplasmosis diseminada (DH) en pacientes tratados con corticosteroides.
- Para identificar las características clínicas y patológicas de la DH en este grupo de pacientes.
- Evaluar los métodos de diagnóstico y su impacto en el pronóstico.
Principales métodos:
- Análisis retrospectivo de las series de casos de cinco pacientes tratados con corticosteroides con histoplasmosis diseminada.
- Revisión de las presentaciones clínicas, los hallazgos diagnósticos (incluido el cultivo de médula ósea) y las características patológicas.
- Correlación del retraso en el diagnóstico con los resultados del paciente.
Principales resultados:
- Cinco pacientes en tratamiento con corticosteroides desarrollaron histoplasmosis diseminada.
- La fiebre persistente e inexplicable fue el síntoma principal.
- Los hallazgos patológicos incluyeron numerosas formas de levadura dentro de los macrófagos, granulomas ausentes y inflamación mínima.
- El cultivo de médula ósea fue identificado como el estudio de diagnóstico óptimo.
- El diagnóstico tardío se asoció con un pronóstico adverso, con cuatro muertes directamente atribuidas a la DH.
Conclusiones:
- La terapia con corticosteroides puede predisponer a los pacientes a la histoplasmosis diseminada.
- Los pacientes inmunodeprimidos, en particular los que toman corticosteroides, con fiebre inexplicable deben ser evaluados para la infección por Histoplasma capsulatum.
- El diagnóstico y la intervención inmediatos son fundamentales para el manejo de la histoplasmosis diseminada en huéspedes inmunocomprometidos.
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