Histoplasmose em indivíduos HIV positivos no estado do Ceará : estudo clínico epidemiológico e teste de sensibilidade antimicrobiana de cepas de Histoplasma capsulatum var. Capsulatum

• Autor(a) principal: Fechine, Maria Auxiliadora Bezerra
• Data de Publicação: 2011
• Tipo de documento: Tese
• Idioma: por
• Título da fonte: Repositório Institucional da Universidade Federal do Ceará (UFC)
• Texto Completo: http://www.repositorio.ufc.br/handle/riufc/12256
• topic: Testes de Sensibilidade Microbiana; Histoplasma; Antifúngicos

Histoplasmosis, caused by the fungus Histoplasma capsulatum, is the most prevalent of the systemic mycoses and a marker disease for acquired immune deficiency syndrome (AIDS). A descriptive analysis was carried out of 254 cases of patients suffering from histoplasmosis and AIDS between 2006 and 2010 in the state of Ceará, northeastern Brazil, noting the epidemiological, clinical, laboratory and therapeutic aspects. Additionally, the in vitro sensitivity profile of strains of H. capsulatum in the filamentous and yeast phases was tested by the microdilution method against the antifungals amphotericin B, fluconazole, itraconazole, voriconazole and caspofungin and the combined antimicrobial sulfametoxazol-trimetoprim, according to protocol M-27A2 from the CLSI. The results were compared with those of strains obtained from southeastern Brazil. In 39.37% of the cases, histoplasmosis was the first event indicating AIDS and in 80.4% of the patients the CD4 cell count was under 100 cells/ml. The levels of lactate dehydrogenase were high in all the patients evaluated, with impaired hepatic and renal function evolving to death being observed in 41.7% of the cases. The in vitro sensitivity profile demonstrated there was no antifungal resistance in the strains analyzed and all the strains were sensitive to sulfametoxazol-trimetoprim. The MFC levels of caspofungin, itraconazole, voriconazole and sulfametoxazol-trimetoprim were higher for the strains from the Northeast than those from the Southeast. In recent years there has been a significant increase in the number of histoplasmosis cases in HIV-positive individuals in the state of Ceará, but the results showed no resistance among the strains of H. capsulatum tested. These showed sensitivity of sulfametoxazol-trimetoprim, but there was a difference in sensitivity between the strains from the northeastern and southeastern regions of Brazil