Achados clÃnicos laboratoriais como auxiliares no diagnÃstico de histoplasmose disseminada em pacientes febris com AIDS de hospital de referÃncia do Cearà / Clinical laboratory findings to support diagnosis of Disseminated Histoplasmosis of AIDS patients in a reference hospital in CearÃ

AUTOR(ES)
FONTE

IBICT - Instituto Brasileiro de Informação em Ciência e Tecnologia

DATA DE PUBLICAÇÃO

17/06/2008

RESUMO

Disseminated histoplasmosis (DH) is a severe disease that delay in diagnosis and specific treatment is associated with a high mortality. Since the AIDS epidemic, cases of DH are frequently diagnosed in patients with HIV from Fortaleza, a city in Northeastern Brazil. A cross sectional study was conducted on AIDS patients with symptoms suggestive of HD at hospital admission to correlate clinics and laboratory findings with the definitive diagnostic of this mycose, in a reference hospital from January 2006 to January 2007. There were identified 48 DH from 136 subjects. Patients with DH had more temperature higher than 38,5ÂC, splenomegaly, hepatomegaly, multiple papular skin lesions and sibilant respiratory sound (p<0.05). The more frequent manifestations in other diseases were pleuritic pain and arthralgia (p<0.05). High levels of lactate dhydrogenase (LDH), aspartate aminotransferase (AST) and amylase as well as lower levels of hemoglobin (≤10 g/dl) and CD4 (≤ 75 cel/mm3) were more frequent in DH (p<0.05). Multivariate analysis showed that temperature higher than 38,5ÂC (adjusted OR, 5.9; p=0.007; 95% CI= 1,62-21,77), LDH level ≥ 5 times normal (adjusted OR, 4.3; p=0.007; 95% CI= 1,49-12,55), CD4 ≤ 75 cel/mm3 (adjusted OR, 4.9; p=0.004; 95% CI= 1,64-14,88), hepatomegaly (adjusted OR, 3.4, p=0.01; 95% CI= 1,33-8,55) and multiple papular skin lesions (adjusted OR, 5.8; p=0.01; 95% CI= 1,50-22,68) were independently associated like the diagnosis of HD. Pleuritic pain was associated negatively with HD diagnosis (adjusted OR 0.2, p=0.02; 95% CI= 0,06-0,78). Suspected DH patients without hepatomegaly and temperature <38,5ÂC have negative predictive value for DH of 100%. Patients without elevated LDH have negative predictive value for HD of 74,3%. We can eliminate most DH in patients without hepatomegaly, temperature <38,5ÂC and normal LDH. This study helped diagnosis of HD among suspected patients.

ASSUNTO(S)

saude publica sÃndrome de imunodeficiÃncia adquirida hiv

ACESSO AO ARTIGO

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