Histoplasmosis in Two Human Immunodeficiency Virus-positive
Histoplasmosis in Two Human Immunodeficiency Virus-positive
We report two cases of histoplasmosis occurring in human immunodeficiency virus-positive patients who immigrated to Italy, and focus our attention on the clinical features and therapeutic aspects, with particular emphasis on secondary prophylaxis. The patients had comparable human immunodeficiency virus baseline parameters, but had a completely different compliance over therapeutic regimens. The two patients were followed in two different city hospitals of our region, Padua and Verona, and the diagnosis was made on the basis of instrumental, histologic, and microbiologic findings. One of them was treated with corticosteroids because of nephrotic syndrome.
The risk and severity of histoplasmosis, which is now recognized as an important infection in patients with acquired immunodeficiency syndrome (AIDS), increase as immune function declines. Disseminated histoplasmosis is more likely to be encountered in patients with CD4 cell counts below 200 cells/mm, suggesting that cell-mediated immunity plays a key role against Histoplasma capsulatum. After acute treatment, human immunodeficiency virus (HIV)-infected persons generally receive lifelong suppressive therapy with itraconazole (200 mg bid), but insufficient data exist regarding the necessity of prolonged secondary prophylaxis. We report two cases of histoplasmosis occurring in HIV-positive patients who immigrated to Italy, and focus our attention on the clinical features and therapeutic aspects, with particular emphasis on secondary prophylaxis.
We report two cases of histoplasmosis occurring in human immunodeficiency virus-positive patients who immigrated to Italy, and focus our attention on the clinical features and therapeutic aspects, with particular emphasis on secondary prophylaxis. The patients had comparable human immunodeficiency virus baseline parameters, but had a completely different compliance over therapeutic regimens. The two patients were followed in two different city hospitals of our region, Padua and Verona, and the diagnosis was made on the basis of instrumental, histologic, and microbiologic findings. One of them was treated with corticosteroids because of nephrotic syndrome.
The risk and severity of histoplasmosis, which is now recognized as an important infection in patients with acquired immunodeficiency syndrome (AIDS), increase as immune function declines. Disseminated histoplasmosis is more likely to be encountered in patients with CD4 cell counts below 200 cells/mm, suggesting that cell-mediated immunity plays a key role against Histoplasma capsulatum. After acute treatment, human immunodeficiency virus (HIV)-infected persons generally receive lifelong suppressive therapy with itraconazole (200 mg bid), but insufficient data exist regarding the necessity of prolonged secondary prophylaxis. We report two cases of histoplasmosis occurring in HIV-positive patients who immigrated to Italy, and focus our attention on the clinical features and therapeutic aspects, with particular emphasis on secondary prophylaxis.