Histoplasmosis, An Underdiagnosed Disease Affecting People Living With HIV/AIDS in Brazil: Results of a Multicenter Prospective Cohort Study Using Both Classical Mycology Tests and Histoplasma Urine Antigen Detection.

摘要: Background Histoplasmosis is highly endemic in the American continent. This condition associated with a high mortality, particularly people living HIV/AIDS (PLWHA). Diagnosis of histoplasmosis usually late South America, as Histoplasma antigen detection rarely available. Here we determined prevalence, risk factors, and outcome PLWHA Brazilian hospitals. Methods was prospective cohort study (2016-2018) involving 14 tertiary medical centers Brazil. We included hospitalized presenting fever additional clinical findings. Patients were investigated at each participant center classical mycology methods. Also, performed urine samples (IMMY). Probable/proven defined according to European Organization for Research Treatment Cancer/Invasive Fungal Infections Cooperative Group/National Institute Allergy Infectious Diseases Mycoses Study Group criteria. Results From 616 eligible patients, 570 included. identified 21.6% (123/570) patients. Urine testing increased diagnostic yield 53.8%, comparison standard Variables independently CD4+ count <50 cells/mm3, use an antiretroviral (protective effect), sample collection Northeast region Dyspnea presentation death. more frequent than tuberculosis patients low counts. Overall 30-day mortality 22.1%, decreasing 14.3% antigen-based diagnosis. Conclusions very affecting Brazil, when counts are lower 50 cells/mm3. Antigen may detect earlier disease, probable impact on outcomes. Access this tool needed improve management countries.