Gastrointestinal histoplasmosis in the acquired immunodeficiency syndrome: report of 18 cases and literature review

被引:54
作者
Assi, Maha
McKinsey, David S. [1 ]
Driks, Michael R.
O'Connor, Mary C.
Bonacini, Maurizio
Graham, Bruce
Manian, Farrin
机构
[1] Infect Dis Associates Kansas City, Kansas City, MO 64132 USA
[2] Mayo Clin, Rochester, MO USA
[3] Calif Pacific Med Ctr, Dept Transplantat, San Francisco, CA 94115 USA
[4] Colon Rectal Surg Kansas City, Kansas City, MO 64132 USA
[5] St Johns Mercy Med Ctr, Div Infect Dis, St Louis, MO 63141 USA
关键词
gastrointestinal histoplasmosis; acquired immunodeficiency syndrome; Histoplasma capsulatum;
D O I
10.1016/j.diagmicrobio.2006.01.015
中图分类号
R51 [传染病];
学科分类号
100401 ;
摘要
No large case series of gastrointestinal histoplasmosis (GIH) in patients with AIDS has been published. We report 18 cases and review 34 published cases in the medical literature. We did a retrospective chart review from patients seen in our medical practices between 1989 and 2004. Most of our patients were men who had sex with men and who were not receiving highly active antiretroviral therapy. Median CD4 count was 34/mu L. The most common presenting symptoms were diarrhea, fever, abdominal pain, and weight loss. The most commonly involved site was the colon or cecum. Biopsies revealed visible Histoplasma capsulatum organisms in 89%. Cultures from any site were positive in 76.9%. Four patients died from GIH. Gastrointestinal histoplasmosis occurs in severely immunocompromised patients with AIDS not receiving highly active antiretroviral therapy. Typical manifestations include diarrhea, fever, abdominal pain, and weight loss. Diagnosis is confirmed by blood or gastrointestinal tissue culture. Improvements in antiretroviral and antifungal therapies appear to have reduced the incidence of GIH and may improve the prognosis of this disease. (c) 2006 Elsevier Inc. All rights reserved.
引用
收藏
页码:195 / 201
页数:7
相关论文
共 34 条
[1]   HISTOPLASMOSIS OF THE COLON IN PATIENTS WITH AIDS - IMAGING FINDINGS IN 4 CASES [J].
BALTHAZAR, EJ ;
MEGIBOW, AJ ;
BARRY, M ;
OPULENCIA, JF .
AMERICAN JOURNAL OF ROENTGENOLOGY, 1993, 161 (03) :585-587
[2]   GASTROINTESTINAL HISTOPLASMOSIS PRESENTING AS HEMATOCHEZIA IN HUMAN IMMUNODEFICIENCY VIRUS-INFECTED HEMOPHILIC PATIENTS [J].
BECHERER, PR ;
SOKOLANDERSON, M ;
JOIST, JH ;
MILLIGAN, T .
AMERICAN JOURNAL OF HEMATOLOGY, 1994, 47 (03) :229-231
[3]   GASTROINTESTINAL HISTOPLASMOSIS [J].
CAPPELL, MS ;
MANDELL, W ;
GRIMES, MM ;
NEU, HC .
DIGESTIVE DISEASES AND SCIENCES, 1988, 33 (03) :353-360
[4]  
CIMPONERIU D, 1994, AM J GASTROENTEROL, V89, P129
[5]  
CLARKSTON WK, 1991, AM J GASTROENTEROL, V86, P913
[6]   DISSEMINATED HISTOPLASMOSIS IN AIDS - AN UNUSUAL CASE OF ESOPHAGEAL INVOLVEMENT AND GASTROINTESTINAL-BLEEDING [J].
FORSMARK, CE ;
WILCOX, CM ;
DARRAGH, TM ;
CELLO, JP .
GASTROINTESTINAL ENDOSCOPY, 1990, 36 (06) :604-605
[7]   Safety of discontinuation of maintenance therapy for disseminated histoplasmosis after immunologic response to antiretroviral therapy [J].
Goldman, M ;
Zackin, R ;
Fichtenbaum, CJ ;
Skiest, DJ ;
Koletar, SL ;
Hafner, R ;
Wheat, LJ ;
Nyangweso, PM ;
Yiannoutsos, CT ;
Schnizlein-Bick, CT ;
Owens, S ;
Aberg, JA .
CLINICAL INFECTIOUS DISEASES, 2004, 38 (10) :1490-1494
[8]   DISSEMINATED HISTOPLASMOSIS - CLINICAL AND PATHOLOGIC CORRELATIONS [J].
GOODWIN, RA ;
SHAPIRO, JL ;
THURMAN, GH ;
THURMAN, SS ;
DESPREZ, RM .
MEDICINE, 1980, 59 (01) :1-33
[9]  
GOODWIN RA, 1978, AM REV RESPIR DIS, V117, P929
[10]   COLONIC HISTOPLASMOSIS IN ACQUIRED-IMMUNODEFICIENCY-SYNDROME - REPORT OF 2 CASES [J].
GRAHAM, BD ;
MCKINSEY, DS ;
DRIKS, MR ;
SMITH, DL .
DISEASES OF THE COLON & RECTUM, 1991, 34 (02) :185-190