Methods: Descriptive retrospective study, reviewed medical records available at Hospital Santo Tomas from 2009 to 2013 of the patients with diagnosis of Disseminated Histoplasmosis, Systemic Micosis or Fungemia and AIDS during the indicated period.
Results: A total of 167 medical records were found and reviewed of 317 that were registered with the indicated diagnosis. The 80% (133) of these were men and 34 were women. The mean of age was 36.24 years with a standard deviation of ± 11.1. The median of CD4 level was 37.5 cells/ µL (1 – 482). The most common clinical manifestations were fever (72.4%), weight loss (55.1%), weakness (49.1%), diarrhea (46.7%) and dyspnoea (39.5%). Other infections were found in 110 patients; Oropharyngeal Candidiasis (34.5%), Pulmonary Tuberculosis (33.6%) and Pneumocystis jirovecii Pneumonia (20%). Confirmatory diagnosis was achieved in 101 (60.5%) of the patients and the diagnostic tests that showed positivity were bone marrow Wright smears (33.6%), bone marrow biopsy (31.7%) and peripheral blood Wright smears (20,8%). 94.6% of the patients received amphotericin B. The intrahospital mortality rate was 58.7% (98 patients). 30 patients had relapse of Histoplamosis (18%) and 19 of these patients died after this. 57.1% of the patients that died had DHL levels 3 times the upper limit of normal in our hospital (>1800 U/L), 77.5% of them had elevated transaminase levels (AST/ALT >50 UI/L) and 38.8% had pancytopenia. Transaminases elevation had a statistical significance with mortality at the hospital [OR=2.36 (1.2-4.63); p=0.016].
Conclusion: Panama is an endemic area of Histoplamosis with a incidence of 9.6% among hospitalized patients with AIDS at Hospital Santo Tomas during the five years of study. The confirmation of the diagnosis was only possible in 60% of patients, that manifest the need in Panama to have access to better diagnostics tests like the histoplasma urinary antigen to identify this patients earlier and start treatment or even primary prophylaxis as soon as possible.
M. Beitia Ureña,
A. B. Araúz Rodríguez, None