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Escalante L, Granizo-Rubio J, Pinos-León V, Tello S, Maldonado A, Cherrez-Ojeda I. Nasal cartilage destruction associated to cutaneous histoplasmosis in AIDS. BMC Infect Dis 2022; 22:377. [PMID: 35421945 PMCID: PMC9011989 DOI: 10.1186/s12879-022-07351-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 04/05/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Systemic histoplasmosis is a disease of high morbidity and mortality in immunocompromised patients. Patients with AIDS get the infection through inhalation of spores, triggering a primary lung infection with a subsequent hematogenous spread to multiple organs, including the skin. Tissue necrosis have been documented in cutaneous histoplasmosis with multiple clinical manifestations that mimic other diseases.
Case presentation
We report the case of nasal cartilage destruction associated to cutaneous histoplasmosis in AIDS. A 24-year-old man, resident in Ecuadorian coast, with a history of HIV for 7 years without any treatment. In the last 3 months, he has been presenting a molluscum-like lesions on his nasal bridge with subsequent dissemination to the trunk and extremities. He was admitted to the emergency department for dyspnoea, cough, and malaise. Due to his respiratory failure, he was admitted to the intensive care unit (ICU) with mechanical ventilation. Physical examination reveals a crusted surface ulcer that involves the nose and cheeks, associated with erythematous papules, some with a crusted surface which are spread to the face, trunk, and upper limbs. The patient has a specific skin involvement with a butterfly-like ulcer appearance and destruction of the upper and lower lateral cartilage of the nose. At admission CD4 cell count was 11/mm3 with a HIV viral load of 322,908 copies. Mycological cultures identified Histoplasma capsulatum. A treatment with highly active antiretroviral therapy (HAART) was stablished, associated with liposomal amphotericin B at a dose of 3 mg/kg/day and itraconazole 200 mg twice a day for 12 months.
Conclusions
Cutaneous histoplasmosis is a rare manifestation of pulmonary histoplasmosis in patients with AIDS. The cutaneous manifestations included papules, nodules, plaques, and ulcers. A histology examination is required to rule out other fungal or parasitic infections. Treatment includes highly active antiretroviral therapy (HAART), amphotericin B liposomal and itraconazole, the latest for at least 12 months.
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Ok SM, Ho D, Lynd T, Ahn YW, Ju HM, Jeong SH, Cheon K. Candida Infection Associated with Salivary Gland-A Narrative Review. J Clin Med 2020; 10:E97. [PMID: 33396602 PMCID: PMC7795466 DOI: 10.3390/jcm10010097] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 12/21/2020] [Accepted: 12/26/2020] [Indexed: 11/22/2022] Open
Abstract
Candida species are common global opportunistic pathogens that could repeatedly and chronically cause oral mucosa infection and create an inflammatory environment, leading to organ dysfunction. Oral Candida infections may cause temporary or permanent damage to salivary glands, resulting in the destruction of acinar cells and the formation of scar tissue. Restricted function of the salivary glands leads to discomfort and diseases of the oral mucosa, such as dry mouth and associated infection. This narrative review attempts to summarize the anatomy and function of salivary glands, the associations between Candida and saliva, the effects of Candida infection on salivary glands, and the treatment strategies. Overall, clinicians should proactively manage Candida infections by educating patients on oral hygiene management for vulnerable populations, conducting frequent checks for a timely diagnosis, and providing an effective treatment plan.
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Affiliation(s)
- Soo-Min Ok
- Department of Oral Medicine, Dental and Life Science Institute, Pusan National University, Yangsan 50612, Korea; (S.-m.O.); (Y.-W.A.); (H.-M.J.); (S.-H.J.)
- Dental Research Institute, Pusan National University Dental Hospital, Yangsan 50612, Korea
- Department of Pediatric Dentistry, University of Alabama at Birmingham, Birmingham, AL 35294, USA; (D.H.); (T.L.)
| | - Donald Ho
- Department of Pediatric Dentistry, University of Alabama at Birmingham, Birmingham, AL 35294, USA; (D.H.); (T.L.)
| | - Tyler Lynd
- Department of Pediatric Dentistry, University of Alabama at Birmingham, Birmingham, AL 35294, USA; (D.H.); (T.L.)
| | - Yong-Woo Ahn
- Department of Oral Medicine, Dental and Life Science Institute, Pusan National University, Yangsan 50612, Korea; (S.-m.O.); (Y.-W.A.); (H.-M.J.); (S.-H.J.)
- Dental Research Institute, Pusan National University Dental Hospital, Yangsan 50612, Korea
| | - Hye-Min Ju
- Department of Oral Medicine, Dental and Life Science Institute, Pusan National University, Yangsan 50612, Korea; (S.-m.O.); (Y.-W.A.); (H.-M.J.); (S.-H.J.)
- Dental Research Institute, Pusan National University Dental Hospital, Yangsan 50612, Korea
| | - Sung-Hee Jeong
- Department of Oral Medicine, Dental and Life Science Institute, Pusan National University, Yangsan 50612, Korea; (S.-m.O.); (Y.-W.A.); (H.-M.J.); (S.-H.J.)
- Dental Research Institute, Pusan National University Dental Hospital, Yangsan 50612, Korea
| | - Kyounga Cheon
- Department of Pediatric Dentistry, University of Alabama at Birmingham, Birmingham, AL 35294, USA; (D.H.); (T.L.)
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Lehur AC, Zielinski M, Pluvy J, Grégoire V, Diamantis S, Bleibtreu A, Rioux C, Picard A, Vallois D. Case of disseminated histoplasmosis in a HIV-infected patient revealed by nasal involvement with maxillary osteolysis. BMC Infect Dis 2017; 17:328. [PMID: 28476105 PMCID: PMC5418854 DOI: 10.1186/s12879-017-2419-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2016] [Accepted: 04/25/2017] [Indexed: 11/10/2022] Open
Abstract
Background Disseminated Histoplasmosis (DH) is a rare manifestation of Acquired Immune Deficiency Syndrome (AIDS) in European countries. Naso-maxillar osteolysis due to Histoplasma capsulatum var. capsulatum (Hcc) is unusual in endemic countries and has never been reported in European countries. Differential diagnoses such as malignant tumors, cocaine use, granulomatosis, vasculitis and infections are more frequently observed and could delay and/or bias the final diagnosis. Case presentation We report the case of an immunocompromised patient infected by Human Immunodeficiency Virus (HIV) with naso-maxillar histoplasmosis in a non-endemic country. Our aim is to describe the clinical presentation, the diagnostic and therapeutic issues. A 53-year-old woman, originated from Haiti, was admitted in 2016 for nasal deformation with alteration of general condition evolving for at least 6 months. HIV infection was diagnosed in 2006 and classified at AIDS stage in 2008 due to cytomegalovirus infection associated with pulmonary histoplasmosis. At admission, CD4 cell count was 9/mm3. Surgical biopsies were performed and ruled out differential or associated diagnoses. Mycological cultures identified Hcc and Blood Polymerase Chain Reaction (PCR) for Hcc was positive. The patient was given daily Amphothericin B liposomal infusion during 1 month. Hcc PCR became negative in the blood under treatment, and then oral switch by itraconazole was introduced. Antiretroviral treatment was reintroduced after a 3-week histoplasmosis treatment. Normalization of naso-maxillar mucosa enabled a palatal prosthesis. Conclusion Naso-maxillar histoplasmosis is extremely rare; this is the first case ever reported in a non-endemic country. Differential diagnoses must be ruled out by conducting microbiologic tools and histological examinations on surgical biopsies. Early antifungal treatment should be initiated in order to prevent DH severe outcomes.
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Affiliation(s)
- A C Lehur
- Infectious and Tropical Diseases Department, University Hospital Bichat-Claude Bernard, APHP, 46 rue Henri Huchard, 75018, Paris, France
| | - M Zielinski
- Otorhinolaryngology Department, University Hospital Bichat-Claude Bernard, APHP, Paris, France
| | - J Pluvy
- Infectious and Tropical Diseases Department, University Hospital Bichat-Claude Bernard, APHP, 46 rue Henri Huchard, 75018, Paris, France
| | - V Grégoire
- Hematology Department, Meaux Hospital, Meaux, France
| | - S Diamantis
- General Medecine and Infectious Diseases Department, Melun Hospital, Melun, France
| | - A Bleibtreu
- Infectious and Tropical Diseases Department, University Hospital Bichat-Claude Bernard, APHP, 46 rue Henri Huchard, 75018, Paris, France
| | - C Rioux
- Infectious and Tropical Diseases Department, University Hospital Bichat-Claude Bernard, APHP, 46 rue Henri Huchard, 75018, Paris, France
| | - A Picard
- Otorhinolaryngology Department, University Hospital Bichat-Claude Bernard, APHP, Paris, France
| | - D Vallois
- Infectious and Tropical Diseases Department, University Hospital Bichat-Claude Bernard, APHP, 46 rue Henri Huchard, 75018, Paris, France.
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Facial skin findings are indicators of human immunodeficiency virus infection and acquired immune deficiency syndrome: a retrospective study. J Public Health (Oxf) 2016. [DOI: 10.1007/s10389-016-0750-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Perforation of the nasal septum as the first sign of histoplasmosis associated with AIDS and review of published literature. Mycopathologia 2013; 176:145-50. [PMID: 23661050 DOI: 10.1007/s11046-013-9662-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2012] [Accepted: 04/27/2013] [Indexed: 10/26/2022]
Abstract
Disseminated histoplasmosis in South America is associated with AIDS in 70-90 % of cases. It is visceral and cutaneous, compromising the oral, pharynx, and laryngeal mucous membranes. The involvement of the nasal mucosa is unusual. Two patients with perforation of the nasal septum as the only sign of their disease were clinically and histopathologically diagnosed as leishmaniasis. The revision of the biopsies and the culture of nasal discharge secretions showed that the pathogens seen were not amastigotes but Histoplasma capsulatum. Other mycotic lesions were not detected, nor there was history of cutaneous leishmaniasis. The leishmanin skin test, available only for the male patient, was negative. The PCR and immunofluorescence antibody titers for Leishmania were negative in both patients. They were HIV positive; in the male, his CD4+ T cell count was 60/mm(3) and in the female 133/mm(3). The nasal ulcer was the only manifestation of histoplasmosis and the first of AIDS in both patients. The male patient recovered with amphotericin B and itraconazole treatment. The female has improved with itraconazole. Both patients received antiretroviral treatment. Nasal mucous membrane ulcers should include histoplasmosis among the differential diagnosis. In conclusion, two patients had perforation of their nasal septum as the only manifestation of histoplasmosis, a diagnosis confirmed by nasal mucosa biopsy and by culture of H. capsulatum, findings which demonstrated that both patients had AIDS.
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Harnalikar M, Kharkar V, Khopkar U. Disseminated cutaneous histoplasmosis in an immunocompetent adult. Indian J Dermatol 2012; 57:206-9. [PMID: 22707773 PMCID: PMC3371525 DOI: 10.4103/0019-5154.96194] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Histoplasmosis, a systemic mycosis caused by the dimorphic fungus Histoplasma capsulatum var capsulatum and Histoplasma capsulatum var duboisii is endemic to many parts of the world. The clinical manifestations range from acute or chronic pulmonary infection to a progressive disseminated disease. After initial exposure to the fungus, the infection is self-limited and restricted to the lungs in 99% of healthy individuals. The remaining 1%, however, progress to either disseminated or chronic disease involving the lungs, liver, spleen, lymph nodes, bone marrow or rarely, the skin and mucous membranes. Mucocutaneous histoplasmosis is frequently reported in patients with acquired immune deficiency syndrome (AIDS), but it is rare in immunocompetent hosts. A 60-year-old male presented with asymptomatic swelling of the hard palate and crusted papules and nodules over the extremities, face and trunk. Clinically, the diagnoses of cutaneous cryptococcosis versus histoplasmosis was considered in this patient. A chest X-ray revealed hilar lymphadenopathy. Enzyme-linked immunosorbent assay (ELISA) for human immunodeficiency virus (HIV) was nonreactive. Skin biopsy revealed multiple tiny intracellular round yeast forms with a halo in the mid-dermis. Culture of the skin biopsy in Sabouraud's dextrose agar showed colonies of Histoplasma capsulatum. Despite an investigation including no evidence of underlying immunosuppression was found, he was started on IV amphotericin-B (0.5 mg/kg/day). However, the patient succumbed to his disease 2 days after presentation. We report a rare case of disseminated cutaneous histoplasmosis in an immunocompetent individual.
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Affiliation(s)
- Manoj Harnalikar
- Departments of Dermatology, Venereology, and Leprology, Seth G.S. Medical College and KEM Hospital, Mumbai, India
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Enache-Angoulvant A, Torti F, Tassart M, Poirot JL, Jafari A, Roux P, Hennequin C. Candidal abscess of the parotid gland due toCandida glabrata: report of a case and literature review. Med Mycol 2010; 48:402-5. [DOI: 10.3109/13693780903176503] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Abstract
BACKGROUND Histoplasmosis is a deep fungus infection that occurs worldwide and is caused by Histoplasma capsulatum. Oral histoplasmosis has been of considerable importance in recent years because it occurs frequently in immunosuppressed patients, more often in those who test positive for the human immunodeficiency virus (HIV). However, the literature contains reports of histoplasmosis in immunocompetent patients, especially in endemic areas. CASE DESCRIPTION The authors describe a case of an HIV-negative, immunocompetent 60-year-old man with ulcerative and painful oral lesions. The clinician included squamous cell carcinoma and systemic mycosis in the differential diagnosis. After the patient underwent a biopsy and a definitive diagnosis was reached, his initial treatment regimen included itraconazole (200 milligrams per day for one month), nystatin and chlorhexidine mouthrinse (0.12 percent, 10 milliliters, two times a day). The itraconazole treatment was continued for three more months (100 mg daily) until the lesions had resolved completely. CLINICAL IMPLICATIONS Clinicians need to conduct a careful clinical evaluation and make an accurate diagnosis of ulcerated oral lesions. Knowledge of the oral manifestations of histoplasmosis may enable clinicians to reach a diagnosis earlier and initiate therapy more quickly.
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Alcure ML, Di Hipólito Júnior O, Almeida OPD, Bonilha H, Lopes MA. Oral histoplasmosis in an HIV-negative patient. ACTA ACUST UNITED AC 2006; 101:e33-6. [PMID: 16448911 DOI: 10.1016/j.tripleo.2005.06.028] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2005] [Revised: 05/25/2005] [Accepted: 06/22/2005] [Indexed: 11/23/2022]
Abstract
Histoplasmosis is a deep mycosis caused by Histoplasma capsulatum, which has been found in soil with accumulated excreta of bats and birds. This disease has variable clinical findings with only pulmonary or systemic involvement. Upper aerodigestive lesions are found mainly associated with systemic disease, affecting particularly patients with immunosuppression conditions mainly caused by HIV. However, it is uncommon in immunocompetent patients. This report describes a case of oro-laryngeal-esophageal histoplasmosis in a HIV-seronegative patient without detectable systemic involvement.
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Affiliation(s)
- Mônica Leal Alcure
- Department of Oral Diagnosis, Dental School, University of Campinas (UNICAMP), Piracicaba, Sao Paulo, Brazil
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Abstract
Infection with HIV or AIDS has a great impact on skin diseases, not only by affecting the immune system and thereby host defense against bacterial, viral, or mycotic infection, but also by changing tumor immune response and autoimmune reactivity. In the present review, emphasis will be made on infectious diseases, including sexually transmitted disease, inflammatory skin disease, and neoplasias. Knowledge of changing disease pattern with HIV/AIDS may help the clinical dermatologist and venerologist to identify dermatoses and act in the most appropriate manner to support the patient.
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Affiliation(s)
- Beatriz Moritz Trope
- Department of Dermatology, Clementino Fraga Filho Hospital, Federal University of Rio de Janeiro, Brazil.
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Loeb I, Keiani-Motlagh K, Dargent JL, Hermans P, Van Reck J. [Histoplasmosis of the oral cavity]. ACTA ACUST UNITED AC 2004; 105:215-8. [PMID: 15510072 DOI: 10.1016/s0035-1768(04)72310-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Histoplasmosis is an endemic mycosis. Histoplasma capsulatum, and duboisiï are the pathogenic agents in humans. The disease is reported as endemic in more than 30 countries. Three clinical forms are distinguished; acute, chronic and disseminated. Oral lesions may take on different clinical aspects which are often associated with disseminated histoplasmosis. Disseminated histoplasmosis is frequently diagnosed in immunocompromised hosts. High risk of mortality dictates rapid diagnosis and treatment.
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Affiliation(s)
- I Loeb
- Service de stomatologie et chirurgie Maxillo-faciale, CHU Saint-Pierre, Bruxelles, Belgique
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Hernández SL, López de Blanc SA, Sambuelli RH, Roland H, Cornelli C, Lattanzi V, Carnelli MA. Oral histoplasmosis associated with HIV infection: a comparative study. J Oral Pathol Med 2004. [DOI: 10.1111/j.1600-0714.2004.00200.x-i1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Hodgson TA, Rachanis CC. Oral fungal and bacterial infections in HIV-infected individuals: an overview in Africa. Oral Dis 2002; 8 Suppl 2:80-7. [PMID: 12164666 DOI: 10.1034/j.1601-0825.2002.00017.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Oral opportunistic infections developing secondary to human immunodeficiency virus (HIV) infection have been reported from the early days of the epidemic and have been classified by both the EC-Clearinghouse and the World Health Organisation (WHO). Among the fungal infections, oral candidiasis, presenting in African HIV-infected patients has been sporadically documented. We review the literature with respect to candidal carriage, oral candidiasis prevalence and the predictive value of oral candidiasis for a diagnosis of underlying HIV disease in African HIV-infected patients. The use of oral candidiasis as a marker of disease progression, the species of yeasts isolated from the oral cavity in Africa and the resistance of the yeasts to antifungal agents and treatment regimens are discussed. Orofacial lesions as manifestations of the systemic mycoses are rarely seen in isolation and few cases are reported in the literature from Africa. In spite of the high incidence of noma, tuberculosis, chronic osteomyelitis and syphilis in Africa, surprisingly there have been very few reported cases of the oral manifestations of these diseases in HIV-positive individuals. Orofacial disease in HIV-infected patients is associated with marked morbidity, which is compounded by malnutrition. The authors indicate specific research areas, initially directed at the most effective management strategies, which would complete data in this important area.
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Affiliation(s)
- T A Hodgson
- Department of Oral Medicine, Eastman Dental Institute for Oral Health Care Sciences, University College London, UK.
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Ferreira OG, Cardoso SV, Borges AS, Ferreira MS, Loyola AM. Oral histoplasmosis in Brazil. ORAL SURGERY, ORAL MEDICINE, ORAL PATHOLOGY, ORAL RADIOLOGY, AND ENDODONTICS 2002; 93:654-9. [PMID: 12142871 DOI: 10.1067/moe.2002.122588] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE We report 10 cases of histoplasmosis with oral manifestations seen in a teaching hospital in Brazil. STUDY DESIGN This is a retrospective study of the sociodemographic, clinicopathologic, and treatment data of these cases. RESULTS Overall, 8 of 10 cases were seropositive for human immunodeficiency virus (HIV), whereas 2 were negative. The predominant oral manifestations found in HIV-seropositive patients were ulcers, oral pain, and odynophagia; both of the HIV-seronegative patients were symptom-free. HIV infection was suspected in 7 cases because of the presence of oral lesions of histoplasmosis. Asthenia, fever, weight loss, lymphadenopathy, and hepatosplenomegaly were found only in HIV-seropositive patients. Radiographs in 3 out of 10 patients suggested pulmonary involvement. Amphotericin B was the antifungal therapy chosen, and clinical remission of oral lesions occurred in an average of 30 days (accumulated doses: 500-1500 mg). Itraconazole was very effective as a follow-up treatment in terms of prevention of recurrence. CONCLUSION Histoplasmosis only rarely affects HIV-seronegative patients; however, the possibility of hidden immunodepression should be considered when oral manifestations of histoplasmosis are present.
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Stanford TW, Rivera-Hidalgo F. Oral mucosal lesions caused by infective microorganisms. II. Fungi and parasites. Periodontol 2000 1999; 21:125-44. [PMID: 10551179 DOI: 10.1111/j.1600-0757.1999.tb00172.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- T W Stanford
- Department of Periodontics, Baylor College of Dentistry, Texas A&M University System, Dallas, USA
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Economopoulou P, Laskaris G, Kittas C. Oral histoplasmosis as an indicator of HIV infection. ORAL SURGERY, ORAL MEDICINE, ORAL PATHOLOGY, ORAL RADIOLOGY, AND ENDODONTICS 1998; 86:203-6. [PMID: 9720097 DOI: 10.1016/s1079-2104(98)90126-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Histoplasmosis as a serious opportunistic infection in association with AIDS has assumed considerable importance. We have gathered 20 case reports from the literature of oral histoplasmosis in HIV-infected patients. In some cases, oral lesions appear to be the primary or only manifestation of disease. We report one such case of oral histoplasmosis in a bisexual man who was seen with ulcerations on the palate and proved to be infected by HIV.
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São Thiago PDT, Santos JID, Steindel M. Histoplasmose em região de palato duro simulando lesão causada por Leishmania. Rev Soc Bras Med Trop 1998. [DOI: 10.1590/s0037-86821998000200009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Os autores relatam um caso de histoplasmose em indivíduo com suspeita clínica de leishmaniose mucosa. A infecção por Leishmania foi descartada, pela negatividade do teste de Montenegro e ausência do parasita. O diagnóstico de histoplasmose foi confirmado pelo encontro do fungo na lesão e o seu isolamento em Ágar-Sabouraud. O tratamento do paciente com anfotericina B resultou na remissão da lesão.
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Angius AG, Viviani MA, Muratori S, Cusini M, Brignolo L, Alessi E. Disseminated histoplasmosis presenting with cutaneous lesions in a patient with acquired immunodeficiency syndrome. J Eur Acad Dermatol Venereol 1998. [DOI: 10.1111/j.1468-3083.1998.tb00724.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Casariego Z, Kelly GR, Perez H, Cahn P, Guelfan L, Kaufman S, Scully C. Disseminated histoplasmosis with orofacial involvement in HIV-I-infected patients with AIDS: manifestations and treatment. Oral Dis 1997; 3:184-7. [PMID: 9467363 DOI: 10.1111/j.1601-0825.1997.tb00033.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Histoplasmosis is a deep mycosis which is increasingly seen in HIV disease. It has emerged as a relatively common infection in Argentina, mainly in HIV-infected and other immunocompromised persons, and is often disseminated (DH). OBJECTIVE The aim of this study was to describe 32 HIV-I-seropositive patients with AIDS who had DH, 21 of whom presented orofacial manifestations, and their treatment. SUBJECTS AND METHODS A retrospective study of 876 HIV-seropositive patients revealed 32 with a clinical diagnosis of DH confirmed by special stains on histopathologic specimens, or by culture. RESULTS Thirty-two HIV-infected patients had DH. Two-thirds (21 patients) had oral lesions of histoplasmosis, of which six presented with oral cavity (OC) lesions as the sole orofacial manifestation of disease, nine patients presented oral and facial (OF) lesions and six presented facial lesions only. A unique case of submandibular histoplasmosis is also reported. Antifungal therapy cleared more than 90% of the orofacial and disseminated lesions of histoplasmosis. Over the 7-year period there was a mortality of 85%. CONCLUSION DH should be considered as a possible diagnosis in HIV patients with chronic ulcerative or nodular orofacial or oral lesions. Itraconazole is an effective and acceptable therapy.
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Affiliation(s)
- Z Casariego
- Department of Infectology, Fernandez Hospital, Buenos Aires, Argentina
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Abstract
The deep mycoses are uncommon infections, usually acquired from the inhalation or ingestion of fungal spores, sometimes from the soil in areas of endemicity, such as in the Americas and south-east Asia, or from decaying vegetable matter. They are also seen in immunocompromised persons and, increasingly, in HIV-infected persons. Respiratory involvement is frequent, with granuloma formation, and mucocutaneous involvement may be seen. Oral lesions of the deep mycoses are typically chronic but non-specific, though nodular or ulcerative appearances are common. Person-to-person transmission is rare. In HIV disease, the most common orofacial involvement of deep mycoses has been in histoplasmosis, cryptococcosis, aspergillosis and zygomycosis. Diagnosis is usually confirmed by lesional biopsy although culture may also be valuable. Treatment is with amphotericin or an azole.
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Affiliation(s)
- C Scully
- Eastman Dental Institute and Hospital for Oral Health Care Sciences, London, UK
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