Abstract

VILLALOBOS ZUNIGA, Manuel Antonio  and  RODRIGUEZ SANCHEZ, Saúl Mauricio. Treatment efficacy of the disseminated histoplasmosis in Costa Rica with the Use of Amphotericin B deoxycholate and Fluconazole. Report of 15 cases since 2008 to 2012 at the Hospital San Juan de Dios. Medicas UIS [online]. 2014, vol.27, n.3, pp.19-26. ISSN 0121-0319.

Background: histoplasmosis is a fungic infectious disease described for the first time in Panama by the specie Histoplasma capsulatum, a dimorphic fungus endemic from the fluvial valleys from America, the disease is developed in very few persons mostly in those with deficience in their celular inmunity particularly with HIV. The International Guidelines define the first line of therapy against histoplasmosis with Liposomal Amphotericin B therapy until the clinical condition improve, and then switched to itraconazole for at least 12 months. Objetive: to know the characteristics of the patients with histoplasmosis at Hospital San Juan de Dios and to state the value of the combined use of amphotericin B deoxycholate and fluconazole as alternative therapy to liposomal amphotericin and itraconazole. Methods: It was made a retrospective study with histoplasmosis positive cases in 2008 to 2012 attended in the Hospital San Juan de Dios, obtained from laboratory and HIV local group files. It was founded 36 cases, and for archive technical reasons we only had access to review 15 clinical records. This study had the local bioethical and research commission approval. The statistical analysis was made in Excell 2007 through the estimation of absolute and relative frecuencies of the variables of interest. Results: this is the case of 15 patients with the diagnosis of histoplasmosis made by culture and direct observation in bone marrow samples, and only one by biopsy. A 60% were male, the average age of the infection onset nearby 35 years old, 86,7% corresponded to HIV patients among which the mean of lymphocites CD4 was 60 cells/mm³. The 15 patients have acute progressive disseminated histoplasmosis as clinical presentation, and two also have intestinal involve. Only two patients had a histoplasmosis relapse and both with HAART desertion associated. Conclusions: it was founded the combination of Amphotericin B deoxycholate, fluconazole and HAART with good clinical outcome in 86,5% with a year relapse free. This combination of HAART and a second line treatment for histoplsmosis with fluconazole was effective, avoiding the bioavailability issues and drug interactions with the itraconazole, particularly in HIV patients. MÉD.UIS. 2014;27(3):19-26

Keywords : Histoplasmosis; HIV infections; Anti- HIV Agents; Fluconazole; Amphotericin B.

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