Disseminated Histoplasmosis in Costa Rica and the Use of Amphotericin B deoxycholate and Fluconazole as First Line of Theraphy

M. A. Villalobos, S. M. Rodriguez

Author address: 

Hosp. San Juan De Dios, San Jose, COSTA RICA

Abstract: 

Background: The histoplasmosis is an infectious disease caused by the dimorphic fungus Histoplasma capsulatum, particularly in those with deficience in their celular inmunity like 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. In Costa Rica in order to avoid drug interactions with other medications like antiretrovirals we use Amphotericin B deoxycholate switched to fluconazole as first line of therapy in our institution. Methods: We made a retrospective study with the histoplasmosis positive cases in 2008 to 2012 attended in the Hospital San Juan de Dios. We founded 36 cases, and for archive technical reasons we only had access to review 15 clinical records. This study count with 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: We present 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. The mean 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. HAART was started later the histoplasmosis diagnosis to 84% of the cases with a mean of 73 days. The 15 patients have acute progressive disseminated histoplasmosis as clinical presentation, and two also have intestinal involve. The induction treatment was Amphotericin B deoxycholate for 14 patients. The mean of acumulated dose was 520 mg administrated in 16 days. The consolidation phase was given in 11 patiens with fluconazole at dose of 400 mg/day along a mean of 4,6 months. Only two patients had a histoplasmosis relapse and both also with HAART desertion.Conclusions: In this 15 histoplasmosis cases atended in a public hospital in Costa Rica, mostly with HIV, we 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.
2013

abstract No: 

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Full conference title: 

53rd Interscience Conference on Antimicrobial Agents and Chemotherapy
    • ICAAC, 53rd (2013)