RESUMEN
The burden of histoplasmosis has been poorly documented in most of the endemic areas for the disease, including Brazil. Also, modern non-culture-based diagnostic tests are often non-available in these regions. This was a prospective cohort study in HIV-infected patients with suspected disseminated disease evaluated with different diagnostic tests. Patients were enrolled in three referral medical centres in Porto Alegre, Brazil. Among 78 evaluated patients, disseminated histoplasmosis was confirmed in eight individuals (10.3%) by the means of classical (culture/histopathology) tests. Antigen detection in the urine was found to be more sensitive: IMMY® ALPHA ELISA detected 13 positive cases (16.7%) and the in-house ELISA test developed by the Centers for Disease Prevention and Control (CDC) detected 14 (17.9%). IMMY® and CDC tests provided concordant results in 96.2% of cases. This is the first study to compare the performance of the in-house CDC ELISA test with the IMMY® commercial test for the diagnosis of histoplasmosis, and a high degree of concordance was observed. The study revealed that H. capsulatum is an important agent of disseminated disease in AIDS patients in Brazil, reinforcing the importance of making available modern diagnostic tests as well as safer antifungal agents for the treatment of histoplasmosis.
Asunto(s)
Síndrome de Inmunodeficiencia Adquirida/diagnóstico , Pruebas Diagnósticas de Rutina/métodos , Histoplasmosis/sangre , Histoplasmosis/diagnóstico , Síndrome de Inmunodeficiencia Adquirida/complicaciones , Síndrome de Inmunodeficiencia Adquirida/epidemiología , Síndrome de Inmunodeficiencia Adquirida/inmunología , Adulto , Antígenos Fúngicos/orina , Brasil/epidemiología , Estudios de Cohortes , Ensayo de Inmunoadsorción Enzimática/métodos , Femenino , Infecciones por VIH/sangre , Infecciones por VIH/epidemiología , Infecciones por VIH/microbiología , Infecciones por VIH/virología , Histoplasma/inmunología , Histoplasmosis/epidemiología , Histoplasmosis/inmunología , Humanos , Inmunoensayo/métodos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Sensibilidad y Especificidad , Centros de Atención TerciariaRESUMEN
The aim was to evaluate the effect of control selection on risk factor analysis for extended-spectrum beta-lactamase-producing Klebsiella pneumoniae (ESBL-KP) infections. Four contemporaneous case-control studies were conducted prospectively with 372 patients: Study 1 (ESBL-KP-infected vs non-infected); Study 2 (ESBL-KP-infected vs non-ESBL-KP-infected); Study 3 (all KP-infected vs non-infected); Study 4 (non-ESBL-KP-infected vs non-infected). Time at risk (TAR, i.e. duration of hospital stay) was the most significant risk factor [Study 1: odds ratio (OR): 5.74 (95% CI: 2.26-14.59; P<0.001); Study 2: 3.52 (1.47-8.43; P=0.005); Study 3: 2.68 (1.57-4.58; P<0.001)]; central venous catheterisation (CVC) was a risk factor in Study 1: 5.31 (1.67-16.82; P=0.005) and Study 3: 2.10 (1.04-4.27; P=0.04). Prior use of cephalosporins (PUC) was a risk factor only in studies with non-infected patients as controls [Study 1: 5.64 (1.90-16.72; P=0.002) and Study 3: 4.60 (2.09-10.13; P<0.001)]. The ORs were uniformly lower with 'non-ESBL-KP-infected' (TAR: 3.52; CVC: 2.07; PUC: 1.97) compared with 'non-infected' patients (TAR: 5.74; CVC: 5.31; PUC: 5.64) as control groups. Selection of control patients has a crucial role in the evaluation of risk factors for ESBL-KP infections. A consistent underestimation of the magnitude of the risk factors is observed when the control group is defined by the non-ESBL-KP-infected patients.
