Dysphagia and Mucosal Lesions Related to Better Outcomes in the Context of Disseminated Histoplasmosis

Disseminated histoplasmosis is an opportunistic infection associated with high morbidity and mortality in patients coinfected with HIV. Although new diagnostic methods exist, they are not yet incorporated into the public health system, limiting options to time-consuming methods that require highly trained professionals (cultures and direct visualization in clinical specimens). In addition to seeking more effective means of diagnosis, it is also of interest to determine the risk of unfavorable outcomes at the first evaluation, especially in resource-limited settings. A retrospective analysis of 92 cases of disseminated histoplasmosis was performed, with 62 patients discharged and 30 deaths during treatment of the fungal infection. Signs and symptoms presented at the initial evaluation of the hospitalization in which the diagnosis occurred were analyzed. Both populations had similar epidemiological characteristics to reduce bias: predominance of male sex (83.9% in the “Discharge” group and 83.3% in the “Death” group); mean age 38.2 years in the first group (median 38) and 39.7 years (median 37.5) among those with unfavorable outcomes. Regarding HIV, patients already had a diagnosis of retroviral infection in 67.7% and 66.7% of cases, respectively. There was no statistical difference regarding fever or weight loss, nor in time from admission to diagnostic determination. Both groups underwent invasive evaluation (myelogram and/or biopsy). However, the prevalence of dysphagia and mucosal lesions showed statistically significant differences: the “Discharge” group had 37.1% and 43.5% for dysphagia and mucosal lesions, whereas the “Death” group had 6.7% and 16.7%, respectively. Chi-square analysis showed p-values of 0.005 and 0.021, with odds ratios of 0.12 and 0.26. The presence of dysphagia or mucosal lesions in the context of histoplasmosis seems to be related to better outcomes (hospital discharge). This finding is of interest given the possibility of using lower doses of amphotericin and/or timely transition to oral medications.