Guía de práctica clínica para el diagnóstico y tratamiento de la histoplasmosis en personas adultas que viven con el VIH – versión corta
Contenido principal del artículo
Resumen
La histoplasmosis es la infección fúngica ocasionada, en humanos, por el hongo dimórfico Histoplasma spp. que afecta con mayor frecuencia a personas con compromiso del sistema inmune. En las personas que viven con el virus de la inmunodeficiencia humana (VIH) y se encuentran en un estadio avanzado de la enfermedad, la histoplasmosis es una infección oportunista de gran importancia, debido a su frecuencia de presentación, y consecuente impacto en morbilidad, mortalidad y altos costos. La problemática global de resistencia a los antimicrobianos, a la que contribuye el uso inapropiado o indiscriminado de antifúngicos, ha puesto en la mira a Histoplasma spp., por lo que resulta de importancia generar directrices que permitan orientar el uso adecuado de antifúngicos en el manejo de la histoplasmosis, con el objetivo de obtener mejores desenlaces clínicos y propender por un uso racional de antifúngicos. La presente guía contiene recomendaciones para el diagnóstico y tratamiento de la histoplasmosis en personas adultas que viven con el VIH, basadas en la evidencia, realizadas mediante el proceso de adaptación de guías de práctica clínica internacionales para el contexto colombiano.
Detalles del artículo
Citas
Mittal J, Ponce MG, Gendlina I, Nosanchuk JD. Histoplasma Capsulatum: Mechanisms for Pathogenesis. Curr Top Microbiol Immunol 2019; 422: 157-91. https://doi.org/10.1007/82_2018_114
Caceres DH, Gomez BL, Tobon AM, Restrepo A, Chiller T, Lindsley MD, et al. Tackling Histoplasmosis Infection in People Living with HIV from Latin America: From Diagnostic Strategy to Public Health Solutions. J Fungi (Basel) 2023; 9. https://doi.org/10.3390/jof9050558
Heninger E, Hogan LH, Karman J, Macvilay S, Hill B, Woods JP, et al. Characterization of the Histoplasma capsulatum-induced granuloma. J Immunol 2006; 177: 3303-13. https://doi.org/10.4049/jimmunol.177.5.3303
Prado MKB, Fontanari C, Souza COS, Gardinassi LG, Zoccal KF, de PaulaSilva FWG, et al. IL-22 Promotes IFN-gamma-Mediated Immunity against Histoplasma capsulatum Infection. Biomolecules 2020; 10. https://doi.org/10.3390/biom10060865
Arauz AB, Papineni P. Histoplasmosis. Infect Dis Clin North Am 2021; 35: 471-91. https://doi.org/10.1016/j.idc.2021.03.011
Chen Z, Wang N, Huang Y, Wang M. Clinical characteristics and cerebrospinal fluid cytokine changes in patients with acquired immunodeficiency syndrome and central nervous system infection. Exp Ther Med 2019; 18: 523-30. https://doi.org/10.3892/etm.2019.7587
Sati H, Alastruey-Izquierdo A, Perfect J, Govender NP, Harrison TS, Chiller T, et al. HIV and fungal priority pathogens. Lancet HIV 2023. https://doi.org/10.1016/S2352-3018(23)00174-1
Adenis AA, Valdes A, Cropet C, McCotter OZ, Derado G, Couppie P, et al. Burden of HIV-associated histoplasmosis compared with tuberculosis in Latin America: a modelling study. Lancet Infect Dis 2018; 18: 1150-9. https://doi.org/10.1016/S1473-3099(18)30354-2
Rajasingham R, Medina N, Mousquer GT, Caceres DH, Jordan A, Nacher M, et al. Cost-effectiveness evaluation of routine histoplasmosis screening among people living with advanced HIV disease in Latin America and the Caribbean. PLOS Glob Public Health 2023; 3: e0001861. https://doi.org/10.1371/journal.pgph.0001861
Damasceno LS, Ramos AN, Jr., Alencar CH, Gonçalves MV, de Mesquita JR, Soares AT, et al. Disseminated histoplasmosis in HIV-infected patients: determinants of relapse and mortality in a north-eastern area of Brazil. Mycoses 2014; 57: 406-13. https://doi.org/10.1111/myc.12175
Cherabie J, Mazi P, Rauseo AM, Ayres C, Larson L, Rutjanawech S, et al. Long Term Mortality after Histoplasma Infection in People with HIV. J Fungi (Basel) 2021; 7. https://doi.org/10.3390/jof7050369
Nacher M, Valdes A, Adenis A, Blaizot R, Abboud P, Demar M, et al. Disseminated Histoplasmosis in HIV Infected Patients: A Description of 34 Years of Clinical and Therapeutic Practice. J Fungi (Basel) 2020; 6. https://doi.org/10.3390/jof6030164
Samayoa B, Roy M, Cleveland AA, Medina N, Lau-Bonilla D, Scheel CM, et al. High Mortality and Coinfection in a Prospective Cohort of Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome Patients with Histoplasmosis in Guatemala. Am J Trop Med Hyg 2017; 97: 42-8. https://doi.org/10.4269/ajtmh.16-0009
Cuenta de Alto de Costo (CAC), Fondo Colombiano de Enfermedades de Alto Costo, Cuenta de Alto Costo (CAC). Situación del VIH en Colombia, 2022; Bogotá, D.C. 2023.
Hoyos Pulgarin JA, Alzate Piedrahita JA, Moreno Gomez GA, Sierra Palacio JF, Ordonez KM, Arias Ramos D. Closing gaps in histoplasmosis: clinical characteristics and factors associated with probable/histoplasmosis in HIV/AIDS hospitalized patients, a retrospective cross-sectional study in two tertiary centers in Pereira, Colombia. AIDS Res Ther 2021; 18: 51. https://doi.org/10.1186/s12981-021-00377-5
Denning DW. Antifungal drug resistance: an update. Eur J Hosp Pharm 2022; 29: 109-12. https://doi.org/10.1136/ejhpharm-2020-002604
WHO fungal priority pathogens list to guide research, development and public health action. Geneva: World Health Organization; 2022. Licence: CC BY-NC-SA 3.0 IGO.
Colombia. Ministerio de Salud y Protección Social. Guía Metodológica, Adopción Adaptación de Guías de Práctica Clínica Basadas en Evidencia. Guía metodológica en Internet. Edición 1ª. Bogotá DC. 2017, Disponible en gpc.minsalud.gov.co.
Schunemann HJ, Wiercioch W, Brozek J, Etxeandia-Ikobaltzeta I, Mustafa RA, Manja V, et al. GRADE Evidence to Decision (EtD) frameworks for adoption, adaptation, and de novo development of trustworthy recommendations: GRADE-ADOLOPMENT. J Clin Epidemiol 2017; 81: 101-10. https://doi.org/10.1016/j.jclinepi.2016.09.009
Schunemann HJ, Mustafa R, Brozek J, Santesso N, Alonso-Coello P, Guyatt G, et al. GRADE Guidelines: 16. GRADE evidence to decision frameworks for tests in clinical practice and public health. J Clin Epidemiol 2016; 76: 89-98. https://doi.org/10.1016/j.jclinepi.2016.01.032
WHO. Guidelines for diagnosing and managing disseminated histoplasmosis among people living with HIV. April 2020. ISBN: 978-92-4- 000643-0.
Balshem H, Helfand M, Schunemann HJ, Oxman AD, Kunz R, Brozek J, et al. GRADE guidelines: 3. Rating the quality of evidence. J Clin Epidemiol 2011; 64: 401-6. https://doi.org/10.1016/j.jclinepi.2010.07.015
Gutierrez GC, Pulido Álvarez AC, de la Hoz AM, Alviar KM, Muñoz Velandia ÓM, Guerrero Carvajar R, et al. Guía Metodológica para la elaboración de Guías de Práctica Clínica con Evaluación Económica en el Sistema General de Seguridad Social en Salud Colombiano Bogotá DC: Fundación Santa Fe de Bogotá - Centro de Estudios e Investigación en Salud; 2014.
Andrews J, Guyatt G, Oxman AD, Alderson P, Dahm P, Falck-Ytter Y, et al. GRADE guidelines: 14. Going from evidence to recommendations: the significance and presentation of recommendations. J Clin Epidemiol 2013; 66: 719-25. https://doi.org/10.1016/j.jclinepi.2012.03.013
Caceres DH, Knuth M, Derado G, Lindsley MD. Diagnosis of Progressive Disseminated Histoplasmosis in Advanced HIV: A Meta-Analysis of Assay Analytical Performance. J Fungi (Basel) 2019; 5. https://doi.org/10.3390/jof5030076
Messina FA, Corti M, Negroni R, Arechavala A, Bianchi M, Santiso G. [Histoplasmosis in AIDS patients without tegumentary manifestations]. Rev Chilena Infectol 2018; 35: 560-5. https://doi.org/10.4067/s0716-10182018000500560
Bianchi M, Robles AM, Vitale R, Helou S, Arechavala A, Negroni R. The usefulness of blood culture in diagnosing HIV-related systemic mycoses: evaluation of a manual lysis centrifugation method. Med Mycol 2000; 38: 77-80. https://doi.org/10.1080/mmy.38.1.77.80
Oliveira Fde M, Fernandes SS, Severo CB, Guazzelli LS, Severo LC. Histoplasma capsulatum fungemia in patients with acquired immunodeficiency syndrome: detection by lysis-centrifugation bloodculturing technique. Rev Inst Med Trop Sao Paulo 2007; 49: 135-8. https://doi.org/10.1590/S0036-46652007000300001
Unis G, da Silva VB, Severo LC. [Disseminated histoplasmosis and AIDS. The role of culture medium for the bronchoscopic clinical specimens]. Rev Soc Bras Med Trop 2004; 37: 234-7. https://doi.org/10.1590/S0037-86822004000300008
Arechavala AI, Robles AM, Negroni R, Bianchi MH, Taborda A. [Value of direct and indirect diagnostic methods in systemic mycoses associated with AIDS]. Rev Inst Med Trop Sao Paulo 1993; 35: 163-9. https://doi.org/10.1590/S0036-46651993000200008
Zarabi CM, Thomas R, Adesokan A. Diagnosis of systemic histoplasmosis in patients with AIDS. South Med J 1992; 85: 1171-5. https://doi.org/10.1097/00007611-199212000-00005
Nightingale SD, Parks JM, Pounders SM, Burns DK, Reynolds J, Hernandez JA. Disseminated histoplasmosis in patients with AIDS. South Med J 1990; 83: 624-30. https://doi.org/10.1097/00007611-199006000-00007
Almeida MA, Damasceno LS, Pizzini CV, Muniz MM, Almeida-Paes R, Zancopé-Oliveira RM. Role of western blot assay for the diagnosis of histoplasmosis in AIDS patients from a National Institute of Infectious Diseases in Rio de Janeiro, Brazil. Mycoses 2019; 62: 261-7. https://doi.org/10.1111/myc.12877
Caceres DH, Scheel CM, Tobón AM, Ahlquist Cleveland A, Restrepo A, Brandt ME, et al. Validation of an enzyme-linked immunosorbent assay that detects Histoplasma capsulatum antigenuria in Colombian patients with AIDS for diagnosis and follow-up during therapy. Clin Vaccine Immunol 2014; 21: 1364-8. https://doi.org/10.1128/CVI.00101-14
Scheel CM, Samayoa B, Herrera A, Lindsley MD, Benjamin L, Reed Y, et al. Development and evaluation of an enzyme-linked immunosorbent assay to detect Histoplasma capsulatum antigenuria in immunocompromised patients. Clin Vaccine Immunol 2009; 16: 852-8. https://doi.org/10.1128/CVI.00066-09
Negroni R, Iovannitti C, Arechavala AI, Carnovale S, Euguchi K. [Preparation and study of an exoantigen of Histoplasma capsulatum for serological reactions.]. Rev Iberoam Micol 1998; 15: 282-5.
Guimaraes AJ, Pizzini CV, De Abreu Almeida M, Peralta JM, Nosanchuk JD, Zancopé-Oliveira RM. Evaluation of an enzyme-linked immunosorbent assay using purified, deglycosylated histoplasmin for different clinical manifestations of histoplasmosis. Microbiol Res (Pavia) 2010; 1. https://doi.org/10.4081/mr.2010.e2
Cáceres DH, Samayoa BE, Medina NG, Tobón AM, Guzmán BJ, Mercado D, et al. Multicenter Validation of Commercial Antigenuria Reagents To Diagnose Progressive Disseminated Histoplasmosis in People Living with HIV/AIDS in Two Latin American Countries. J Clin Microbiol 2018; 56. https://doi.org/10.1128/JCM.01959-17
Caceres DH, Minderman MC, Chaney L., Gomez BL, Wheat LJ, Chiller TM Evaluación de un ensayo de flujo lateral del antígeno de histoplasma para el diagnóstico rápido de histoplasmosis progresiva diseminada en pacientes con SIDA. ISHAM 2018. [(consultado el 14 de agosto de 2019)]; Disponible en línea: https://www.morressier.com/article/ evaluación-histoplasma-antigen-lateral-flow-assay-rapid-diagnosisprogressive-disseminate-histoplasmosis-aids-patients/5ac39997d462b8 028d899d7d. https://doi.org/10.26226/morressier.5ac39997d462b8028d 899d7d
Torres González P, Niembro Ortega MD, Martínez Gamboa A, AhumadaTopete VH, Andrade-Villanueva J, Araujo-Meléndez J, et al. Diagnostic accuracy cohort study and clinical value of the Histoplasma urine antigen (ALPHA Histoplasma EIA) for disseminated histoplasmosis among HIV infected patients: A multicenter study. PLoS Negl Trop Dis 2018; 12: e0006872. https://doi.org/10.1371/journal.pntd.0006872
Hoffmann ER, Daboit TC, Paskulin DD, Monteiro AA, Falci DR, Linhares T, et al. Disseminated histoplasmosis and AIDS: a prospective and multicentre study to evaluate the performance of different diagnostic tests. Mycoses 2017; 60: 20-4. https://doi.org/10.1111/myc.12536
Hage CA, Ribes JA, Wengenack NL, Baddour LM, Assi M, McKinsey DS, et al. A multicenter evaluation of tests for diagnosis of histoplasmosis. Clin Infect Dis 2011; 53: 448-54. https://doi.org/10.1093/cid/cir435
Swartzentruber S, LeMonte A, Witt J, Fuller D, Davis T, Hage C, et al. Improved detection of Histoplasma antigenemia following dissociation of immune complexes. Clin Vaccine Immunol 2009; 16: 320-2. https://doi.org/10.1128/CVI.00409-08
Connolly PA, Durkin MM, Lemonte AM, Hackett EJ, Wheat LJ. Detection of histoplasma antigen by a quantitative enzyme immunoassay. Clin Vaccine Immunol 2007; 14: 1587-91. https://doi.org/10.1128/CVI.00071-07
Gomez BL, Figueroa JI, Hamilton AJ, Ortiz BL, Robledo MA, Restrepo A, et al. Development of a novel antigen detection test for histoplasmosis. J Clin Microbiol 1997; 35: 2618-22. https://doi.org/10.1128/jcm.35.10.2618-2622.1997
Durkin MM, Connolly PA, Wheat LJ. Comparison of radioimmunoassay and enzyme-linked immunoassay methods for detection of Histoplasma capsulatum var. capsulatum antigen. J Clin Microbiol 1997; 35: 2252-5. https://doi.org/10.1128/jcm.35.9.2252-2255.1997
Wheat LJ, Connolly-Stringfield P, Williams B, Connolly K, Blair R, Bartlett M, et al. Diagnosis of histoplasmosis in patients with the acquired immunodeficiency syndrome by detection of Histoplasma capsulatum polysaccharide antigen in bronchoalveolar lavage fluid. Am Rev Respir Dis 1992; 145: 1421-4. https://doi.org/10.1164/ajrccm/145.6.1421
Wheat LJ, Connolly-Stringfield P, Kohler RB, Frame PT, Gupta MR. Histoplasma capsulatum polysaccharide antigen detection in diagnosis and management of disseminated histoplasmosis in patients with acquired immunodeficiency syndrome. Am J Med 1989; 87: 396-400. https://doi.org/10.1016/S0002-9343(89)80820-4
Buitrago MJ, Gómez López A, Monzón A, Rodríguez Tudela JL, CuencaEstrella M. [Assessment of a quantitative PCR method for clinical diagnosis of imported histoplasmosis]. Enferm Infecc Microbiol Clin 2007; 25: 16-22. https://doi.org/10.1157/13096748
Gago S, Esteban C, Valero C, Zaragoza O, Puig de la Bellacasa J, Buitrago MJ. A multiplex real-time PCR assay for identification of Pneumocystis jirovecii, Histoplasma capsulatum, and Cryptococcus neoformans/ Cryptococcus gattii in samples from AIDS patients with opportunistic pneumonia. J Clin Microbiol 2014; 52: 1168-76. https://doi.org/10.1128/JCM.02895-13
Toranzo AI, Tiraboschi IN, Fernández N, Ibarra Camou B, Rivas MC, Lee W, et al. [Molecular diagnosis of human histoplasmosis in whole blood samples]. Rev Argent Microbiol 2009; 41: 20-6.
Maubon D, Simon S, Aznar C. Histoplasmosis diagnosis using a polymerase chain reaction method. Application on human samples in French Guiana, South America. Diagn Microbiol Infect Dis 2007; 58: 441-4. https://doi.org/10.1016/j.diagmicrobio.2007.03.008
Buitrago MJ, Berenguer J, Mellado E, Rodríguez Tudela JL, CuencaEstrella M. Detection of imported histoplasmosis in serum of HIV infected patients using a real time PCR based assay. Eur J Clin Microbiol Infect Dis 2006; 25: 665-8. https://doi.org/10.1007/s10096-006-0207-y
Murray M, Hine P. Treating progressive disseminated histoplasmosis in people living with HIV. Cochrane Database Syst Rev 2020; 4: Cd013594. https://doi.org/10.1002/14651858.CD013594
Johnson PC, Wheat LJ, Cloud GA, Goldman M, Lancaster D, Bamberger DM, et al. Safety and efficacy of liposomal amphotericin B compared with conventional amphotericin B for induction therapy of histoplasmosis in patients with AIDS. Ann Intern Med 2002; 137: 105-9. https://doi.org/10.7326/0003-4819-137-2-200207160-00008
Luckett K, Dummer JS, Miller G, Hester S, Thomas L. Histoplasmosis in Patients With Cell Mediated Immunodeficiency: Human Immunodeficiency Virus Infection, Organ Transplantation, and Tumor Necrosis Factor alfa Inhibition. Open Forum Infect Dis 2015; 2: ofu116. https://doi.org/10.1093/ofid/ofu116
Wheat J, MaWhinney S, Hafner R, McKinsey D, Chen D, Korzun A, et al. Treatment of histoplasmosis with fluconazole in patients with acquired immunodeficiency syndrome. National Institute of Allergy and Infectious Diseases Acquired Immunodeficiency Syndrome Clinical Trials Group and Mycoses Study Group. Am J Med 1997; 103: 223-32. https://doi. org/10.1016/S0002-9343(97)00151-4
Hecht FM, Wheat J, Korzun AH, Hafner R, Skahan KJ, Larsen R, et al. Itraconazole maintenance treatment for histoplasmosis in AIDS: a prospective, multicenter trial. J Acquir Immune Defic Syndr Hum Retrovirol 1997; 16: 100-7. https://doi.org/10.1097/00042560-199710010-00005
Goldman M, Zackin R, Fichtenbaum CJ, Skiest DJ, Koletar SL, Hafner R, et al. Safety of discontinuation of maintenance therapy for disseminated histoplasmosis after immunologic response to antiretroviral therapy. Clin Infect Dis 2004; 38: 1485-9. https://doi.org/10.1086/420749
Wheat J, Hafner R, Wulfsohn M, Spencer P, Squires K, Powderly W, et al. Prevention of relapse of histoplasmosis with itraconazole in patients with the acquired immunodeficiency syndrome. Ann Intern Med 1993; 118: 610-6. https://doi.org/10.7326/0003-4819-118-8-199304150-00006
Grant PM, Komarow L, Andersen J, Sereti I, Pahwa S, Lederman MM, et al. Risk factor analyses for immune reconstitution inflammatory syndrome in a randomized study of early vs. deferred ART during an opportunistic infection. PLoS One 2010; 5: e11416. https://doi.org/10.1371/journal.pone.0011416
Melzani A, de Reynal de Saint Michel R, Ntab B, Djossou F, Epelboin L, Nacher M, et al. Incidence and Trends in Immune Reconstitution Inflammatory Syndrome Associated With Histoplasma capsulatum Among People Living With Human Immunodeficiency Virus: A 20-Year Case Series and Literature Review. Clin Infect Dis 2020; 70: 643-52. https://doi.org/10.1093/cid/ciz247
Agudelo CA, Restrepo CA, Molina DA, Tobon AM, Kauffman CA, Murillo C, et al. Tuberculosis and histoplasmosis co-infection in AIDS patients. Am J Trop Med Hyg 2012; 87: 1094-8. https://doi.org/10.4269/ajtmh.2012.12-0292
Drayton J, Dickinson G, Rinaldi MG. Coadministration of rifampin and itraconazole leads to undetectable levels of serum itraconazole. Clin Infect Dis 1994; 18: 266. https://doi.org/10.1093/clinids/18.2.266
WHO consolidated guidelines on tuberculosis. Module 4: treatment - drug-susceptible tuberculosis treatment. Geneva: World Health Organization; 2022. Licence: CC BY-NC-SA 3.0 IGO.
Ministerio de salud y Protección social. Resolución 227 de 2020 por medio de la cual se adoptan los lineamientos técnicos y operativos del Programa Nacional de Prevención y Control de la Tuberculosis - PNPCT en Colombia