Resumen
La histoplasmosis cerebral primaria es poco frecuente, en la mayoría de los casos se presenta en forma secundaria a la diseminación desde un foco primario pulmonar. El histoplasma es un hongo dimórfico y endémico que ha sido identificado en Estados Unidos, Canadá, México, Centro y Sudamérica, y es menos común en África, Asia y Europa. La infección se produce por la inhalación inadvertida de las conidias contenidas en los cuerpos fructíferos; el pulmón es el sitio de infección primaria. De las infecciones documentadas por histoplasma en individuos inmunocompetentes, entre el 50 % y el 90 % son asintomáticas, y de las infecciones sintomáticas, el 80 % no requiere terapia y resuelve en forma espontánea; sin embargo, el histoplasma puede diseminarse por toda la economía, incluyendo el sistema nervioso central (SNC). La presentación clínica de histoplasmosis con compromiso del SNC es inespecífica y puede simular otras patologías más comunes. El diagnóstico es particularmente difícil en casos en los que solamente se presenta compromiso aislado del SNC. La histoplasmosis diseminada conlleva un alto riesgo de mortalidad; el tratamiento consta de una fase de inducción seguida de una fase de mantenimiento.
Citas
Darling ST. A protozoon general infection producing pseudotubercles in the lungs and focal necrosis in the liver, spleen, and lymph nodes. JAMA. 1906; 1283-5.
Dodd K, Tompkins E. A case of histoplasmosis of darling in an infant. Am J Trop Med. 1934;14:127-37.
Wheat LJ, Azar MM, Bahr NC, Spec A, Relich RF, Hage C. Histoplasmosis. Infect Dis Clin North Am. 2016;30(1):207-27. doi: 10.1016/j.idc.2015.10.009.
Saccente M, McDonnell RW, Baddour LM, Mathis MJ, Brad-sher RW Cerebral histoplasmosis in the azole era: report of four cases and review. South Med J. 2003;96(4):410-6. doi: 10.1097/01.SMJ.0000051734.53654.
Riddell J 4th, Wheat LJ. Central nervous system infection with histoplasma capsulatum. J Fungi (Basel). 2019;5(3):70. doi: 10.3390/jof5030070.
Nyalakonda H, Albuerne M, Suazo Hernandez LP, Sarria JC. Central Nervous system histoplasmosis in acquired immunodeficiency syndrome. Am J Med Sci. 2016;351(2):177-86. doi: 10.1016/j.amjms.2015.11.016.
Wheat J, Myint T, Guo Y, Kemmer P, Hage C, Terry C, Azar MM, Riddell J, Ender P, Chen S, et al. Central nervous system histoplasmosis: multicenter retrospective study on clinical features, diagnostic approach and outcome of treatment. Medicine (Baltimore). 2018;97(13):e0245. doi: 10.1097/MD.0000000000010245. Erratum in: Medicine (Baltimore). 2018 Apr;97(16):e0537.
Berger JR, Greenberg RN. Isolated central nervous system histoplasmosis in an immunocompetent patient: 53-month hiatus to diagnosis and treatment. J Neurovirol. 2010;16(6):472-4. doi: 10.1007/BF03210853.
Bloch KC, Myint T, Raymond-Guillen L, Hage CA, Davis TE, Wright, et al. Improvement in diagnosis of histoplasma meningitis by combined testing for histoplasma antigen and immunoglobulin g and immunoglobulin m anti-histoplasma antibody in cerebrospinal fluid. Clin Infect Dis. 2018;66(1) :89-94. doi: 10.1093/cid/cix706.
Muñoz CO, Cano LE, González A. Detección e identificación de Histoplasma capsulatum por el laboratorio: de los métodos convencionales a las pruebas moleculares. Infect. 2010;14 Suppl 2: S145-58.
Schestatsky P, Chedid MF, Amaral OB, Unis G, Oliveira FM, Severo LC. Isolated central nervous system histoplasmosis in immunocompetent hosts: A series of 11 cases. Scand J Infect Dis. 2006;38(1):43-8. doi: 10.1080/00365540500372895.
Starkey J, Moritani T, Kirby P. MRI of CNS fungal infections: review of aspergillosis to histoplasmosis and everything in between. Clin Neuroradiol. 2014;24(3):217-30. doi: 10.1007/s00062-014-0305-7.
Kauffman CA. Histoplasmosis: a clinical and laboratory update. Clin Microbiol Rev. 2007;20(1):115-32. doi: 10.1128/CMR.00027-06.
Rangel-Castilla L, Hwang SW, White AC, Zhang YJ. Neuroendoscopic diagnosis of central nervous system histoplasmosis with basilar arachnoiditis. World Neurosurg. 2012;77(2):399. E9-13. doi: 10.1016/j.wneu.2011.06.016.
Hariri OR, Minasian T, Quadri SA, Dyurgerova A, Farr S, Miulli DE, Siddiqi J. Histoplasmosis with deep CNS involvement: case presentation with discussion and literature review J Neurol Surg Rep. 2015;76(1):e167-72. doi: 10.1055/s-0035-1554932.
Wheat LJ, Musial CE, Jenny-Avital E. Diagnosis and management of central nervous system histoplasmosis. Clin Infect Dis. 2005;40(6):844-52. doi: 10.1086/427880.
Ranganath S, McGhie TA, LaRosa S, Lehman W, Fader R. Clinical and laboratory diagnosis of central nervous system histoplasmosis. Am J Med. 2012;125(10):e1-2. doi: 10.1016/j.amjmed.2011.12.011.
Carod-Artal F, Venturini M, Gomes E, de Mello M. Histoplasmosis crónica del sistema nervioso central en un paciente inmunocompetente. Neurología. 2008;23(4):263-8.
Veeravagu A, Ludwig C, Camara-Quintana JQ, Jiang B, Lad N, Shuer L. Fungal infection of a ventriculoperitoneal shunt: histoplasmosis diagnosis and treatment. World Neurosurg. 2013;80(1-2):222.e5-13. doi: 10.1016/j.wneu.2012.12.016.
Abdulla MC, Narayan R , Mampilly N , Kumar P. Subdural empyema in disseminated histoplasmosis. Ann Indian Acad Neurol. 2017;20(4):414-5. doi: 10.4103/aian.AIAN_306_17.
Kaplan JE, Benson C, Holmes KK, Brooks JT, Pau A, Masur H, et al. Guidelines for prevention and treatment of opportunistic infections in HIV-infected adults and adolescents. MMWR Recomm Rep. 2018;58(4):1-207. Disponible en: https://wwwidsociety.org/practice-guideline/prevention-and-treatment-of-opportunistic-infections-among-adults-and-adolescents/
Nacher M, Adenis A, Basurko C, Vantilcke V, Blanchet D, Aznar C, Carme B, Couppié P. Primary prophylaxis of disseminated histoplasmosis in HIV patients in French Guiana: arguments for cost effectiveness. Am J Trop Med Hyg. 2013;89(6):1195-8. doi: 10.4269/ajtmh.13-0082.
McKinsey DS. Histoplasmosis in AIDS: advances in management. AIDS Patient Care STDS. 1998;12(10):775-81. doi: 10.1089/apc.1998.12.775.
Baddley JW, Sankara IR, Rodriquez JM, Pappas PG, Many WJ Jr. Histoplasmosis in HIV-infected patients in a southern regional medical center: poor prognosis in the era of highly active antiretroviral therapy. Diagn Microbiol Infect Dis. 2008;62(2):151-6. doi: 10.1016/j.diagmicrobio.2008.05.006.
Wheat LJ, Freifeld AG, Kleiman MB, Baddley JW, McKinsey DS, Loyd JE, Kauffman CA; Infectious Diseases Society of America. Clinical practice guidelines for the management of patients with histoplasmosis: 2007 update by the Infectious Diseases Society of America. Clin Infect Dis. 2007;45(7):807-25. doi: 10.1086/521259.
Johnson PC, Wheat LJ, Cloud GA, Goldman M, Lancaster D, Bamberger DM, Powderly WG, Hafner R, Kauffman CA, Dismukes WE; U.S. National Institute of Allergy and Infectious Diseases Mycoses Study Group. 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(2):105-9. doi: 10.7326/0003-4819-137-2-200207160-00008.
Murray M, Hine P. Treating progressive disseminated histoplasmosis in people living with HIV. Cochrane Database Syst Rev. 2020;4(4):CD013594. doi: 10.1002/14651858.CD013594.
Groll AH, Giri N, Petraitis V, Petraitiene R, Candelario M, Bacher JS, et al. Comparative efficacy and distribution of lipid formulations of amphotericin B in experimental Candida al-bicans infection of the central nervous system. J Infect Dis. 2000;182(1):274-82. doi: 10.1086/315643.
Hamill RJ. Amphotericin B formulations: a comparative review of efficacy and toxicity. Drugs. 2013;73(9):919-34. doi: 10.1007/s40265-013-0069-4.
Freifeld A, Proia L, Andes D, Baddour LM, Blair J, Spellberg B, Arnold S, Lentnek A, Wheat LJ. Voriconazole use for endemic fungal infections. Antimicrob Agents Chemother. 2009,53(4):1648-51. doi: 10.1128/AAC.01148-07.
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(3):223-32. doi: 10.1016/s0002-9343(97)00151-4.
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 HIV: a 20-year case series and literature review. Clin Infect Dis. 2020;70(4):643-52. doi: 10.1093/cid/ciz247.
Negroni R, Messina F, Arechavala A, Santiso G, Bianchi M. Eficacia del tratamiento y de la profilaxis antifúngica secundaria en la histoplasmosis asociada al sida. Experiencia del Hospital de Infecciosas Francisco J. Muñiz. Rev Iberoam Micol. 2017;34(2):94-8. doi: 10.1016/j.riam.2016.10.002.
Negroni R. Micosis sistémicas tropicales asociadas al sida. Enf Emerg. 2003;5(1):27-40. Disponible en: http://enfermedadesemergentes.com/articulos/a137/s-5-1-007.pdf
Negroni R, Helou SH, López-Daneri G, Robles AM, Arechavala AI, Bianchi MH. Interrupción de la profilaxis secundaria antifúngica en la histoplasmosis asociada al sida. Rev Iberoam Micol. 2004;21(2):75-8.
Tobón ÁM. Protocolo de estudio y manejo de histoplasmosis. Infectio. 2012;16:126-8. doi: 10.1016/S0123-9392(12)70039-5.
Esta obra está bajo una licencia internacional Creative Commons Atribución-NoComercial-SinDerivadas 4.0.