组织胞浆菌病在全球范围内提出了重大的临床挑战,在南美洲特别流行,特别是在并发人类免疫缺陷病毒(HIV)感染的患者中。尽管伊曲康唑已确立疗效,研究替代治疗方法仍然势在必行。这是我们地区迄今为止最大的研究,评估探索较少的泊沙康唑治疗的有效性。这项观察性研究,2016年至2022年在ValledelLili基金会(FVL)进行,包括患有播散性组织胞浆菌病的成年人。患者(n=31)接受脂质体两性霉素B作为初始治疗,然后用泊沙康唑或伊曲康唑进行巩固治疗。单器官病例的患者,那些缺乏微生物诊断的人,那些接受非脂质体两性霉素B的抗真菌药物初始治疗和那些<6个月随访的患者被排除在外(图1)分析考虑了人群特征,治疗,和结果。患者(平均年龄:45.6岁;58.1%为女性)有常见的合并症(HIV38.7%,实体器官移植29%和肿瘤疾病12.9%)。肺部(48.4%)和淋巴结(16.1%)普遍受到影响。活检(64.5%)是主要的诊断方法。使用脂质体两性霉素B(100%)的初始治疗平均14天。随访表明71%完成,19.4%需要修改治疗。值得注意的是,70.9%的人平均在350天内得出泊沙康唑巩固方案。合并期间的药物相互作用很常见(80.6%)。没有复发,报告了3例与组织胞浆菌病无关的死亡。传统上,伊曲康唑一直是普遍的初始治疗方法;然而,在我们的队列中,55.9%的患者接受泊沙康唑作为主要选择。令人鼓舞的是,泊沙康唑表现出良好的耐受性,感染分辨率,提示其作为巩固治疗的有效和耐受性良好的替代方案的潜力。这一发现促使进一步探索泊沙康唑,可能导致更有效的患者护理和更好的结果。
组织胞浆菌病在南美是一个至关重要的问题,特别是在艾滋病毒患者中,导致高死亡率。这项研究,我们地区最大的,研究泊沙康唑作为伊曲康唑替代疗法的有效性。结果为增强患者护理和改善预后提供了潜力。
Histoplasmosis presents a substantial clinical challenge globally, with a particular prevalence in South America, especially among patients with concurrent Human Immunodeficiency Virus (HIV) infection. Despite itraconazole\'s established efficacy, investigating alternative therapeutic approaches remains imperative. This is the largest study in our region to date, assessing the effectiveness of the less explored posaconazole treatment. This observational study, conducted at Fundación Valle del Lili (FVL) from 2016 to 2022, encompassed adults with disseminated histoplasmosis. Patients (n = 31) were treated with liposomal amphotericin B as an initial treatment, followed by consolidation treatment with posaconazole or itraconazole. Patients with single-organ cases, those lacking microbiological diagnosis, those who received initial treatment with antifungals other than liposomal Amphotericin B and those with < 6 months follow-up were excluded (Figure 1). Analyses considered population characteristics, treatments, and outcomes. Patients (average age: 45.6; 58.1% female) had common comorbidities (HIV 38.7%, solid organ transplantation 29% and oncologic disease 12.9%). Lungs (48.4%) and lymph nodes (16.1%) were commonly affected. Biopsy (64.5%) was the primary diagnostic method. Initial treatment with liposomal amphotericin B (100%) was given for 14 days on average. Follow-up indicated 71% completion with 19.4% requiring treatment modifications. Notably, 70.9% completed a posaconazole consolidation regimen over 350 days on average. Drug interactions during consolidation (80.6%) were common. No relapses occurred, and three deaths unrelated to histoplasmosis were reported. Traditionally, itraconazole has been the prevalent initial treatment; however, in our cohort, 55.9% of patients received posaconazole as the primary option. Encouragingly, posaconazole showed favorable tolerance and infection resolution, suggesting its potential as an effective and well-tolerated alternative for consolidation treatment. This finding prompts further exploration of posaconazole, potentially leading to more effective patient care and better outcomes.
Histoplasmosis is a critical concern in South America, notably among human immunodeficiency virus patients, leading to high mortality rates. This study, the largest in our region, investigates the effectiveness of posaconazole as an alternative treatment to itraconazole. The results offer the potential for enhanced patient care and improved outcomes.