Open forum infectious diseases · 2025
Development of a Diagnostic Score for Histoplasmosis in a Cohort of Patients With HIV.
СтатьяНазвание и аннотация: Перевод в очереди
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Hoyos Pulgarín Julián Andrés, Moreno Gómez Germán Alberto, Atehortua Otero Miguel Ángel, Cortés Isabella, Jaramillo Heredia Alexander
Аннотация
BACKGROUND: Disseminated histoplasmosis is more common in patients with impaired immune function, with HIV infection being a recognized risk factor for its development. In this patient group, diagnosis poses a challenge due to the nonspecific clinical picture. We aimed to develop a diagnostic predictive scale for disseminated histoplasmosis in patients with HIV.
METHODS: We analyzed records from 2 tertiary institutions in the city of Pereira between May 2014 and December 2022. We selected 313 cases of HIV: 90 patients were diagnosed with histoplasmosis and 223 with other opportunistic infections.
RESULTS: Variables associated with the diagnosis of histoplasmosis were hemoglobin <10 g/dL (odds ratio [OR], 2.0; 95% CI, 1.0-4.2; P = .039), leukopenia (OR, 2.2; 95% CI, 1.1-4.2; P = .019), elevated lactate dehydrogenase (OR, 2.2; 95% CI, 1.0-4.5; P = .034), an aspartate transaminase/alanine transaminase ratio >2 (OR, 3.8; 95% CI, 2.0-7.4; P < .001), and a CD4+ lymphocyte count <50 cells/μL (OR, 2.4; 95% CI, 1.2-4.6; P = .011). With these parameters, a diagnostic predictive scale was developed. With a cutoff of ≥4 points, it correctly classified 76.7% of cases with a sensitivity of 62.3% and a specificity of 82.9%, with adequate accuracy demonstrated by an area under the receiver operating characteristic curve of 78%.
CONCLUSIONS: This study proposes a simple and cost-effective tool that facilitates timely diagnosis and treatment of histoplasmosis in patients with HIV.
METHODS: We analyzed records from 2 tertiary institutions in the city of Pereira between May 2014 and December 2022. We selected 313 cases of HIV: 90 patients were diagnosed with histoplasmosis and 223 with other opportunistic infections.
RESULTS: Variables associated with the diagnosis of histoplasmosis were hemoglobin <10 g/dL (odds ratio [OR], 2.0; 95% CI, 1.0-4.2; P = .039), leukopenia (OR, 2.2; 95% CI, 1.1-4.2; P = .019), elevated lactate dehydrogenase (OR, 2.2; 95% CI, 1.0-4.5; P = .034), an aspartate transaminase/alanine transaminase ratio >2 (OR, 3.8; 95% CI, 2.0-7.4; P < .001), and a CD4+ lymphocyte count <50 cells/μL (OR, 2.4; 95% CI, 1.2-4.6; P = .011). With these parameters, a diagnostic predictive scale was developed. With a cutoff of ≥4 points, it correctly classified 76.7% of cases with a sensitivity of 62.3% and a specificity of 82.9%, with adequate accuracy demonstrated by an area under the receiver operating characteristic curve of 78%.
CONCLUSIONS: This study proposes a simple and cost-effective tool that facilitates timely diagnosis and treatment of histoplasmosis in patients with HIV.