Abordagem soroepidemiológica e multifatorial da histoplasmose: uma revisão sistemática

Abstract

Histoplasmosis, a systemic fungal infection caused by Histoplasma capsulatum, is endemic in several regions of the world, especially in the Mississippi and Ohio river valleys (USA) and Latin America. Progressive disseminated histoplasmosis usually occurs in immunocompromised hosts and can lead to death. In endemic areas, histoplasmosis is common among those infected with HIV and is an aids-defining infection. To establish more uniform parameters for and identify possible gaps in serologic methods and prevention and control measures, this work analyzed seroepidemiologic data through a systematic review of seroprevalence studies of antibodies, antigenic targets, techniques, and immunoglobulins used in the disease diagnosis. Relevant studies on the seroepidemiology of histoplasmosis published since 1985 were analyzed. The term “histoplasmosis,” associated with “serology,” “antibodies,” “immunoglobulins,” “antigens,” and “antigenemia,” was searched on the MEDLINE (via PubMed), SciELO, and LILACS platforms, and 2,352 articles were found. Of these, 24 were included after considering the exclusion and inclusion criteria and critical evaluation tool. Demographic, population, and seroprevalence records and serologic diagnostic methods were categorized. Since its notification is not compulsory, histoplasmosis is underdiagnosed in most countries. Mortality may exceed 40% depending on the diagnostic method, treatment, and medical follow-up. MAIN CONCLUSIONS The total burden of this mycosis remains unknown and the diagnosis remains challenging. Unfortunately, it is still a serious public health problem, particularly in HIV-infected individuals, despite highly active antiretroviral therapy (HAART). Seroepidemiologic data support this review, providing a multifactorial view on the search for the best methodology together with standardizations for a better management of histoplasmosis.