Abstract
In Guatemala progressive disseminated histoplasmosis (PDH) is common among patients infected with HIV. A retrospective review of the records of 120 HIV-positive patients admitted to the San Juan de Dios Hospital in Guatemala City during 1984-94 revealed 8 PDH cases (6.7%). All cases involved men 17-35 years of age; 6 men were from farming or cave regions where histoplasmosis is endemic. Clinical findings included hypotension weight loss splenomegaly fatigue fever diarrhea cough and sensory alteration (similar to those found in disseminated tuberculosis patients). The clinical diagnosis was confirmed by blood smear and bone marrow aspirate smear in 6 patients and by postmortem hepatic biopsy results in the 2 patients who died within 48 hours of admission. All patients with PDH died within 10 days of admission. Given the high mortality associated with PDH in Guatemalan HIV patients identification of risk factors is essential to facilitate rapid correct diagnosis. In this series risk factors included immunodepression residence in farming or cave areas and the presence of calcification or perihilar adenopathy on chest radiographs.
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