Infecção por histoplasma capsulatum em profissionais e estudantes de instituições de saúde de Fortaleza

Abstract

Histoplasmosis is a systemic mycosis caused by the fungus Histoplasma capsulatum that affects humans and various animal species. The fungus is found in nature, especially in places rich in bird and bat droppings. About 90% of individuals who become infected do not get sick, or if they do have clinical manifestations meaningless. Despite the state of Ceará come with one of the largest series of histoplasmosis in patients with aids in the world, few studies have addressed the epidemiology, risk factors and frequency of this fungus in this state. This study aims to evaluate the prevalence of infection by H. capsulatum health professionals and students from three institutions of Fortaleza (two hospitals and a referral center for outpatient) and identify factors associated with the acquisition of the fungus. Were examined 248 professionals and 31 students in the period from June 17, 2010 to March 31 2011, through the application of intradermal test with 0.1 ml of 1:1000 solution of histoplasmin and performing for Histoplasma immunodiffusion. Reading was held between 48 and 72 hours, and considered positive the presence of ≥ 5 mm induration. Mean age of the study population was 43.46 years, the majority of participants belonged to females (74.19%) had a family income of one to three minimum wages (36.9%) studied over 12 years (45.9%) and resided at home (69,9%). Prevalence of histoplasmosis infection in the sample was 20.78% and the positivity of the immunodiffusion test was 0.35%. Presence of bats in residence at today (RP = 1.76, 95% CI 1.03 to 2.99), presence of tree mango (Mangifera indica) in residence today (RP = 1.72, 95% CI 1.02 to 2.89) , being a student (RP = 2.07, 95% CI 1.07 to 4.03) were associated with positive testing, while having age above 40 years (RP = 0.43, 95% CI = 0.25 to 0.72) and the presence of pigeons in the present work showed a negative association (RP = 0.61, 95% CI 0.37 to 0.99) intradermal skin test reactivity. Analyzing gender, men showed statistical significance for the presence of bat the residence today (RP = 2.91, 95% CI 1.34 to 6.33), presence of mango tree in residence today (RP = 2.91, 95% CI 1.34 to 6.33) and women for the presence of bats in the neighborhood in the past (RP = 1.86, CI: 1.07 to 3.22) and negative association between age group of 41 years and over (RP = 0.27, 95% CI 0.15 to 0.49). Was found an association between being a student and the following variables: presence of bats in the neighborhood today (RP = 2.1, 95% CI 1.26 to 4.40) and in the past (RP= 2.4, 95% CI 1.18 to 4.85), visit the site today (RP = 3.84; 95% CI = 2.03 to 7.22) and in the past (RP = 2.4, 95% CI 1.57 to 3.65). It can be concluded that the city of Fortaleza is up area with high prevalence of Histoplasma infection and conditions associated with the presence of bats is more often associated with infection by the fungus.