PREVALÊNCIA E EVOLUÇÃO DE MICOSES PULMONARES E SISTÊMICAS EM PACIENTES COM AIDS E IMUNOSSUPRESSÃO GRAVE EM MATO GROSSO DO SUL

Abstract

Pulmonary and systemic fungal diseases constitute a significant public health problem, especially in people living with HIV/AIDS (PLWHA) in advanced stages of immunosuppression. These infections present high morbidity and mortality, since they are frequently diagnosed and treated late or inadequately. This is due to nonspecific clinical manifestations, the unavailability of accurate diagnostic methods, and limited access to first-line antifungals. This study investigated the frequency and clinical evolution of cryptococcosis, histoplasmosis, pneumocystosis (PCP), chronic pulmonary aspergillosis (CPA), and paracoccidioidomycosis (PCM) in a cohort of 232 AIDS patients with CD4⁺ counts ≤ 200 cells/mm³ treated at a reference hospital in Mato Grosso do Sul. The sample was predominantly composed of men (68.5%) and people who self-identified as mixed-race or black (74.6%). Almost half had low levels of education (42.6%) and a monthly income equal to or less than one minimum wage (48.8%), highlighting significant social vulnerability. The median CD4⁺ cell count was 59.5 cells/mm³ and the median viral load was 4.56 log/mL, reflecting late diagnosis and/or immunological and virological failure. The overall mortality rate at six months was 15.9%, concentrated in the first weeks after admission, and a low rate of immunological recovery was observed among survivors. Cryptococcosis was diagnosed in 35 patients (15.1%), with a mortality rate of 20%. Headache (p=0.001), disorientation (p=0.003), and diplopia (p=0.002) were manifestations associated with its occurrence. PCP had a prevalence of 9.5% and a mortality rate of 22.7%, being diagnosed exclusively by clinical-radiological criteria and in patients with a recent HIV diagnosis. The predominant clinical manifestations were cough and dyspnea (p