A histoplasmose à considerada a micose endÃmica mais comum em seres humanos, com distribuiÃÃo cosmopolita e significativa incidÃncia no Brasil. Nas Ãltimas dÃcadas, Histoplasma capsulatum tem surgido como patÃgeno oportunista em indivÃduos com distÃrbios da imunidade celular, como aqueles em corticoterapia prolongada, transplantados, imunodeprimidos e principalmente que desenvolveram a sÃndrome da imunideficiÃncia adquirida (aids). A literatura dispÃe de poucos inquÃritos sorolÃgicos sobre a prevalÃncia dessa doenÃa no Brasil, dificultando o conhecimento sobre sua distribuiÃÃo. Nesse contexto, o Estado do Cearà tem-se destacado como Ãrea de elevada notificaÃÃo de casos de Histoplasmose Disseminada (HD) associada a aids no paÃs. A utilizaÃÃo de Sistemas de InformaÃÃes GeogrÃficas (SIG) na SaÃde PÃblica tem auxiliado na compreensÃo do processo saÃde-doenÃa em diversas situaÃÃes, como o planejamento e avaliaÃÃo de aÃÃes de saÃde, definiÃÃo de Ãreas de risco para incidÃncia de doenÃas ou anÃlise de dispersÃo espacial de epidemias. O presente estudo propÃe avaliar a distribuiÃÃo espacial dos casos de HD associada a aids no municÃpio de Fortaleza, CearÃ, ocorridos de 1999 a 2007.Dados sÃciodemogrÃficos e clÃnicos foram coletados em questionÃrio semiestruturado a partir de informaÃÃs contidas no registro do ServiÃo de Arquivo MÃdico e EstatÃstica do Hospital SÃo Josà de DoenÃas Infecciosas (SAME/HSJ), efetuando-se em seguida o georreferenciamento e anÃlise estatÃstica espacial dos casos com auxÃlio do software Terraview 4.0.0, utilizando-se os bairros e regionais (divisÃo polÃtico-administrativa da cidade) como unidades de agregaÃÃo. Foram identificados 238 casos de HD/aids, sendo excluÃdos 86 indivÃduos procedentes de outros municÃpios que nÃo Fortaleza. A razÃo entre os sexos masculino e feminino foi de 1,43, a mÃdia de idade foi de 40,3  12,8 anos, o nÃvel de escolaridade mais freqÃente ficou na faixa entre 4 e 7 anos de estudo (34,9%) e a maioria (53,02%) recebia no mÃximo trÃs salÃrios mÃnimos. Houve predomÃnio de desempregados (13,16%, p= 0.003), com a maioria (38,71%) correspondendo a mulheres. Setenta e cinco (64,7%) dos 116 bairros que compreendem o municÃpio de Fortaleza foram citados pelos pacientes como logradouro atual. A relaÃÃo da nuvem de pontos com mapas de indicadores sÃcioambientais demonstrou associaÃÃo com mÃdia e baixa cobertura de esgotamento sanitÃrio e mÃdio e baixo Ãndice de desenvolvimento humano. O Ãndice de domicÃlios particulares permanentes demonstrou que os casos se agruparam em Ãreas com alta densidade de casas. O presente trabalho à o primeiro estudo associando HD/aids e SIG no municÃpio de Fortaleza, permitindo localizar geograficamente o perfil de morbimortalidade por HD/aids na cidade, indicando Ãreas onde investigaÃÃes e intervenÃÃes sobre essas doenÃas devam acontecer. / Histoplasmosis is considered the most common endemic mycosis in humans, with acosmopolitan distribution and significant impact in Brazil. In recent decades, Histoplasma capsulatum has emerged as an opportunistic pathogen in individuals with impaired cellular immunity such as patients on prolonged corticosteroid therapy, transplant recipients, and immune compromised patients who developed acquire dimunideficiÃncia syndrome (AIDS). The published literature has few serological surveys on the prevalence of this disease in Brazil and little is known about its distribution; in this context, the State of Cearà has been identified as an area of high prevalence of cases of disseminated histoplasmosis (DH) associated with AIDS in this country. The use of Geographic Information Systems (GIS) in Public Health has aimed to understand the health-disease process in many situations, such as planning and evaluation of health actions, definition of risk areas for disease incidence or analysis of spatial dispersion epidemics. The goal of this study was to evaluate the spatial distribution of DH associated with AIDS cases from 1999 to 2007 in Fortaleza, CearÃ. The spatial analysis of DH / AIDS cases was based on medical records information obtained from the Medical and Statistics File System of the SÃo Josà Hospital of Infectious Diseases (SAME / HSJ) . Demographic and clinical data were collected in semi-structured questionnaires to characterize the population studied, and in sequence the geo referencing and spatial statistical analysis of cases was performed through the software Terra view 4.0.0, utilizing the districts as the aggregation units. We identified 238 cases of HD / AIDS; 86 individuals were from other municipalities and excluded. The males/females ratio was 1.43, the mean age was 40.3  12.8 years, the education level was more frequent in the range of 4 to 7 years of study (34.9% ) and most (53.02%) received up to 3 minimum wages. There was a predominance of unemployed (13.16%, p = 0.003) and the majority of them (38.71%) was women. Seventy-five (64.7%) of the 116 districts that comprise the city of Fortaleza were cited as home address by the patients. The analysis of Kernel maps with the social-environmental indicators showed an association with a medium and low sanitation coverage and medium and low Human Developing Index. The cases were clustered in areas with high density of houses. This is the first study associating DH / AIDS and GIS in Fortaleza, allowing the geographic localization of morbidity and mortality profile of DH / AIDS in this city, indicating areas where specific investigations and interventions should be carried out.

Untreated human immunodeficiency virus (HIV) can be complicated by opportunistic infections, including disseminated histoplasmosis (DH). Although endemic to portions of the United States and usually benign, DH can rarely act as an opportunistic infection in immunocompromised patients presenting with uncommon complications such as acute kidney injury and idiopathic thrombocytopenic purpura. We report a rare presentation of DH presenting with acute kidney injury and immune thrombocytopenic purpura in an immunocompromised patient with HIV.