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PubMed2002

Cervical abscess and mediastinal adenopathy: an unusual presentation of childhood histoplasmosis.

Histoplasmosis is the most common endemic respiratory mycosis in the United States. We report the clinical and imaging findings in a case of a child with the rare presentation of a neck abscess and mediastinal lymphadenopathy secondary to acute, non-disseminated histoplasmosis. Imaging findings often mimic other granulomatous infections such as tuberculosis or neoplastic processes such as lymphoma. Histoplasmosis should be considered in the differential diagnosis of a child who presents with enlarged mediastinal and cervical lymphadenopathy.

Abscess↗

PubMed1999

Fluconazole in the therapy of multiple osteomyelitis in African histoplasmosis.

Amphotericin B has been the standard treatment for deep mycoses including African histoplasmosis, but its use is complicated by its toxicity. More recently, Fluconazole, a water-soluble triazole with antimycotic activity and little side effects, has become available. A case of African histoplasmosis from Nigeria, manifesting as multiple osteomyelitis and successfully treated with oral Fluconazole, is presented. Fluconazole may be preferred in the therapy of African histoplasmosis.

Administration, Oral↗

PubMed2006

Articular presentation of disseminated histoplasmosis.

Histoplasmosis is an important opportunistic disease to consider in immunocompromised patients from endemic areas. Articular presentations of disseminated histoplasmosis are uncommon. We describe the case of a renal transplant recipient originating from South Africa in whom a suppurative arthritis presented as a manifestation of disseminated histoplasmosis.

Arthritis, Infectious↗

PubMed1981

Histoplasmosis of bone.

A case of histoplasmosis of bone manifested by a single punched-out lesion in the humerus is reported in a man with asymptomatic mild chronic disseminated histoplasmosis. Roentgenologically evident lesions of bone due to Histoplasma capsulatum are rare, and this is the only report of a large punched-out lytic lesion. Such lesions are common in disseminated histoplasmosis due to the African strain H. duboisii. Although H. duboisii has been accorded species differentiation, there are only two clearly defined differences, compared to H. capsulatum. One is morphologic (size of yeast cell), and the other is a different clinical disease spectrum. Many believe that this organism is best viewed as a stable variant of H. capsulatum. At times, the two strains are indistinguishable morphologically, and at times, as in the case reported, there may be clinical similarities in their respective disease entities.

Aged↗

PubMed1987

Esophageal fistula complicating mediastinal histoplasmosis. Response to amphotericin B.

A 41-year-old man was admitted for evaluation of hemoptysis, dysphagia, and pleuritic chest pain associated with a mediastinal mass. Esophagography demonstrated a fistula between the mass and the esophagus. Results of histoplasmosis complement fixation serologic testing suggested an active infection. A methenamine silver stain of a lymph node obtained at mediastinoscopy revealed Histoplasmosis capsulatum. The patient was successfully treated with amphotericin B. This is believed to be the first reported case of an esophageal fistula as a complication of mediastinal histoplasmosis successfully treated with amphotericin B.

Adult↗

PubMed1979

Disseminated histoplasmosis in renal transplant recipients.

Five cases of disseminated histoplasmosis complicating renal transplantation are reported. Nine previously reported cases from the literature are reviewed. In this setting disseminated histoplasmosis usually presents as a nonspecific systemic febrile illness that may be fulminant or more subacute. Five of 14 patients presented with skin lesions; only one patient presented with primary pulmonary symptoms of cough and dyspnea. Three of our patients and three others previously reported on survived the infection and maintained good function in the transplanted kidney despite prolonged therapy with amphotericin B. Immunosuppression was the only predisposing factor that could be identified with certainty in the five patients reported on herein. However, in two of the five patients the onset of disseminated histoplasmosis coincided with a well documented cytomegalovirus infection; the viral infection may have been a factor predisposing to infection in these two cases.

Adult↗

PubMed1981

Histoplasmosis presenting as the carpal tunnel syndrome.

An otherwise asymptomatic 53 year old woman presented with symptoms typical of median nerve compression in the carpal tunnel. At operation, the tendon sheath was obviously inflamed. The diagnosis of histoplasmosis was made on microscopic examination of the surgical specimen. Cultures of synovial tissue grew H. capsulatum. Review of the literature and of experience at Barnes Hospital indicates that the carpal tunnel syndrome is a very unusual primary manifestation of histoplasmosis. However, as histoplasmosis is a treatable cause of the carpal tunnel syndrome, this diagnosis should be considered in endemic areas.

Adult↗

PubMed1989

Chronic pulmonary histoplasmosis with an oral lesion.

Histoplasmosis is a fungal disease resulting from inhalation of airborne spores of the organism Histoplasma capsulatum. The disease is endemic to the Ohio and Mississippi river valleys. Oral lesions are not common, but when present, they are usually associated with the severe disseminated form of histoplasmosis. This particular case is presented as an example of chronic pulmonary histoplasmosis in which a localized gingival lesion represented the initial clinical manifestation of the disease. Diagnosis was based on a positive biopsy and the results of chest radiographic examination. If, as in this case, serologic, hematologic, and physical examination results are negative, the biopsy of suspicious lesions is of paramount importance to the clinical differential diagnosis.

Aged↗

PubMed1993

Concomitant psoriasis, seborrheic dermatitis, and disseminated cutaneous histoplasmosis in a patient infected with human immunodeficiency virus.

Cutaneous involvement with disseminated histoplasmosis occasionally occurs in patients infected with the human immunodeficiency virus. We describe a profoundly immunocompromised patient with acquired immunodeficiency syndrome who had concomitant psoriasis, seborrheic dermatitis, and disseminated histoplasmosis, each with similar features. Findings of a skin biopsy specimen from a lesion on the forehead showed an infiltrate of histiocytes filled with Histoplasma capsulatum. In disseminated histoplasmosis involving the skin, lesions may have features more characteristic of a papulosquamous dermatosis than an infectious disease. In patients infected with human immunodeficiency virus, especially those with low numbers of CD4+ cells, serious infectious diseases may have unusual features and may assume the appearance of concomitant inflammatory diseases.

Acquired Immunodeficiency Syndrome↗

PubMedDate not supplied

Histoplasmosis of the larynx.

INTRODUCTION: Laryngeal histoplasmosis was first described in 1952. Since then, fewer than 100 cases had been reported. This dimorphic fungus is endemic in the Mississippi and Ohio River Valleys. The yeast phase is responsible for human infection. METHODS: We report a 44-year-old woman who developed laryngitis. The markedly abnormal larynx, which could have been mistaken for papillomatosis, was biopsied, at which time the diagnosis of histoplasmosis was confirmed. Treatment with oral ketoconazole was instituted. RESULTS: Objective voice assessment showed abnormalities of maximum phonation time, speaking fundamental frequency, perturbation, percent voicing, mean flow rate, and spectral pattern. Subsequent to antifungal therapy, objective measures were improved. CONCLUSION: This represents the first case of laryngeal histoplasmosis in which response to therapy is documented by objective vocal assessment.

Adult↗

PubMed2005

Dr William DeMonbreun: description of his contributions to our understanding of histoplasmosis and analysis of the significance of his work.

Histoplasmosis was proven to be a fungal infection 70 years ago by Dr William DeMonbreun, at the time an assistant professor in the Department of Pathology at Vanderbilt Medical School. The significance of his work is analyzed in relationship to the evolution of knowledge about this important fungal infection. His discovery was also central to establishing the legitimacy of the recently reorganized medical school. Vanderbilt Medical School in 1925 was an experiment in building an educational institution essentially from scratch-the outcome of the experiment could be judged in the near term only by research productivity and Dr DeMonbreun's work was one of the 5 major discoveries made at Vanderbilt in the first decade of its existence. Further, his work is the bedrock on which Christie and Peterson later showed that histoplasmosis was endemic in the Ohio River Valley. Their studies plus a host of case reports and reviews up to recent times have contributed significantly to the academic standing of Vanderbilt. Heretofore unpublished illustrations and details about the prototypic cases are included for historical purposes. New light is also shed on the chain of circumstances that led to Vanderbilt's role in the evolution of knowledge about histoplasmosis. Finally, information is provided about Dr DeMonbreun's career after his discovery.

Animals↗

PubMed2005

Disseminated cryptococcosis and histoplasmosis co-infection in a HIV-infected woman in France.

We report the first case in Europe of co-infection with disseminated cryptococcosis and histoplasmosis. The diagnosis of invasive histoplasmosis was confirmed by microscopic examination of the anatomic right colon specimen (hemicolectomy). Histoplasma antigen detection is not yet available in France but it could have a key role in the early diagnosis of disseminated histoplasmosis co-existing with a cryptococcal infection, especially in HIV-infected African people.

AIDS-Related Opportunistic Infections↗

PubMed2006

Preventing reactivation of ocular histoplasmosis: guidance for patients at risk.

BACKGROUND: Ocular histoplasmosis syndrome (OHS), a significant cause of vision loss in young and middle-aged adults, is associated with the fungus Histoplasma capsulatum (Hc). There is considerable evidence that recurrent reactivation of perimacular ocular histoplasmosis lesions is an important cause of disease progression and that vision loss is at least, in part, a consequence of host sensitivity to fungal antigen. METHODS: The etiology and pathogenesis of OHS is reviewed and specific recommendations are made for patients with OHS that may decrease the risk of reactivation of ocular histoplasmosis lesions and slow disease progression. CONCLUSION: Patients with perimacular chorioretinal scars secondary to OHS should be informed by the clinician that they are at risk for vision loss; they should be told the symptoms of choroidal neovascularization and how to self-monitor their vision with an Amsler grid. We recommend they also be instructed on how to decrease their risk of reinfection by Hc. Aggressive treatment of dermatomycoses, onychomycosis, vaginal candidiasis, and other chronic fungal infections may decrease the risk of reactivation of ocular lesions. Patients with OHS who are considering LASIK surgery should be informed that the procedure may trigger choroidal neovascularization.

Animals↗

PubMed2006

Reactivation histoplasmosis after treatment with anti-tumor necrosis factor alpha in a patient from a nonendemic area.

Histoplasma capsulatum (HC) is a thermally dimorphic ascomycete that is a significant cause of respiratory infections (>80%) in endemic areas (Midwest and southeast USA), but infections are rare in non-endemic areas. Most primary HC infections are subclinical or self-limited. While reactivation Histoplasmosis has been reported in the setting of immunosuppression, it remains unclear whether remote primary latent infection represents risk of endogenous reactivation after anti-tumor necrosis factor (TNF)-alpha therapy. We report a case of a patient who developed reactivation Histoplasmosis after receiving anti-TNF-alpha. To our knowledge, this is the first clear report of reactivation of "latent" Histoplasmosis after anti-TNF-alpha therapy.

Adult↗

PubMed2003

Current diagnosis of histoplasmosis.

Histoplasmosis is a common infection endemic in many regions of America, Asia, India and Africa, with sporadic cases also occurring throughout the world. Although excellent laboratory methods for diagnosis are available, there are deficiencies that must be met by continued research. Clinicians and laboratory directors must be familiar with the uses and limitations of a battery of serologic and mycological tests to accurately diagnose histoplasmosis. Research is needed to reduce false-negative and false-positive results, and to improve the identification of the organism in tissues. Approaches to the diagnosis of histoplasmosis and areas that require further research will be reviewed.

Antigens, Fungal↗

PubMed1997

Perfusion of the subfoveal choriocapillaris affects visual recovery after submacular surgery in presumed ocular histoplasmosis syndrome.

PURPOSE: To determine the relationship between the visual result and perfusion of the subfoveal choriocapillaris after surgical excision of subfoveal neovascularization in presumed ocular histoplasmosis syndrome. METHODS: We reviewed the records of 38 eyes of 37 patients with gradable postoperative fluorescein angiograms and color photographs after surgical excision of a subfoveal neovascular membrane in presumed ocular histoplasmosis syndrome. The postoperative photographs and fluorescein angiograms were graded in a masked fashion for the presence of perfusion of the subfoveal choriocapillaris. We used preoperative and postoperative best-corrected visual acuities to determine the correlation between postoperative perfusion of the subfoveal choriocapillaris and both final visual acuity and visual improvement after surgery. RESULTS: After surgery, the subfoveal choriocapillaris was perfused in 24 of the 38 eyes (63%) and nonperfused in 14 (37%). Best-corrected visual acuity improved by at least 2 Snellen lines in 17 of the 24 perfused eyes (71%) and two of the 14 nonperfused eyes (14%) (P = .0089). Best-corrected visual acuity of 20/100 or better was achieved in 18 of the perfused eyes (75%) and four nonperfused eyes (29%) (P = .0076). CONCLUSION: Both final visual acuity and improvement in visual acuity were correlated with postoperative perfusion of the subfoveal choriocapillaris in patients with presumed occular histoplasmosis syndrome. Development of techniques to maintain or reestablish perfusion of the subfoveal choriocapillaris after surgery may improve visual outcome in these eyes.

Capillaries↗

PubMed1987

Laboratory methods for the diagnosis of disseminated histoplasmosis: clinical importance of the lysis-centrifugation blood culture technique.

Disseminated histoplasmosis, an uncommon disease that is usually fatal if not treated, is being recognized with increasing frequency in immunosuppressed patients. We retrospectively reviewed the laboratory methods used to establish the diagnosis of disseminated histoplasmosis in 28 patients examined at our institution. Tissue stains provided the initial diagnosis in 13 of the patients (46%). Serologic tests (complement fixation or immunodiffusion) were positive in 25 patients (89%); the frequencies of positive serologic results were similar in immunocompetent and in immunosuppressed patients. Blood cultures were positive in 20 of the patients (71%) and provided the initial diagnosis in 7 (25%); 5 of these 7 cases (71%) were detected with use of the lysis-centrifugation method. Furthermore, the recovery time for this blood culture method was less than that for a conventional blood culture method (brain-heart infusion biphasic technique). The lysis-centrifugation blood culture technique is an important laboratory method for the diagnosis of disseminated histoplasmosis.

Adult↗

PubMed2004

[Histoplasmosis of the oral cavity].

Histoplasmosis is an endemic mycosis. Histoplasma capsulatum, and duboisiï are the pathogenic agents in humans. The disease is reported as endemic in more than 30 countries. Three clinical forms are distinguished; acute, chronic and disseminated. Oral lesions may take on different clinical aspects which are often associated with disseminated histoplasmosis. Disseminated histoplasmosis is frequently diagnosed in immunocompromised hosts. High risk of mortality dictates rapid diagnosis and treatment.

AIDS-Related Opportunistic Infections↗