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PubMed1989

Acute histoplasmosis: a modern appraisal.

Acute histoplasmosis is an infrequently recognized pulmonary disease endemic in Puerto Rico. Two cases of acute histoplasmosis which followed an exposure to bat guano in a tunnel are presented. Negative cultures of bronchial washings and negative transbronchial biopsies illustrate the usual difficulty in establishing a definitive diagnosis. Serial serum complement fixation titers suggested a recent infection. The illness was quickly and effectively controlled with oral ketoconazole. When symptoms of acute histoplasmosis persist beyond two weeks treatment with ketoconazole for at least two months should be considered.

Acute Disease↗
PubMed1989

[Histoplasmosis and other imported mycoses in 1989].

The most common systemic mycoses imported into France are the histoplasmosis caused by H. capsulatum, which comes from Black Africa and from the French overseas departments and territories (Guyane, Martinique, Guadeloupe, New Caledonia), and the histoplasmosis caused by the larger H. duboisii, which is exclusively Central African. In recent years, histoplasmosis has become an opportunistic infection in immunocompromised patients, particularly those with AIDS. Blastomycosis, imported from North America as well as from North Africa and Central Africa, and paracoccidioidomycosis, imported from Latin America, are pulmonary mycoses with cutaneous manifestations on the face and extremities and with various deep localizations which often follow a chronic course. Coccidioidomycosis, strictly limited to the desertic regions in the western part of the American continent, is also a pulmonary mycosis with multiple granulomas in the skin, bones, lymph nodes and meninges. Penicilliosis caused by Penicillium marneffei is a mycosis from South-East Asia which has recently been observed in European AIDS patients who had travelled in that part of the world.

Africa↗
PubMed1988

Fungal infections in AIDS. Histoplasmosis and coccidioidomycosis.

Histoplasma capsulatum and Coccidioides immitis are two fungi that are regional in occurrence and cause opportunistic fungal infections in patients with AIDS. Many cases of histoplasmosis have been reported in patients months or years after they have been in an endemic area. These are obviously cases of reactivation of latent infections. With coccidioidomycosis, the cases have been reported from endemic areas, but some also appear to be reactivation infections, and we should anticipate such cases in nonendemic areas just as with histoplasmosis. The clinical presentations may be atypical, even mimicking acute bacterial sepsis. The diagnosis should be sought in any HIV-infected patient with an unexplained infection and residence or travel in an endemic area even in the remote past. Studies should include bone marrow examinations for histoplasmosis as well as skin biopsies with special strains and cultures for fungi for both infections. Sputum or bronchoscopy specimens have often been the source of a diagnosis in coccidioidomycosis. Serologic tests for antibody in both diseases yield inconsistently positive results in AIDS patients. Treatment of the acute infection should be with amphotericin B followed by maintenance suppressive therapy with ketoconazole or Amphotericin B.

Acquired Immunodeficiency Syndrome↗
PubMed1988

Systemic fungal infections: diagnosis and treatment. I. Histoplasmosis.

Histoplasmosis is a fungus disease of nearly worldwide distribution. Because of its wide distribution and tendency to be endemic near large cities, it is the most common systemic mycosis in the United States, with an estimated 500,000 new infections per year. Although millions of persons in the United States have been infected with this fungus, few show signs of disease. Histoplasmosis has emerged as an important opportunistic infection in immunocompromised patients, including those with AIDS. This review of histoplasmosis builds upon basic descriptions found in standard texts, incorporating important recent observations.

Antifungal Agents↗
PubMed1988

[Cutaneous localizations of disseminated Histoplasma capsulatum histoplasmosis in a case of acquired immunodeficiency].

A widespread maculo-papular cutaneous rash appeared on a HIV-positive young bisexual Cambodian man. He was treated for Mycobacterium tuberculosis and Pneumocystis carinii infections. He had been residing in France for seven years. Histology showed, within the dermis, abundant extracellular and intramacrophagic yeast-like organisms suggestive of histoplasmosis. Cultured specimens produced a growth of colonies after three weeks on Sabouraud 4 p. 100 dextrose agar at 25 degrees C. Numerous macroconidia were found which made the species diagnosis of Histoplasma capsulatum possible. Despite initiation of therapy with amphotericin B the patient died. Cutaneous involvement with or without specific features is uncommon in disseminated histoplasmosis. The specific cutaneous lesions are protean. They rarely are the presenting sign of initial infection. Disseminated histoplasmosis has a poor prognosis in acquired immunodeficiency syndrome: amphotericin B is not curative. Maintenance suppressive therapy with ketoconazole has been recommended following amphotericin B completion, although break-through has been reported.

Acquired Immunodeficiency Syndrome↗
PubMed1987

Disseminated histoplasmosis in the acquired immunodeficiency syndrome. Report of five cases from a nonendemic area.

Disseminated histoplasmosis is predominantly a disease of the immunocompromised. However, it has been reported infrequently in patients with the acquired immunodeficiency syndrome (AIDS), and then almost exclusively from patients residing in endemic areas. We report five cases of disseminated histoplasmosis in patients with AIDS in a nonendemic area. The initial diagnosis was made by fiberoptic bronchoscopy in three patients and by bone marrow and liver biopsy specimens in one patient each. All patients had fungemia, septic shock, and multiple organ involvement. Three patients had a fulminant course and died within four weeks. Two patients had more prolonged courses, with one survival period of ten months. We conclude that patients with AIDS are at high risk to contract disseminated histoplasmosis with an extremely high morbidity and mortality. This risk is not limited to residents of endemic areas.

Acquired Immunodeficiency Syndrome↗
PubMed1979

Histoplasmosis of skin and lymph nodes and chronic lymphocytic leukemia.

Nodular skin and cervical lymph node lesions of histoplasmosis, unassociated with systemic symptoms of the infection, developed in a 63-year-old man with untreated chronic lymphocytic leukemia. The histologic patterns in both the skin and lymph node were those of a lymphoproliferative disorder, but Histoplasma organisms were found within a few scattered histiocytes after a careful search. The subtle clinical and pathologic presentation might lead one to overlook the organisms and to believe that the leukemic process had progressed, resulting in potentially dangerous systemic involvement of histoplasmosis and unnecessary chemotherapy for his leukemic process. Complete remission of histoplasmosis was obtained with amphotericin B therapy.

Dermatomycoses↗
PubMed1965

Histoplasmosis and thrombocytopenic purpura: transmission by renal homotransplantation.

Two patients with disseminated histoplasmosis are reported. One patient presented with severe thrombocytopenic purpura and splenomegaly. Histoplasmin skin test, blood and bone marrow cultures and smears, sputum cultures, and chest radiographs were negative for Histoplasma capsulatum. She died on the sixth hospital day from a massive intracerebral hemorrhage. Cardiorespiratory function was maintained until one kidney was removed for homotransplantation. The second patient, with chronic glomerulonephritis and uremia, received the renal homograft from the first patient. Initial signs of homograft rejection developed five days postoperatively. Diffuse thrombocytopenic purpura occurred shortly thereafter. Spores of Histoplasma capsulatum were observed in blood smears, in leukocyte concentrates, and in five-day leukocyte cultures from the blood obtained prior to death. Disseminated histoplasmosis was found in both patients at autopsy. The severe platelet deficit in both cases suggests that systemic histoplasmosis should be considered as a cause of thrombocytopenic purpura.To our knowledge, this is the first reported instance of direct transmission of Histoplasma capsulatum, and must be considered a hazard in homotransplantation.In vitro leukocyte cultures as a method for early diagnosis of certain disseminated fungous infections needs further investigation.

Adult↗
PubMed1979

Histoplasmosis in the Cape Province. A report of the second known outbreak.

Histoplasmosis is a rare disease in the Cape Province. The diagnosis of acute disseminated histoplasmosis in a patient who presented at Groote Schuur Hospital 3 weeks after a caving expedition, led to the identification of acute benign pulmonary histoplasmosis in 9 other people who had explored the same cave. Possible explanations for this outbreak are discussed.

Aged↗
PubMed1983

Serum angiotensin converting enzyme activity in patients with histoplasmosis.

The association between increased serum angiotensin converting enzyme (ACE) activity and active sarcoidosis is well documented. During a recent outbreak of acute histoplasmosis, a disease that shares many of the clinical and roentgenographic features of sarcoidosis, we examined serum ACE activity. Twenty-one (25%) of 86 patients with histoplasmosis had increased serum ACE activity. There were neither roentgenographic nor other substantive clinical differences between the groups of patients with increased and normal ACE values. Therefore, an increase in serum ACE activity must not be assumed to be caused by sarcoidosis unless histoplasmosis had been excluded.

Acute Disease↗
PubMed1984

The epidemiology and ecology of blastomycosis, coccidioidomycosis and histoplasmosis.

Blastomycosis, coccidioidomycosis and histoplasmosis are the major pulmonary mycoses of humans. Each is considered to be a primary pulmonary disease acquired by inhalation of infectious spores from the environment. Blastomycosis occurs predominantly in the Mississippi River Valley and Southeastern portions of the U.S.A. Clinical cases have also been noted from a few other areas of the world. The etiologic agent, Blastomyces dermatitidis, is not readily recoverable from nature, but the disease is not contagious and must be acquired from some exogenous source poorly defined at present. Blastomycosis is common in dogs but unusual in other species although a wide variety of animals can be infected experimentally. The disease is more common in middle age, in blacks, and in males. Coccidioidomycosis is restricted to the Western Hemisphere where most cases occur in the semiarid regions of Southwestern U.S. and contiguous areas of Mexico. Limited endemic foci are found in South and Central American locations. The arthroconidia of Coccidioides immitis occur in the soil of endemic areas from whence they are inhaled by humans and other animals. The disease is not customarily contagious. Handling cultures in the laboratory is a serious biohazard. The basis for an apparent racial predisposition to develop disseminated disease is unknown. Two clinical entities distinguishable by their etiologic agents are recognized to comprise histoplasmosis. Histoplasmosis caused by Histoplasma capsulatum var. capsulatum is a cosmopolitan disease with the greatest known concentration of cases located in the eastern half of the U.S. and most of Latin America.(ABSTRACT TRUNCATED AT 250 WORDS)

Age Factors↗
PubMed1978

African histoplasmosis of the jejunum. Report of a case.

A case of histoplasmosis of the jejunum is presented. This is apparently the first reported case of African histoplasmosis primarily affecting the jejunum. Grossly, there was stricture formation together with tubercles scattered over the surface of the bowel and adjoining mesentery. Also the mesenteric lymphnodes were enlarged. It is therefore difficult to distinguish jejunal histoplasmosis from tuberculosis, carcinoma and lymphoma of the jejunum and diagnosis can only be based on the demonstration of the characteristic yeast cells from the specimen.

Adult↗
PubMed1983

Unusual manifestations of histoplasmosis in childhood.

Nine previously healthy children were seen with unique, and in several instances, unreported manifestations of acute histoplasmosis. Presenting manifestations included: obstructive airway disease; subacute parotitis; unilateral cervical lymphadenopathy; anterior mediastinal mass-simulating neoplasm; immune hemolytic anemia; a cutaneous lesion with regional lymphadenopathy; mediastinal mass and pericardial effusion; pulmonary infarction; and a symptom complex of cervical lymphadenopathy, CSF pleocytosis, arthritis, and interstitial nephritis. In eight children histoplasmosis was not initially considered, and the correct diagnosis was made only after complex, and sometimes invasive, diagnostic evaluation and considerable delay. All patients recovered fully without antifungal therapy. Reports of uncontrolled trials of new antifungal agents for treatment of histoplasmosis in immunocompetent hosts should be cautiously evaluated.

Adolescent↗
PubMed1980

[Histoplasmosis: clinical, biological, and therapeutic aspects in ten cases (author's transl)].

The authors present 10 cases of histoplasmosis, 3 due to H. capsulatum, and 7 to H. duboisii. The presenting signs were stomatological or laryngeal with H. capsulatum, and ganglionic, cutaneous, or skeletal with H. duboisii. Diagnosis was confirmed by the discovery of histoplasms in the lesions: 7 times the examination of a needle biopsy sample was positive; in 8 cases out of 10, culture on Sabouraud's medium was positive; in 3 cases out of 4 the inoculated hamster showed the presence of a histoplasmosis. Histological examination of lesions biopsies demonstrated histoplasms in the 9 cases studied. The intradermal reaction to histogical examination of lesion biopsies demonstrated histoplasms in the 9 cases studied. The intradermal reaction to histoplasmin, positive in only 1 out of 7 cases, and serological tests which showed precipitating antibodies in only 4 cases out of 10, are of very little diagnostic value. All patients were treated with amphotericin B, sometimes associated with clotrimazole (3 cases), miconazole (1 case), and rifampicin (2 cases). Two relapses occurred, one, after too soon an interruption of treatment relapsed two months later, and the other followed 18 months after a total dose of 4,200 mg of amphotericin. Surgical treatment of active subcutaneous ganglionic and bony foci may be necessary, and was employed in three cases, with a favourable result in a case of severe disseminated histoplasmosis.

Adolescent↗
PubMed1994

Argon green vs krypton red laser photocoagulation for extrafoveal choroidal neovascularization. One-year results in ocular histoplasmosis. The Canadian Ophthalmology Study Group.

OBJECTIVE: To determine whether the krypton red laser is superior to the argon green laser or vice versa for treatment of choroidal neovascularization located between 200 and 2500 microns from the center of the foveal avascular zone in patients with ocular histoplasmosis syndrome. DESIGN: Multicenter, randomized, controlled clinical trial. SETTING: Ophthalmologic clinics throughout Canada. PARTICIPANTS: Patients who provided informed consent, were aged 18 years or older, and had extrafoveal membranes associated with ocular histoplasmosis syndrome. RESULTS: One hundred forty-one patients were randomized, 134 (95%) of whom were determined eligible. Of the eligible patients, 128 (96%) had sufficient follow-up for the primary outcome comparison of visual acuity at 1 year. In the argon green laser group, there was a mean increase of 3 letters at 1 year, while in the krypton red laser group there was a mean decrease of 2.5 letters in visual acuity. CONCLUSION: The krypton red laser is no better than the argon green laser for the treatment of well-defined extrafoveal choroidal neovascularization secondary to ocular histoplasmosis syndrome.

Adult↗
PubMedDate not supplied

[Epidemic of pulmonary histoplasmosis after visiting a cave in New Caledonia].

We report an epidemic of acute pulmonary histoplasmosis which occurred in February 1994 among a group of 24 persons after they had once or twice visited a cave in New Caledonia. This study describes the physical and laboratory findings, which lead to the diagnosis of histoplasmosis. Each test was evaluated. All members of the group had a physical examination, early and late serological tests, pulmonary X-rays (including CT) and some had mycological examination of bronchoalveolar washes. Mycological investigations were made on samples collected from the cave. Histoplasmic skin testing was not possible. We defined a case as a person who visited the cave in January 1994, had evocative radiological features and at least four symptoms among the following: weakness, fever, headache, arthralgia, thoracic pains, dyspnea, cough and nausea. Of the 24 exposed persons, 7 cases were considered as severe, 8 cases as moderate, and 6 cases as mild, for a total of 21 cases and an attack rate of 87.5%. There was no progression towards disseminated histoplasmosis and no recorded death. The incubation period lasted from 5 to 17 days. The symptoms were divided into three groups. In the first group, the symptoms of fever, headache and arthralgia were common and nonspecific. In the second group, the symptoms of chest pain, cough, and dyspnea which often occurred later, were less common and more specific. In the third group, the symptoms of vomiting, diarrhea and dizziness were less common. The chest X-ray showed abnormalities in 100% of the cases, and in 11 of the 21 cases the characteristic finding was a miliary.(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Disease↗
PubMed1995

[Round pulmonary lesions after returning from French Guyana. Six cases of american pulmonary histoplasmosis].

From 1989 to 1994, 71 patients were hospitalized for diagnosis of round lung lesions including 49 servicemen under the age of 45 years who had been stationed in tropical areas. In 6 of these servicemen, the diagnosis was pulmonary histoplasmosis at the tertiary stage of histoplasmoma. All had done duty in French Guyana and were negative for human immunodeficiency virus. The subpleural lung opacity was the only lesion in 5 out of 6 patients and was calcified in 4 out of 6 patients. Since skin tests with histoplasmin and serologic testing for histoplasmosis failed to achieve definitive diagnosis, surgical biopsy was performed by conventional thoracotomy in 2 cases and video-assisted thoracic surgery in 4 cases. The specimens obtained confirmed diagnosis of histoplasmosis on mycologic criteria in 3 cases and on a combination of findings including compatible histologic evidence in 3 cases. Treatment consisted in surgical excision of the nodules, for which video-assisted thoracoscopic surgery proved to be an excellent technique because of its simplicity and rapidity.

Adult↗
PubMed1995

Disseminated histoplasmosis presenting as tongue nodules in a patient infected with human immunodeficiency virus.

A 39-year-old woman infected with human immunodeficiency virus had disseminated histoplasmosis that presented with nodules on her tongue. This is the seventh reported case of biopsy- and/or culture-proven oropharyngeal histoplasmosis in patients with acquired immunodeficiency syndrome. We review those previous reports and discuss the clinical features of disseminated histoplasmosis in patients with acquired immunodeficiency syndrome.

AIDS-Related Opportunistic Infections↗