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PubMed1989

African histoplasmosis masquerading as carcinoma of the colon. Report of a case and review of literature.

A case of African histoplasmosis primarily affecting the large bowel--a very unusual manifestation--is reported. In the absence of classical clinical features, pathognomonic of large bowel histoplasmosis, the macroscopic appearance at surgery was confused with large-bowel cancer. The diagnosis was, therefore, retrospective and based on demonstration of large yeast cells of Histoplasma capsulatum var. duboisii in tissue sections of the lesions.

Colon↗
PubMed1998

[Inflammatory pseudotumor of the lung in hilus lymph node histoplasmosis].

The article deals with the case of an inflammatory pseudotumour of the lung in conjunction with histoplasmosis of the hilar lymph glands in a 35-year-old immunocompetent woman in a non-endemic area. She had been suffering from headaches and painful swelling of the lower legs, reddening and hyperthermia for 1.5 years. In addition to the above-mentioned symptoms she also complained of a typical flush syndrome which had begun a year later. The main paraclinical finding was a round mass in the right lung in chest radiography. After considering various differential diagnostic possibilities, thoracotomy and resection of the upper lobe of the right lung were performed. The histological diagnosis of the material removed was that of an inflammatory pseudotumour of the lung, combined with histoplasmosis of the hilar lymph glands. Following a postoperative period without complications, antimycotic treatment was performed. The discussion includes whether the simultaneous occurrence of these two diseases is coincidental or whether there is a causal relation between the two. The authors also discuss various treatments with reference to the relevant literature.

Adult↗
PubMedDate not supplied

Adrenal histoplasmosis: clinical presentation and imaging features in nine cases.

BACKGROUND: We describe a retrospective analysis of the clinical presentation and imaging features in nine patients with adrenal histoplasmosis in nonimmunocompromised patients from a nonendemic region. METHODS: Clinically, a tuberculosis-like presentation in four patients and a tumor-like presentation in five patients were seen. All patients were seronegative for the human immunodeficiency virus. Ultrasound (US) in all patients, computed tomography (CT) in six, and magnetic resonance imaging (MRI) in three showed suprarenal masses. CT-guided (in five) and US-guided (in four) biopsy and fine-needle aspiration cytology established a definite diagnosis. The work-up for malignancy and tuberculosis was negative. RESULTS: On cross-sectional imaging, eight patients had bilateral adrenal masses and one had a unilateral adrenal mass. Imaging features were variable. All adrenal masses were hypoechoic on US, homogeneous in five, and heterogeneous in four patients. All adrenal masses were hypodense on CT, homogeneous in four, and heterogeneous in two. Heterogeneous enhancement was seen in three, homogeneous enhancement in two, and no enhancement in one patient. MRI in three patients showed that the masses were of variable signal intensity on all pulse sequences. CONCLUSION: Our case series showed that adrenal histoplasmosis does occur in immunocompetent persons living in areas not endemic for the disease. The imaging features were variable.

Adrenal Gland Diseases↗
PubMed2002

Rapid PCR-based diagnosis of disseminated histoplasmosis in an AIDS patient.

Disseminated histoplasmosis is an unusual opportunistic infection in patients with advanced HIV infection living outside endemic areas. Diagnosis usually is made on the basis of isolation of Histoplasma capsulatum from clinical specimens or histologic examination. Reported is the case of an HIV-infected Columbian individual in whom the diagnosis of histoplasmosis was established within 24 h of collection of an adequate bronchoalveolar lavage specimen. The diagnosis was made by detection of specific fungal DNA and confirmed by isolation of Histoplasma capsulatum from blood, bone marrow and respiratory specimens 10 days later. The patient recovered under antifungal treatment and remained asymptomatic up to the last follow-up visit 6 months later. The polymerase chain reaction assay might be a powerful and rapid diagnostic tool for the diagnosis of non-European invasive fungal infections and should be further evaluated.

AIDS-Related Opportunistic Infections↗
PubMed2005

Histoplasmosis infection in Spanish travelers to Latin America.

The aim of the study presented here was to assess the incidence of histoplasma infection in a cohort of 342 individuals in Spain who had traveled to Latin America for the first time. The histoplasmin skin test was positive in 20% of the travelers, and Central America posed a higher risk for infection than South America (p=0.013). Sleeping outdoors (p=0.031) and the duration of travel (p=0.016) were also identified as significant risk factors. Serological testing demonstrated poor overall sensitivity for detecting infection in the travelers, but for the symptomatic acute cases the results were improved. Histoplasmosis must be considered in patients presenting with fever (odds ratio=3.51 [1.52-8.12]) or cough (odds ratio=4.24 [1.32-13.58]) after visiting Latin America. The results of this study have public health implications and indicate the risks of acquiring histoplasmosis should be included in pre-travel counseling.

Adult↗
PubMed2006

Detection of imported histoplasmosis in serum of HIV-infected patients using a real-time PCR-based assay.

A new real-time PCR-based assay was used for detecting DNA of Histoplasma capsulatum in serum samples collected from four HIV-infected patients with proven histoplasmosis. The assay targeted the ITS1 region of rDNA and its in vitro sensitivity, specificity and reproducibility were evaluated. The technique detected DNA of H. capsulatum in all of the HIV-infected patients with proven histoplasmosis (4/4, 100%). The PCR result was positive for seven of the ten (70%) samples studied. The assay's specificity was determined to be 100%, since the method was negative for 25 other serum samples (10 from patients with proven aspergillosis and 15 from healthy controls). The PCR assay is a new and promising diagnostic alternative and further investigation is warranted.

Adult↗
PubMed1999

A case of HIV-associated cerebral histoplasmosis successfully treated with fluconazole.

Clinically apparent involvement of the central nervous system is a rare event in cases of disseminated histoplasmosis, even in HIV-infected persons. Despite therapy with amphotericin B, mortality remains very high. Reported here is the case of an HIV-infected patient with a 3-month history of fever, cough, weight loss and miliary lung infiltrates. Four weeks after initiation of tuberculostatic therapy, high-grade fever, neurological symptoms, personality changes and respiratory deterioration occurred. Magnetic resonance imaging of the brain showed multiple mass lesions, and a chest radiograph revealed worsening of pulmonary infiltrates. Methenamine silver staining of a lung biopsy specimen demonstrated Histoplasma capsulatum. Subsequently, this pathogen was cultured from lavage fluid. Following high-dose intravenous fluconazole therapy (800 mg once daily), the patient's condition improved markedly within 10 days, followed by an almost complete resolution of pulmonary and cerebral mass lesions. This is believed to be the first documented case of rapid improvement of disseminated histoplasmosis with central nervous system involvement in an HIV-infected patient upon induction of therapy with fluconazole.

AIDS-Related Opportunistic Infections↗
PubMed1999

A case of disseminated histoplasmosis likely due to infection from a liver allograft.

Disseminated histoplasmosis in immunosuppressed patients rarely occurs in nonendemic areas. Reported here is a case of disseminated histoplasmosis in a patient who had undergone orthotopic liver transplantation and had never traveled outside of France. The infection was most likely transmitted via the liver allograft, since the organ donor had lived in an area highly endemic for the disease (French Guiana) 20 years earlier. Two years post-transplantation, none of the other patients who received allografts (heart, cornea, kidneys) from the same donor had developed signs of infection.

Histoplasmosis↗
PubMed2006

Unusual orofacial manifestations of histoplasmosis in renal transplanted patient.

Histoplasmosis is a fungal infection caused by the Histoplasma capsulatum. Mucosal manifestations are uncommon, but, when present, they are usually associated with pulmonary or chronic disseminated infection. The course of the disease is often related to the host immune response. The purpose of this article is to describe the clinical and microscopic findings of unusual involvement of nasal cartilage and septal destruction, and oral lesions of histoplasmosis in an immunosuppressed patient who presented an unusual form of the disease.

Adult↗
PubMed1979

Trephine biopsy of the bone marrow in disseminated histoplasmosis.

Twenty-two patients had bone marrow aspirates for culture and marrow trephine biopsies for histologic examination during the evaluation of an illness eventually proved to be disseminated histoplasmosis. These procedures provided evidence of involvement of the bone marrow with Histoplasma capsulatum in 19 cases. Fungi were demonstrated in trephine biopsy sections in 15 of the patients, permitting a rapid specific diagnosis. Three patterns of bone marrow morphology were observed; each reflected a variation of macrophage proliferation. In two of the patterns, diffuse macrophage proliferation and loose aggregates of macrophages, typical 2 to 4 microns intracellular hisoplasma organisms were numerous and obvious in hematoxylin and eosin-stained sections, were infrequent and were often relatively large (6 to 12 microns). There were four patients from whom H. capsulatum was cultured when organisms could not be demonstrated in either hematoxylin and eosin- or silver-stained sections. The patients with diffuse proliferation of macrophages in the marrow comprised a distinct clinical group associated with immunosuppression, a fulminant course and a fatal outcome despite therapy. Patients in the other two morphologic groups responded well to therapy even though the immune responses on many were also suppressed. Bone marrow examination is an excellent diagnostic procedure in disseminated histoplasmosis. Trephine biopsies permit a rapid diagnosis in most cases and may be of prognostic significance.

Adolescent↗
PubMed1986

Histoplasmosis in patients with the acquired immune deficiency syndrome.

Five patients with disseminated histoplasmosis are reviewed. Four of five had the acquired immune deficiency syndrome (AIDS) and one was receiving steroid therapy. All were immigrants to the United States from Puerto Rico, the Dominican Republic, or South America, and none had a history of travel to regions of the United States where Histoplasma is endemic. Histoplasma complement fixation titers to mycelial antigen were not demonstrable in three of three patients in whom they were measured. Of the four patients with AIDS, Histoplasma capsulatum was isolated from bone marrow aspirates in two patients and from lymph node and liver biopsy specimens in one patient each. One of the bone marrow specimens showed organisms on Gomori-methenamine silver stain. In the other three cases, results of staining were falsely negative and diagnosis awaited culture results weeks later. Amphotericin B therapy resulted in rapid clinical improvement in the three patients that were treated. Intravenous therapy was followed by treatment with oral ketoconazole. Follow-up has not been long enough to determine the ultimate efficacy of ketoconazole. Disseminated histoplasmosis should be considered in all patients from the Caribbean or South America with AIDS or who are receiving immunosuppressive therapy.

Acquired Immunodeficiency Syndrome↗
PubMed1988

Central nervous system histoplasmosis. An unappreciated complication of the acquired immunodeficiency syndrome.

Involvement of the central nervous system (CNS) by Histoplasma capsulatum is a rare event. It is usually not included in the differential diagnosis of CNS lesions in patients with acquired immunodeficiency syndrome (AIDS). Herein are described four patients with AIDS and progressive disseminated histoplasmosis who had CNS involvement. Histoplasmosis in the CNS may produce meningitis, single or multiple brain abscesses, and may present with either a clinical picture of obtundation or a deteriorating space-occupying CNS lesion. Three of the four patients were treated with amphotericin B and had initial clinical response, but ultimately, all experienced a relapse and died from their infection.

Acquired Immunodeficiency Syndrome↗
PubMed1977

Histoplasma capsulatum in the presumed ocular histoplasmosis syndrome.

I demonstrated Histoplasma capsulatum organisms in disciform macular lesions, as well as a peripapillary lesion and peripheral atrophic scars in both eyes and in the lung of a patient with no history of active histoplasmosis. Autopsy findings were compatible with those of the presumed ocular histoplasmosis syndrome.

Aged↗
PubMed1979

Lymphocyte stimulation by yeast phase Histoplasma capsulatum in presumed ocular histoplasmosis syndrome.

We measured skin reactions serum antibody, and lymphocyte stimulation to Histoplasma antigens in a series of patients with presumed ocular histoplasmosis syndrome and in controls. The most sensitive test, lymphocyte stimulation to H. capsulatum sonicate, also correlated with severity of the disease. Lymphocyte stimulation to Histoplasma may be a useful adjunct to the monitoring of presumed ocular histoplasmosis syndrome.

Antibodies, Fungal↗
PubMed1980

Macular lesions in blacks with the presumed ocular histoplasmosis syndrome.

Six black patients had fundus lesions diagnostic of the presumed ocular histoplasmosis syndrome. All patients had peripapillary changes or peripheral punched-out chorioretinal lesions, or both. Five of the six had macular subretinal neovascularization, disciform scarring, or an atrophic macular lesion, and one patient had a macular hole; four of five patients tested had a positive histoplasmin skin test. The macular involvement was bilateral in three of the six cases. HLA B-7 was present in one of four patients who had HLA typing. Macular involvement can occur in blacks with the presumed ocular histoplasmosis syndrome.

Adolescent↗
PubMed1981

The long-term course of multifocal choroiditis (presumed ocular histoplasmosis).

We studied 40 patients with the presumed ocular histoplasmosis triad for ten to 15 years. Another patient developed the choroidal features of the syndrome in previously normal eyes. The basic lesion is a nodular choroidal infiltrate that evolves from clinically and angiographically normal retina. It is initially hypofluorescent and has an overlying serous detachment. It evolves through episodes of serous detachment and hyperfluorescence into a choroidal scar with breaks in Bruch's membrane and occasional subretinal neovascularization. Seven of 42 eyes (16.6%) developed new choroidal infiltrates in choroid and retina that were clinically and angiographically normal more than ten years ago. After ten years about 50% of eyes with central scars will have visual acuity changes of 3 or more lines because of progressive remodeling and extension of the disciform scar. Nine of 40 fellow eyes (22.5%) sustained a disciform process during the entire follow-up period. One patient developed typical choroidal lesions in previously normal fundi. Results of extensive physical and laboratory tests for histoplasmosis and other diseases were normal.

Adult↗
PubMed1990

Left recurrent laryngeal nerve paralysis: an unusual presentation of histoplasmosis.

A case of histoplasmosis seen as left recurrent laryngeal nerve paralysis in a 49-year-old man is described. The patient had roentgenographic findings of a solitary, noncalcified left upper lobe mass and mediastinal adenopathy. Tissue diagnosis of histoplasmosis was obtained using a thoracotomy, allowing institution of appropriate treatment.

Histoplasmosis↗