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PubMed2006

Salvage treatment of histoplasmosis with posaconazole.

Six patients received salvage treatment with posaconazole oral suspension (800 mg/day in divided doses) for severe forms of histoplasmosis. One patient had pulmonary disease and 5 had disseminated disease. Previous antifungal therapy consisted of amphotericin B, itraconazole, fluconazole, or voriconazole. Posaconazole treatment duration for individual patients ranged from 6 weeks to 34 weeks. All patients had successful clinical outcomes with significant clinical improvements noted during the first month of therapy. Although the number of patients evaluated in this case series is small, the findings are encouraging and provide preliminary evidence that posaconazole may be a useful salvage treatment option for histoplasmosis involving a variety of infected tissues and organs.

Adolescent↗

PubMed2005

Efficacy of cell-free antigens in evaluating cell immunity and inducing protection in a murine model of histoplasmosis.

Histoplasma capsulatum is a dimorphic pathogenic fungus that causes a wide spectrum of disease when mycelial fragments are inhaled. Resistance to H. capsulatum is dependent on cellular immunity mediated by T cells and macrophages. Here we standardized the production of extracts containing cell-free antigens (CFAgs) and observed their efficacy in evaluating cellular immunity during murine histoplasmosis. CFAgs induced a more potent delayed-type hypersensitivity (DTH) response in H. capsulatum-infected mice than did histoplasmin-a classical antigen. This DTH response to CFAgs is able to determine the immune status of infected mice and to predict their death. Moreover, CFAgs stimulated spleen cells from immune mice to produce higher amounts of gamma interferon (IFN-gamma) in vitro. Finally, immunization with CFAgs protected against a lethal inoculum of H. capsulatum. These results demonstrate that CFAgs may be useful for the evaluation of cellular immune response and as a potential source for the development of a vaccine against histoplasmosis.

Animals↗

PubMed2005

Maxillary African histoplasmosis: unusual diagnostic problems of an unusual presentation.

Among bone lesions of African histoplasmosis, those affecting the jaw are relatively rare and concern, with other facial involvements, particularly infants and adolescent patients with an usual uncompromised immunologic status. As clinical and radiologic features are not specific, the differential diagnosis to other mandibular diseases is difficult. We report on a case of African histoplasmosis that involved the right mandibula of a 17-year-old Congolese boy with a persistent and fungiform cutaneous ulceration. As mycologic tests had not been carried out initially, the disease was histologically diagnosed on the basis of the presence of numerous intra-cytoplasmic large yeasts in a granulomatous lesion containing giant cells. As it is impossible to confront the histologic diagnosis with mycologic tests in such a situation, the problems of the differential diagnosis to other deep fungus infections and to some yeast-like foreign body-granulomas encountered at the microscopical level underline the importance of culturing organisms from lesions to confirm the histologic diagnosis. It is worth considering this pathology at least for three reasons: it usually mimicks a malignant jaw tumor; it may constitute a migrant pathology; and prognosis is commonly favorable with amphotericin B treatment.

Adolescent↗

PubMed2006

Transformation of pulmonary histoplasmosis to sarcoidosis: a case report.

Histoplasmosis, a dimorphic fungus, and sarcoidosis, a disease of unknown etiology, share many clinical features, including typical manifestations of granulomatous inflammation involving the lungs and mediastinal lymphatics in association with constitutional symptoms. As such, they are often difficult to distinguish based upon clinical presentation. Recent studies suggest that sarcoidosis may be triggered by infectious agents. Here we present a case of documented pulmonary histoplasmosis that evolved into sarcoidosis. This case supports the notion that infections promote sarcoidosis in predisposed hosts.

Histoplasmosis↗

PubMed2005

Acute pulmonary histoplasmosis from Ghana.

A male patient developed acute pulmonary histoplasmosis 2 weeks after bathing in the water falls of Wli, Ghana. Exposure to Histoplasma capsulatum was probably mediated through inhalation of an aerosol of water and guano from the large colony of fruit bats of the falls. More cases of acute pulmonary histoplasmosis can be expected.

Acute Disease↗

PubMed2006

Disseminated histoplasmosis: case report and brief review.

Disseminated Histoplasmosis is a severe and often-fatal opportunistic infection when left untreated among patients with AIDS. Occurring in 3-5 percent of patients with AIDS living in the areas of endemicity, this infection should be suspected in patients with a CD4 cell count of <150 cells/microL presenting with non-specific clinical signs such as fever, weight loss, and lymphadenopathy. We report our experience to increase awareness of the clinical spectrum of disseminated histoplasmosis and its similarity to other infections and malignancies and update the reader on recommended therapeutic modalities.

AIDS-Related Opportunistic Infections↗

PubMed2006

Oral histoplasmosis in an HIV-negative patient.

Histoplasmosis is a deep mycosis caused by Histoplasma capsulatum, which has been found in soil with accumulated excreta of bats and birds. This disease has variable clinical findings with only pulmonary or systemic involvement. Upper aerodigestive lesions are found mainly associated with systemic disease, affecting particularly patients with immunosuppression conditions mainly caused by HIV. However, it is uncommon in immunocompetent patients. This report describes a case of oro-laryngeal-esophageal histoplasmosis in a HIV-seronegative patient without detectable systemic involvement.

Antifungal Agents↗

PubMed2000

Choroidal neovascularization with granulomatous inflammation in ocular histoplasmosis syndrome.

PURPOSE: To report pathologic examination of an excised choroidal neovascular membrane in a patient with ocular histoplasmosis syndrome that demonstrated granulomatous inflammation. METHOD: Case report. A 50-year-old woman with sudden vision loss in her left eye demonstrated clinical and fluorescein angiographic findings characteristic of choroidal neovascularization secondary to ocular histoplasmosis syndrome. RESULTS: Histopathologic examination of the surgically excised choroidal neovascular membrane disclosed granulomatous inflammation. CONCLUSIONS: This case suggests an important role of mononuclear phagocytic cells as primary mediators of angiogenesis or modifiers of choroidal neovascularization. This association of choroidal neovascularization with granulomatous inflammation did not respond to treatment with systemic corticosteroids.

Choroidal Neovascularization↗

PubMed1978

The prevalence of HLA-B7 in presumed ocular histoplasmosis.

Eighteen patients with the presumed ocular histoplasmosis syndrome were typed for HLA histocompatability antigens and 78% were found to have the B7 antigen. This data implies an underlying immunogenic predisposition to the development of the clinical eye findings and active posterior pole lesions in the presumed ocular histoplasmosis syndrome. It is likely that some feature of the immune system of these patients renders them more susceptible either to the initial infection or to a later activation of posterior pole lesions mediated through immunologic mechanisms.

Eye Diseases↗

PubMed1986

Surgical intervention in histoplasmosis.

Histoplasmosis is a ubiquitous disease in endemic areas that has a generally subclinical course. Excessive inflammatory response may bring some patients to the attention of a thoracic surgeon to exclude malignancy of a noncalcified pulmonary or mediastinal mass or to relieve compression of specific structures. Mediastinal granuloma or fibrosing mediastinitis may involve the superior vena cava, pulmonary vessels, heart and pericardium, tracheobronchial tree, or esophagus. The cases of 94 recently treated patients are presented as well as a review of the American surgical literature. The current use of computed tomography, the time and extent of operative intervention, and the role of antifungal therapy are important to an overall understanding of the surgical treatment of the manifestations of histoplasmosis.

Bronchial Diseases↗

PubMed1984

Hematogenous histoplasmosis in the immunocompromised child.

Hematogenous (disseminated) histoplasmosis occurred in 31 of 4158 children with cancer or immune deficiency disorders. Approximately half of the 31 patients had pulmonary lesions, reacted to the histoplasmin skin test, and generated complement-fixing antibodies to Histoplasma capsulatum. In a comparative study delayed hypersensitivity to histoplasmin was demonstrated in 36 (5.7%) of 634 children at the time of diagnosis of cancer. Patients with cancer who were reactive to histoplasmin before treatment were at no greater, and possibly less, risk for hematogenous histoplasmosis than were nonreactors. All of the 27 patients who received treatment for greater than 1 day recovered; three had recurrences that responded to treatment.

Adolescent↗

PubMed1993

Histoplasmosis of the penis.

Histoplasmosis is a common cause of systemic mycosis in endemic areas of the United States. Genitourinary and cutaneous involvement with this dimorphous fungus is rare. We report a case of disseminated histoplasmosis associated with nonpainful ulcerative lesions of the glans and shaft of the penis.

Aged↗

PubMedDate not supplied

Epidemiology of histoplasmosis in the French West Indies (Martinique).

The Caribbean islands are presumed to be an endemic zone for Histoplasma capsulatum infection, but no epidemiological studies have been done in this area. Our purpose was to report the epidemiology of histoplasmosis from 1991 to 1997 in the French West Indies (Martinique). Cases identified from the register of the mycology laboratory were analysed retrospectively. Ten cases (9 male and 1 female) were identified; 8 of the patients were infected with HIV (average T4 lymphocyte count in these 8 patients was 32/mm3). Eight patients had cutaneous involvement. The incidence in AIDS patients was 1.7%. The annual incidence in the general population was 0.34/100,000. Our data showed that histoplasmosis is endemic in Martinique, with an incidence in AIDS patients slightly inferior to that in endemic areas of the USA. The high rate of cutaneous forms (80%) is uncommon.

Acquired Immunodeficiency Syndrome↗

PubMedDate not supplied

Histoplasmosis in eastern India: the tip of the iceberg?

Systemic histoplasmosis has various clinical presentations and is of especially concern in immunocompromised patients. A high index of suspicion is required for its diagnosis. A total of 38 cases had been reported from India up to 1996. The most frequent occurrence of cases was around Calcutta in eastern India where the previous case was detected 20 years earlier. However, we have diagnosed 5 cases in the past 2 years from eastern India which are reported here. These cases may indicate under-diagnosis and under-reporting of histoplasmosis in India. All 5 patients had disseminated disease with multisystem involvement including 2 with bilateral adrenal enlargement. Two were diabetic and only 1 patient was infected with HIV.

AIDS-Related Opportunistic Infections↗

PubMed1982

Role of immunoglobulin classes in experimental histoplasmosis in bats.

Pooled normal bat serum was separated by gel filtration to give fractions rich in IgG-, Iga- and IgM-like proteins. These fractions were analogous to the corresponding human immunoglobulin classes by immunoelectrophoresis and SDS-polyacrylamide gel electrophoresis. Rabbits were immunized with the fractions and the antisera absorbed. Neotropical bats (Artibeus lituratus) were infected with Histoplasma capsulatum and serum samples were collected weekly and tested for specific serologic response to the fungus. A radial immunodiffusion test was devised to monitor changes in concentrations of IgG, IgA and IgM in the same sera. Bats infected with a low dose of fungus had significantly increased levels of IgM and IgA between 2-6 weeks post-infection. Bats receiving a high dose maintained elevated levels of IgM and IgA through the end of the study. Significantly elevated levels of IgG were not detected until late in the disease (8-9 weeks). In bats with histoplasmosis, IgM and IgA appeared to contribute primarily to the early positive serologies, while precipitating antibodies of the IgG class were detectable later in the disease. These results are similar to the serologic profile seen in human histoplasmosis, and extend our understanding of comparative immune responses in an important wildlife reservoir of human mycotic pathogens.

Animals↗

PubMed1982

Blindness from presumed ocular histoplasmosis in Tennessee.

Tennessee has the highest histoplasmosis infection incidence in the United States. Over 60% of the population reacts positively to skin tests and more than 60 new patients require hospitalization for the treatment of this disorder each year. However, the presumed ocular histoplasmosis syndrome (POHS) remains an uncommon cause of blindness in this state. A retrospective analysis performed with the assistance of 173 Tennessee Ophthalmologists identified 98 new POHS cases in 1980. A similar study, performed in a prospective manner, found 44 new POHS cases in the first six months of 1981. An analysis of recipients of Aid to the Blind revealed 0.5% with POHS; while 2.8% of new applicants for Aid to the Blind had POHS.

Adolescent↗

PubMed1984

Optic disc edema in the presumed ocular histoplasmosis syndrome.

Two patients with presumed ocular histoplasmosis syndrome developed optic disc edema. In both cases the edema resolved without residual impairment of visual function. Although peripapillary changes in ocular histoplasmosis are common, optic disc edema is rare. The pathogenesis of the edema is unknown.

Adult↗

PubMed1986

Ocular histoplasmosis syndrome.

The Macular Photocoagulation Study (MPS) is a multi-center clinical trial supported by the National Eye Institute whose purpose is to assess argon laser photocoagulation as a treatment for choroidal neovascular membranes (NVMs) that do not involve the fovea. The MPS documented that in patients with ocular histoplasmosis syndrome argon laser photocoagulation in comparison with no treatment can reduce the risk of severe visual loss from 46 to 13% in the first two years. Accordingly, patients with ocular histoplasmosis and NVMs outside the fovea are advised to undergo prompt treatment with argon laser photocoagulation.

Clinical Trials as Topic↗