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PubMed1979

[Juvenile hemorrhagic ocular choroidopathy (author's transl)].

We observed in 13 young patients a serous or hemorrhagic paramacular detachment of one third to one half disc diameter size. In eight, we have seen also atrophic choroidal scars. In one patient the serous detachment occured at the site of a previously studied choroidal scar. Our cases resemble the presumed ocular histoplasmin choroiditis described in American literature. In our cases histoplasmosis can be excluded. Visual prognosis is dependent upon proximity of the choroidal lesion to the fovea. In most cases this prognosis is poor. The term juvenile hemorrhagic ocular choroidopathy is suggested for the disease.

Adult↗
PubMed1966

Histoplasmosis. A review of three cases studied in San Diego County.

Three cases of histoplasmosis, a disease seldom reported in California, were diagnosed clinically by the authors in San Diego County. It is probable that there is a higher incidence of this disease in California than is at present recognized. Travel history, histoplasmin skin testing and serologic studies for mycotic infection are important in the diagnosis. Cultures of secretions and biopsy material are of great value if positive; but negative cultures (at least in non-endemic areas) do not rule out the disease. Travel and migration to and from endemic areas present opportunities for this disease to constitute a diagnostic problem far from the geographic area in which the disease was acquired.Although usually benign, histoplasmosis may be severe in the acute state, may disseminate or may be chronically active and progressive. Amphotericin B is the only effective chemotherapeutic agent and it is usually reserved for these forms of the disease.

Amphotericin B↗
PubMed1982

Diagnosis of histoplasmosis and blastomycosis by an antiglobulin hemagglutination test.

An antiglobulin hemagglutination test was developed for detection of antibody directed to Histoplasma capsulatum and Blastomyces dermatitidis. The substances responsible for spontaneous agglutination of erythrocytes were removed from histoplasmin and blastomycin by vacuum dialysis, and partial purification of the antigens by gel filtration chromatography on Sephadex G-150 allowed removal of additional nonantigenic material which competed with the antigens for binding on the erythrocyte surface. The test was sensitive enough to detect antibodies in sera which were negative by complement fixation, immunodiffusion, or both, but it failed to discriminate reliably between antibody directed to H capsulatum and antibody directed to B dermatitidis. Erythrocytes sensitized with partially purified blastomycin produced some false-positive reactions with normal canine sera; this was corrected by diluting the antigen before sensitization of the erythrocytes.

Animals↗
PubMed1978

An outbreak of histoplasmosis at an Arkansas courthouse with five cases of probable reinfection.

An outbreak of histoplasmosis occurred at a county courthouse in Arkansas in July, 1975. Fifty cases were identified by symptoms and positive complement fixation (CF) tests and 18 others by the clinical findings alone. Only three positive CF tests (greater than or equal to 1:8) were found in a control group of 55 unexposed persons of the same age. The attack rate for 84 courthouse employees was 52%. Histoplasma capsulatum was isolated from the sputum of two cases, and from bird droppings which had been dumped from the roof of the courthouse two weeks before the epidemic's peak. Window air conditioners apparently helped to distribute infectious particles throughout the building. Nine exposed people had pulmonary calcifications and a negative tuberculin test that were taken as presumptive evidence of previous histoplasmosis. Five (55%) of these became ill. Exposed persons without pulmonary calcifications had an attack rate of 85%. The reinfected cases during convalescence had higher serum CF titers but not larger histoplasmin skin test diameters than the rest of the cases. A microdroplet aerosol of cooking oil was used to simulate air flow patterns during the exposure, and the results agreed with the hypothesized means of infection.

Adult↗
PubMed1981

Presumed ocular histoplasmosis.

Six patients showing typical manifestations and some rare features of the presumed ocular histoplasmosis syndrome are presented and discussed in the light of present knowledge. Krypton laser photocoagulation was used in one patient with encouraging results. Histoplasmin skin testing was negative in all cases. HLA typing supported the previous findings of an association with HLA B7 but not DRw2. Although the presumed ocular histoplasmosis syndrome is not uncommon outside America the true aetiology of this condition remains obscure.

Adult↗
PubMed1980

Scars without wounds: spectrum of delayed manifestations of histoplasmosis outside of the endemic area.

This short series represents a spectrum of histoplasmosis usually described only in places where the infection is nearly universal. In fact, most of the patients in this series were born in such places (17 of 19 patients with complicated presentations; 2 had recent suspicious exposures). As young adults, they had moved away to pursue military life, usually in coastal areas where the evidence of infection with H. capsulatum is a statistical rarity. The implications of these observations are straightforward. At the clinical level, they focus on histoplasmosis as a possible cause of pulmonary, mediastinal, or other lesions of obscure etiology, whether or not the patient has recently lived in "the endemic area". The simple determination of CF gamma titers may heighten the index of suspicion, especially when not confounded by skin testing with histoplasmin, a practice which rarely provides useful information. [Table: see text] With regard to pathogenesis, it seems noteworthy that common form of histoplasmosis was not seen in this brief experience. That is the "marching cavity" described by Goodwin and Des Prez, and other forms of chronic cavitary disease. The absence of such lesions is consonant with the view that they require continuous exogenous infection for their development. As for the forms of histoplasmosis which were seen in this series, it appears that most of the illnesses developed outside of what is usually considered endemic areas. The term endemic, as construed medically, has been defined as "restricted to and constantly present in a particular country or locality". Such a construction is unduly pedantic and rigid for clinicians. A more probabilistic view is needed, with attention to the possible role of inapparent infection early in life and of environmental foci of infection in places where the organism is not notoriously present. The mobile nature of our society makes it likely that the radiographic manifestations of once-regional diseases such as this one will be encountered more generally than in the past.

Adolescent↗
PubMed1981

Histoplasmosis in the eastern Caribbean: a preliminary survey of the incidence of the infection.

A preliminary survey of the incidence of histoplasmosis in the eastern Caribbean was carried out. The percentages of positive histoplasmin skin test reactors in the populations studied were as follows: Barbados (4%), Trinidad (42%) and Guyana (29%). In Trinidad 69% of individuals under 60 had positive test. However a lower proportion (4%) had serological evidence of past infection with Histoplasma capsulatum. The organism was not isolated from the soil although it had been found previously in Trinidad. On this island five previously diagnosed cases of histoplasmosis were identified. The study confirmed the presence of the infection in the area and further investigations are suggested.

Health Surveys↗
PubMed1981

Human lymphocyte blastogenesis induced by living and dead Histoplasma capsulatum yeasts and soluble yeast autolysate.

Human peripheral blood mononuclear cells were cultured with either replicating yeast phase Histoplasma capsulatum, intact dead yeasts of soluble yeast phase autolysate antigen for induction of lymphocyte blastogenesis. H. capsulatum replicated to the same extent in cultures of lymphocytes from histoplasmin skin test-positive and negative cell donors, but stimulated far greater blastogenesis in the former. Dead H. capsulatum yeasts, which were more easily quantified, caused nearly as much specific blastogenesis as live yeasts. Blastogenesis was induced by as few as 1 dead yeast per 10,000 lymphocytes, indicating the antigenic potency of Histoplasma yeasts. Specific blastogenesis was also caused by soluble yeast autolysate. Thus, replicating H. capsulatum yeasts, dead yeasts and autolytically released soluble yeast phase antigen each stimulated specific blastogenesis of lymphocytes from persons sensitized to H. capsulatum in vivo.

Cell Division↗
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↗
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↗
PubMed1978

Effect of corticosteroids on the human immune response: comparison of one and three daily 1 gm intravenous pulses of methylprednisolone.

In spite of the increasing use of single and multiple pharmacologic intravenous pulses of MPS for immunosuppression in various diseases, their immunosuppressive effects have not been documented. We treated two groups of six patients with classic RA unresponsive to conventional therapy with either one or three daily 1 gm intravenous doses of MPS and measured the immune response and clinical activity over 16 weeks. Lymphocytopenia with selective T lymphocyte suppression was noted 2 hr following each infusion, which was maximal at 6 hr with complete recovery 24 hr after each dose beyond which no lymphocytopenia or T lymphocyte depletion was seen. Preservation of skin test positivity to recall antigens such as PPD and histoplasmin, rise in antibody titers to the secondary antigens tetanus and typhoid, and primary antibody response to KLH were found in both groups after treatment. Serum gamma globulin concentrations were unchanged. Five of six patients receiving 3 doses and three of six receiving 1 dose had satisfactory improvement in clinical parameters, with maximal benefit seen within the first 4 days. Six patients still felt better at 4 weeks, and one patient in each group entered a clinical remission greater than 16 weeks. We conclude that higher and repeated doses of MPS caused neither greater lymphocytopenia nor more prolonged suppression of recirculating lymphocytes than the conventional oral doses. The clinical benefits stem from reduction of inflammation, and it is doubtful that pulse therapy by itself induced significant generalized immunosuppression.

Aged↗
PubMedDate not supplied

Comparative immunochemical studies of different antigens of deep mycosis pathogens.

The disintegration of cells of Coccidioides immitis, Histoplasma capsulatum, Blastomyces dermatitidis and Candida albicans by ultrasonical treatment, repeated freezing-thawing or mechanical methods permitted to obtain antigens with a high protein content. The treatment of these fungal cells with beta-naphthol, ethanol, glycerine or alkali makes it possible to isolate antigens containing mainly polysaccharides. The studied antigens turned out to be complex compounds. Proteins, glycoproteins, nucleoproteins and small quantities of phosphorus and nucleic acids were revealed in their composition. The protein-rich antigens were most active as inductors of a cellular and humoral immune response. These preparations turned out to be the most active and specific for DH testing. The polysaccharide-rich antigens were highly active in in vitro reactions but possessed a low immunogenecity. Immunoelectrophoretical analysis showed a mosaic character of antigen assembly in the preparations isolated from fungal cells and culture filtrates. In different antigens of C. immitis there have been revealed 4-7, in H. capsulatum 3-8 and in B. dermatitidis 3-6 components. The culture filtrates and "cell-saps" had a more complex antigenic spectrum: coccidioidin 7, histoplasmin 8, blastomycin 6; in C. albicans cell-sap, up to 20 antigens have been revealed. In the antigenic spectrum of C. immitis, H. capsulatum and B. dermatitidis common components prevailed, but in C. albicans no cross-reacting antigens have been revealed. Species- and phase-specific antigens have been found in preparations of H. capsulatum.

Antigens, Fungal↗
PubMed1977

Cell-mediated immune responses in patients with paracoccidioidomycosis.

We tested the hypothesis that symptomatic infection with Paracoccidioides brasiliensis caused impaired host cellular immune responses. In a cross-sectional study in Colombia, the immune responses of thirty-six patients with paracoccidioidomycosis were compared with those of sixty normal individuals. Patients demonstrated increased skin sensitivity to paracoccidioidin (para) and histoplasmin, and reduced reactivity to candidin and dinitrochlorobenzene as compared to controls. The skin test response to tuberculin (PPD) was similar to that of controls. In vitro lymphocyte transformation (LT) and leucocyte migration responses to phytohaemagglutinin and PPD did not differ in patients and controls; these responses to PPD correlated with skin sensitivity in controls, but not in patients. LT and inhibition of leucocyte migration to para were seen in more patients than controls; the latter response correlated with skin sensitivity in controls only. Positive LT to para was associated with absence of antibodies to P. brasiliensis. Analysis of symptomatic patients suggests that the prevalence of para skin test positivity was lowest in patients with the longest duration of disease; this implies decrease in specific cell-mediated immunity with prolonged active infection. Analysis of clinically cured patients suggests that the prevalence of para skin sensitivity and LT to para and PPD increased with time elapsed since diagnosis; this implies development or restoration of immunocompetence upon clinical recovery. Results of a preliminary longitudinal study on the immunological responses of six patients with active paracoccidioidomycosis are compatible with the above observations.

Antibody Formation↗
PubMed1996

[Acute pulmonary histoplasmosis with liver and lung involvement outside the endemic area--differential diagnosis].

A case of acute pulmonary histoplasmosis in a non-endemic setting is described. A 36 year-old male patient was admitted because of fever attacks, weakness and dyspnea on exertion. The chest X-ray revealed bilateral patchy and nodular consolidations and bilateral enlargement of the hilar lymph nodes. On computed tomography of the abdomen the spleen was enlarged with a longitudinal diameter of 12.7 cm. Respiratory insufficiency was demonstrated by an arterial oxygen tension (PaO2) of 7.71 kPa at rest. Pathological values of liver function tests were indicative of liver involvement. A transbronchial lung biopsy was performed. Histologic examination of the biopsy specimen revealed scattered small nonnecrotizing granulomas with epithelioid cells and multinucleated giant cells. Precipitating antibodies to Histoplasma capsulatum were detected by immunodiffusion in bronchoalveolar lavage fluid and blood, IgG antibodies to Histoplasma capsulatum yeast antigens were revealed by enzyme immunoassay. The histoplasmin skin test was negative. The pneumonitis, lymph node and spleen enlargement and the pathological liver function tests resolved within one month without treatment. The PaO2 returned to normal within one week.

Adult↗