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PubMed1990

Histoplasmosis as a cause of pleural effusion in the acquired immunodeficiency syndrome.

Disseminated histoplasmosis is an increasingly important opportunistic infection in patients with the acquired immunodeficiency syndrome (AIDS). We report the first case of histoplasmosis as a cause of pleural effusion in a patient with AIDS. Recognition of the typical intracellular yeast on a Wright-Giemsa stained smear of the pleural fluid cells allowed prompt initiation of amphotericin B.

Acquired Immunodeficiency Syndrome↗

PubMed2000

Ileal perforation secondary to histoplasmosis in AIDS.

Our patient presented with abdominal pain, weight loss, and fever with evidence of oral thrush and pelvic inflammatory disease on exam. Radiographs demonstrated a small bowel obstruction with free air. An exploratory laparotomy demonstrated 2 perforations of the distal ileum. Pathologic exam revealed features consistent with histoplasmosis. We discuss gastrointestinal involvement of histoplasmosis in AIDS and its treatment.

Acquired Immunodeficiency Syndrome↗

PubMed1978

V/Q mismatch without pulmonary emboli in children with histoplasmosis.

In two children with histoplasmosis pulmonary perfusion and ventilation studies revealed mismatched abnormalities characterized by almost unilaterally absent perfusion but normal ventilation in the right lung. Chest roentgenograms demonstrated right hilar enlargement and pulmonary contrast angiograms revealed narrowing of the right pulmonary arteries by extrinsic fibrotic granulomata but no pulmonary emboli were present. Fibrosing mediastinitis due to histoplasmosis was found by mediastinoscopic examination in one of the patients. Non-embolic causes of V/Q mismatch lung imaging are discussed briefly, and the correlation with clinical findings is stressed for the diagnosis of pulmonary emboli.

Adolescent↗

PubMed1975

Histopathological correlates of presumed ocular histoplasmosis.

There are very few eyes with the ocular histoplasmosis syndrome that have been studied as such by the ophthalmic pathologist. Hoefnagels and Pijpers [6] were the first to demonstrate H. capsulatum in the human eye. However, this was a case of endophthalmitis and not the clinically observe syndrome. Klintworth et. al. [7] demonstrated the organism histologically in granulomatous choroiditis occurring in dissemiated histoplasmosis. The hot was compromised immunologically, and this again is somewhat different from the typical clinical situation. The histopathological material available for study was derived from the eyes of patients enucleated after the diagnosis of malanoma at the AFIP, nd from autopsy material from the Wilmer Institute. These five cases have a number of findings in common. The atrophic scars and punched-out sponts in the periphery and elsewhere correlate with an absence of the pigment epithelium. The degree of inflammation, usually lymphocyte infiltration, can be variable...

Adult↗

PubMedDate not supplied

Histoplasmosis involving the omentum in an AIDS patient: CT demonstration.

The anatomy and pathology of the greater omentum as demonstrated by CT has been well described. Approximately 80% of cases of omental pathology are caused by malignancy and the remaining 20% are the result of inflammatory disease, mainly tuberculosis or pancreatitis. Histoplasmosis has not been previously reported to involve the greater omentum. We report a case of disseminated histoplasmosis that presented with infiltration of the greater omentum and the small bowel mesentery in a patient with acquired immuno-deficiency syndrome.

Acquired Immunodeficiency Syndrome↗

PubMed1992

Thoracic histoplasmosis.

Histoplasmosis is a fungal disease that is seen throughout the world. It is the most common systemic fungal infection in North America, and it is endemic in the Mississippi, Ohio, and St Lawrence River valleys. Its radiographic and clinical spectrum ranges from a totally self-limited disease with minimal or no radiographic findings to a rapidly progressive, disseminated, and sometimes fatal disease. The article discusses the various aspects of thoracic histoplasmosis with emphasis on the radiographic findings.

Histoplasmosis↗

PubMed1983

Pericarditis as a manifestation of histoplasmosis during two large urban outbreaks.

During two histoplasmosis outbreaks in Indianapolis 45 patients presented with pericarditis. The pericarditis occurred as a late complication in individual patients and during the outbreak. Risk factors for this complication included young age, immunocompetence, and male sex in persons between 20 and 39 years old. Intrathoracic adenopathy was present in 66% of cases. Since cultures were uniformly negative, including pericardial fluid or tissue from nine patients, serologic studies provided the basis for diagnosis. Although the course was usually benign, nine patients presented with tamponade and another with constrictive pericarditis. Prompt response to antiinflammatory medications and failure to identify H. capsulatum in the pericardial fluid or tissue support a noninfectious, inflammatory mechanism for this complication. Of 20 patients reexamined 1 year later, none had evidence of constriction but three had pericardial thickening by echocardiography. Histoplasmosis should be considered in patients with pericarditis from endemic areas, particularly when associated with intrathoracic adenopathy.

Cardiac Tamponade↗

PubMed1988

Subfoveal neovascularization in the ocular histoplasmosis syndrome. A natural history study.

The visual outcome of 74 eyes with the ocular histoplasmosis syndrome and active subfoveal subretinal neovascular membranes was studied retrospectively. Follow-up time ranged from 12 to 109 months (median, 36.5 months). Ten eyes (14%) retained visual acuity of 20/40 or better. Fifty-seven eyes (77%) suffered visual loss of 20/100 or worse and 36 eyes (49%) suffered visual loss of 20/400 or worse. Factors significantly associated with retaining vision of 20/40 or better were: age less than 30 years (P = 0.008); smaller membrane size (P = 0.0002); and absence of visual loss secondary to ocular histoplasmosis in the fellow eye (P = 0.053). Factors significantly associated with vision decreasing by four or more lines were: older patient age (P = 0.006); better initial visual acuity (P = 0.090); and more than 50% involvement of the foveal avascular zone (P = 0.059). These results were confirmed by multiple logistic regression. Final vision of 20/40 or better was associated with better initial visual acuity using univariate analysis, but this result was not confirmed by multiple logistic regression.

Adult↗

PubMed1992

Ill-defined choroidal neovascularization within ocular histoplasmosis scars.

Seven patients with scars typical of ocular histoplasmosis syndrome presented with new symptoms of decreased vision or metamorphopsia. In each patient the symptoms corresponded to an atrophic or "punched-out" histoplasmosis scar in the macula. Clinically, a small amount of subretinal fluid overlying the scars and slight hyperfluorescence were seen on fluorescein angiography. These findings were due to a choroidal neovascular membrane growing within the margins of the atrophic scar. The membranes were difficult to diagnose because of the absence of hemorrhage, pigmentation, or growth of vessels beyond the margins of the scar. Clinicians should be aware that these patients may have early and growing choroidal neovascularization and may need to undergo photocoagulation or to be followed closely.

Adult↗

PubMed1977

Disseminated histoplasmosis in an immunosuppressed patient.

A renal transplant recipient was receiving prednisone and azathioprine therapy when he developed fever, cough, and erythema-nodosum-like lesions on the extremities. Disseminated histoplasmosis was diagnosed by skin biopsy. Disseminated histoplasmosis should be considered when a patient under immunosuppressive therapy develops a lesion similar to erythema nodosum or erysipelas with panniculitis.

Azathioprine↗

PubMed1978

Recurrent disseminated histoplasmosis.

A patient who has had three distinct recurrences of disseminated histoplasmosis over 22 years is presented. Measurements of cellular and humoral immune response to histoplasmin antigens were compared with previously reported data. Although initially sulfisoxazole therapy led to regression of disease, over the past 13 years she has required three courses of amphotericin B, each time with resolution of signs and symptoms. Despite minimal evidence of a cellular or humoral immune response to this organism, the patient has done well. Although disseminated histoplasmosis is often a fatal disease, this woman has tolerated the infection well.

Adult↗

PubMed1981

Acute pulmonary histoplasmosis presenting as adult respiratory distress syndrome: effect of therapy on clinical and laboratory features.

Three patients with acute pulmonary histoplasmosis presented with extensive, diffuse bilateral infiltrates on chest roentgenograms. Fungal elements were seen in the bronchial secretions of two patients; Histoplasma capsulatum was grown from the third patient and from soil from the patients' workplace. Two patients were severely hypoxemic and required short courses of amphotericin B therapy; in one of these two, progressive deterioration dictated corticosteroid therapy as well, with a dramatic clinical response. Radiologic resolution of disease occurred more quickly in the treated patients. Initial pulmonary function tests suggested mild restriction in each, with normal test results by the fourth month of follow-up. Our experience suggests that amphotericin B may shorten the course of acute histoplasmosis and that corticosteroid therapy may be efficacious in controlling the symptoms related to hyperresponsiveness in fulminant primary disease.

Adolescent↗

PubMed1981

Cutaneous histoplasmosis after renal transplantation.

A 21-year-old woman with a renal allograft presented with cellulitis of the right foot as the first manifestation of disseminated histoplasmosis. Disseminated histoplasmosis is more common in immunosuppressed hosts, and there is a trend toward more frequent cutaneous manifestations in transplant recipients (47%). Biopsy of cellulitis in these patients may lead to early diagnosis and curative amphotericin therapy.

Adult↗

PubMed1985

Combined ketoconazole and amphotericin B treatment of acute disseminated histoplasmosis in a renal allograft recipient.

We have reported the first case of successful treatment of disseminated histoplasmosis in a renal allograft recipient using a short course (14 days) of amphotericin B in combination with prolonged therapy (161 days) with ketoconazole. This regimen should decrease the risk of antibiotic induced nephrotoxicity, but it requires further study. Five days of treatment with ketoconazole alone was ineffective in our patient's infection. Our protocol might not be as efficacious in patients who are more profoundly immunocompromised, eg, bone marrow allograft recipients. Because relapse of histoplasmosis may occur as long as nine years after treatment, immunocompromised patients being treated with ketoconazole must have close long-term clinical follow-up.

Acute Disease↗

PubMed1991

Intraocular tumor from disseminated histoplasmosis.

We identified and treated a solid, growing fungal tumor mass in a patient with disseminated histoplasmosis. Although the most commonly reported intraocular lesions from disseminated histoplasmosis are areas of inactive chorioretinal scars or areas of localized subretinal neovascular membrane formation, a focus of active fungal growth needs to be ruled out in all such cases. When a solid tumor mass is identified, the most effective way of preserving vision is with systemic antifungal therapy.

Amphotericin B↗

PubMed2003

Intramedullary histoplasmosis spinal cord abscess in a nonendemic region: case report and review of the literature.

An immunocompetent patient from a nonendemic region developed a rare intramedullary thoracic histoplasmoma. A native Arizonan, with no history of travel to endemic regions, received 3 months of itraconazole for confirmed gastrointestinal histoplasmosis at an outside institution. Two years later she experienced the rapid onset of paraplegia and lost bowel and bladder function. Magnetic resonance imaging demonstrated a ring-enhancing intramedullary lesion at T2 and signal abnormality from C2 to T5. Emergent T2-T3 laminectomy was performed with ultrasonographically guided intradural exploration and midline myelotomy. The intramedullary abscess was drained. She was nonambulatory, but motor function was partially restored. An Ommaya reservoir was later placed to deliver amphotericin and a new antifungal agent, voriconazole. Magnetic resonance imaging confirmed that the infection had resolved. Intramedullary spinal histoplasmoma is a rare manifestation of disseminated histoplasmosis, particularly in nonendemic regions. Surgery for focal mass lesions and aggressive antifungal chemotherapy are the optimal treatment. Newer central nervous system-penetrating antibiotics show promise in refractory cases.

Epidural Abscess↗

PubMed1995

New findings in ocular histoplasmosis.

The ocular histoplasmosis syndrome consists of punched-out, atrophic chorioretinal lesions, and peripapillary scarring in the absence of vitreal inflammation. Choroidal neovascularization is the cause of significant visual loss in involved eyes and is estimated to occur in up to 5% of affected eyes. An experimental primate model has given us a better understanding of the possible etiology and pathogenesis. Laser therapy for extrafoveal and juxtafoveal choroidal neovascularization has been shown to be effective. Recent advances in surgical technique and instrumentation have demonstrated the potential for the successful treatment of subfoveal choroidal neovascularization. The surgical specimens obtained from this approach have allowed for the study of the active process of neovascularization in this disease. This report summarizes our current knowledge regarding the pathogenesis and epidemiology of ocular histoplasmosis and the treatments currently utilized in the management of its associated choroidal neovascularization.

Animals↗

PubMed2006

Immune reconstitution inflammatory syndrome in HIV-infected patients with disseminated histoplasmosis.

Four HIV-1-infected patients presented with unusual clinical manifestations in the course of disseminated histoplasmosis, including liver abscesses, compressive lymphadenitis, intestinal obstruction, uveitis and arthritis within a median of 45 days after initiation of highly active antiretroviral therapy (HAART). They had a median increase of 106 CD4 cells/mul and granulomas with caseation in three. Partial immune reconstitution induced by HAART during disseminated histoplasmosis either related to the variety capsulatum or duboisii may be associated with immune reconstitution inflammatory syndrome.

AIDS-Related Opportunistic Infections↗