Acute cavitary histoplasmosis.
A case of acute cavitary histoplasmosis in the upper lobes is documented. The relationship of this entity to chronic cavitary histoplasmosis is discussed.
Acute Disease↗
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Apical localization of pulmonary tuberculosis, chronic pulmonary histoplasmosis, and progressive massive fibrosis of the lung.
We have reviewed the accumulated evidence for the explanation of the apical localization of pulmonary tuberculosis, chronic pulmonary histoplasmosis, and massive fibrosis of the lung due to silicosis and coal-workers pneumoconiosis. The effect of gravity on the erect human lung results in greatly diminished pulmonary artery blood flow in the apical and subapical areas. This in turn results in higher oxygen tensions but also impairment of tissue clearance mechanisms in these areas. Analysis of the accumulated evidence better supports the theory of lymph stasis and impaired clearance of antigenic substances as the major determinant of the apical localization of pulmonary tuberculosis rather than the presently favored oxygen tension theory. The impaired clearance theory also best explains the apical localization of chronic pulmonary histoplasmosis and progressive massive fibrosis of the lung.
Animals↗
Farmer's lung serologies. An early manifestation of acute histoplasmosis.
Three cases of acute histoplasmosis demonstrated, in addition to the usual serologic findings, strongly positive precipitins against farmer's lung antigens. Twelve additional serums from patients with acute histoplasmosis were subsequently studied. Forty percent of these patients demonstrated positive precipitins against organic dust antigens.
Adolescent↗
Histoplasmosis in patients at risk for the acquired immunodeficiency syndrome in a nonendemic setting.
We reviewed 18 cases of histoplasmosis in patients at risk for the acquired immunodeficiency syndrome seen at two New York City hospitals in the past 3 1/2 years. Seventeen patients were Hispanic, including 13 born in Puerto Rico and three in South America. Clinical presentation was subacute, with high fever, weight loss, and mild respiratory symptoms with well-maintained gas exchange. Five patients had normal chest roentgenograms. The most common chest roentgenographic abnormality was diffuse small nodules. A rapid diagnosis was established histologically in 72 percent of patients, most commonly by transbronchial lung biopsy; cultures were positive in 94 percent of patients while serology was positive in five of six patients. Mycobacterium tuberculosis was a concurrent, often unrecognized, pathogen in six cases. Most patients responded to amphotericin therapy. Histoplasmosis may represent an early sign of altered host immunity in the acquired immunodeficiency syndrome.
Acquired Immunodeficiency Syndrome↗
Chronic cavitary histoplasmosis. Failure of oral treatment with ketoconazole.
Ketoconazole appears to be a safe drug in the treatment of chronic cavitary histoplasmosis. Primary failure and relapse have been described, requiring amphotericin B, even after long therapy with ketoconazole. Four typical cases are presented. We caution about such potential failures and stress the importance of close observation of patients begun on therapy with ketoconazole for chronic cavitary histoplasmosis.
Administration, Oral↗
Blood culture as a parameter of treatment effectiveness in experimental histoplasmosis of the hamster.
The aim of this study was to determine the value of blood culture as a parameter of treatment effectiveness in experimental histoplasmosis. A total of thirty five hamsters, weighing approximately 120g, were inoculated intracardially with 0.1 ml of a suspension containing 4 x 10(7) cells/ml of the yeast phase of H. capsulatum. Treatments were started one week after the infection and lasted for 3 weeks. The azoles, (itraconazole, saperconazole and fluconazole) were administered once a day by gavage, at a dose of 8 mg/kg; Amphotericin B was given intraperitoneally every other day at a dose of 6mg/kg. Blood samples (1 ml) were obtained by heart punction from the 4th day after infection and were seeded in Sabouraud honey-agar and BHI-agar. The hamsters that survived were killed one week after treatment completion and the following criteria were considered for treatment evaluation: 1) rate of spontaneous death, at the end of the experience; 2) microscopic examination of Giemsa smears from liver and spleen and 3) determination of CFU in spleen cultures. Amphotericin B was the most effective drug, with negative blood cultures at day 20, negative spleen cultures in all cases and all the animals survived until the end of the study. Fluconazole was the less effective drug, blood cultures were positive during the whole experience, spleen cultures showed a similar average of CFU when compared with the control animals and 42.8% of these animals died. Saperconazole and itraconazole showed a similar activity, with survival of all hamsters and negative blood cultures at 23 and 26 days respectively. Blood culture seems to be valuable parameter for treatments' evaluation in experimental histoplasmosis of the hamster.
Amphotericin B↗
Chronic disseminated histoplasmosis with lesions restricted to the mouth: case report.
We report a rare case of chronic disseminated histoplasmosis with several ulcerated lesions in the oral cavity in an alcoholic patient without human immunodeficiency virus infection, with no detectable signs and symptoms of systemic disease or extraoral manifestations. Histopathological analysis revealed chronic inflammatory process with granulomas containing Histoplasma-like organisms. The isolation of Histoplasma capsulatum provided the definitive diagnosis. Treatment with itraconazole resulted in complete remission of oral lesions. As far we aware, this is the second case report of oral histoplasmosis in an HIV negative patient described in Brazil.
Antifungal Agents↗
[Outbreak of histoplasmosis in Pedro Leopoldo, Minas Gerais, Brazil].
An outbreak of histoplasmosis was spotted in Pedro Leopoldo, a city in Minas Gerais State, Brazil, in 1997, where four individuals had been in contact with a bat-inhabited cave. Acute pulmonary histoplasmosis diagnosis was made by the use of clinical, serologic, radiographic and epidemiological criteria. An antifungal treatment with ketoconazole (400mg daily for 30 days) was administered resulting in symptons' remission in a few days.
Adolescent↗
[Disseminated histoplasmosis and AIDS. The role of culture medium for the bronchoscopic clinical specimens].
Fiberoptic bronchoscopy is a useful procedure in the diagnosis of histoplasmosis, when the clinical material is adequately processed. Ten cases of disseminated histoplasmosis in patients with AIDS are presented here, with a mycological evaluation in culture, Mycosel and Sabouraud's chloramphenicol agar of clinical specimens obtained through fiberoptic bronchoscopy. The yield of Mycosel culture was 60%, while in Sabouraud's chloramphenicol agar it was 20%, supporting the importance of selective medium in the isolation of Histoplasma capsulatum var capsulatum from potentially contaminated clinical specimens, as well as the importance of clinical information for the laboratory as the key for a correct diagnosis.
AIDS-Related Opportunistic Infections↗
A case study of disseminated histoplasmosis linked to common variable immunodeficiency.
Histoplasma capsulatum, a ground fungus, can infect humans, normally in endemic areas; the resulting disease can be asymptomatic or it can have a benign development, but in rare cases it can develop into a serious clinical condition and can even be fatal. Its most characteristic initial location is in the lungs, resembling tuberculosis, often accompanied by mediastinitis and an exuberant fibrotic response. The spread of this infection can be caused by the concomitance of another illness that alters the immunological balance. Sometimes such an association is not clear. Therefore, disseminated histoplasmosis is defined as a clinical condition where the fungus is present in more than one location. Common variable immunodeficiency is characterized by a generalized failure in the synthesis of antibodies, leading the affected individuals to present recurrent infections, especially those caused by encapsulated bacteria, most often involving the respiratory tract. We studied a serious case of disseminated histoplasmosis, accompanied by common variable immunodeficiency, observed at the Infirmary of the department of Medical Practice of the Federal University at Paraná Hospital das Clínicas.
Adult↗
Bats in the belfry: an outbreak of histoplasmosis.
The belfry and attic of a 100-year-old school building located in central Illinois were infested with a colony of big brown bats (Eptesicus fuscus). During the week of April 14, 1980, four workers disturbed the piles of bat droppings in the attic, causing dust to become airborne. Seven to 10 days later, all four workers developed symptoms and chest x-ray findings compatible with acute pulmonary histoplasmosis. Their sera had complement fixation (CF) titers of greater than or equal to 1:32 with fungal antigens and showed M and/or H bands by immunodiffusion tests. An additional 73 persons who had visited the building were also studied, leading to the finding of 16 additional cases of acute pulmonary histoplasmosis, identified on the basis of positive serologies and compatible symptoms. H. capsulatum was isolated from the sputum of one patient and from the soil beneath the hole in the building's eaves where the bats had been entering the attic. Cases were associated with exposure to the attic and with total hours of building exposure when compared with controls. The epidemic curve suggests that sporadic exposures occurred during the spring of 1980, with an epidemic occurring after the bat droppings were disturbed by the four workers.
Animals↗
Disseminated histoplasmosis in a Danish patient with AIDS.
We present the first case of disseminated histoplasmosis in an AIDS patient in Europe, a 33-year-old Danish homosexual man, and recommend a detailed travel history in HIV-positive patients presenting with fever, weight loss and organomegaly. In Scandinavia disseminated histoplasmosis is rare but should be kept in mind as the disease is a major opportunistic infection in patients with AIDS. Treatment with amphotericin B followed by fluconazole was effective.
Acquired Immunodeficiency Syndrome↗
Histoplasmosis cluster, golf course, Canada.
We report a cluster of 4 cases of acute histoplasmosis (1 culture proven and 3 with positive serology, of which 2 were symptomatic) associated with exposure to soil during a golf course renovation. Patients in western Canada with compatible symptoms should be tested for histoplasmosis, regardless of their travel or exposure history.
Adolescent↗
Distinct CD8 T cell functions mediate susceptibility to histoplasmosis during chronic viral infection.
It has long been recognized that some viral infections result in generalized immune suppression. In acute infections, this period of suppressed immunity is relatively short. However, chronic infections associated with a prolonged period of immune suppression present far greater risks. Here, we examined the role of CD8 T cell responses following viral infection in immunity to systemic histoplasmosis. Although wild-type mice with systemic histoplasmosis were able to control the infection, those simultaneously infected with lymphocytic choriomeningitis virus clone 13 showed reduced immunity with greater fungal burden and high mortality. The immune suppression was associated with loss of CD4 T cells and B cells, generalized splenic atrophy, and inability to mount a granulomatous response. Removing the anti-viral CD8 T cells in the coinfected mice enabled them to reduce the fungal burden and survive the infection. Their lymphoid organs were replenished with CD4 T and B cells. In contrast to wild-type mice, perforin-deficient mice infected with lymphocytic choriomeningitis virus clone 13 and Histoplasma showed an absence of immunopathology, but the animals still died. These results show that CD8 T cells can suppress immunity through different mechanisms; although immunopathology is perforin-dependent, lethality is perforin-independent.
Animals↗
Histoplasmosis in Belize, Central America.
After two small outbreaks of histoplasmosis in Belize, an epidemiologic survey was carried out. Forty percent of 141 persons in two groups tested demonstrated a positive histoplasmin reaction. In one study group there was a significant association between visiting caves and histoplasmin positivity. Histoplasma capsulatum was not isolated in 20 soil specimens collected from outbreak-associated caves, but was isolated from 1 of 26 bats collected from the same caves. The presence of histoplasmosis in Belize, C.A. is documented, and this disease should be considered in differential diagnosis in patients, both residents and visitors in Belize, with compatible clinical presentations.
Adolescent↗
Progressive disseminated histoplasmosis; favorable response to ketoconazole.
Four patients with disseminated histoplasmosis, two of whom had late relapses after previous therapy with amphotericin B, were treated with ketoconazole 200 to 400 mg daily for 1 year. All patients improved markedly during therapy, with resolution of symptoms decreasing liver and spleen size, and weight gain; resolution of oral ulcers occurred in the two patients in whom they were present. Decrease in serum alkaline phosphatase levels correlated well with clinical improvement. One patient who was much improved while receiving ketoconazole continued to harbor Histoplasma capsulatum in an abdominal aortic aneurysm, which became symptomatic 4 months after cessation of the drug. He underwent aneurysmectomy, and H. capsulatum isolated from the resected aneurysm was susceptible in vitro to ketoconazole. No significant adverse reactions to the drug were noted despite prolonged therapy. Our results indicate that ketoconazole may have a role in the therapy of disseminated histoplasmosis in adults.
Alkaline Phosphatase↗
Sonography of the adrenal glands in chronic disseminated histoplasmosis.
In this retrospective study, the findings on abdominal sonograms in six patients newly diagnosed as having chronic disseminated histoplasmosis are reported. Five of six patients showed bilateral adrenal gland enlargement that was similar in degree from side to side. The most characteristic feature was the maintenance of a triangular shape in five glands and a cylindrical shape in two glands. Four glands had a nonspecific round or oval shape. All sonographic findings correlated well with the computed tomographic (CT) findings on each patient except that CT detected the one enlarged right adrenal gland not demonstrated sonographically. Abdominal sonography may provide the initial important clue to the diagnosis of chronic disseminated histoplasmosis.
Adrenal Gland Diseases↗
[American pulmonary histoplasmosis caused by Histoplasma capsulatum].
American pulmonary histoplasmosis is a deep mycosis imported from North America caused by the inhalation of Histoplasma capsulatum. It is endemic in several countries throughout the world and occasional cases have been reported in France, mainly imported from out lying French territories. The most frequent clinical forms observed in immunocompetent subjects are generally benign or silent and usually limited to a fortuitously discovered pulmonary nodule. Massive exposure may lead to an acute primary invasion producing a miliary aspect. Chronic forms simulating tuberculosis are exceptional. Inversely, opportunistic histoplasmosis in AIDS patients can produce an severe multiple organ disease. Ideally, mycelium should be isolated for diagnosis, a task which is easier in disseminated or operated nodular forms. More often, the epidemiological context, clinical and radiological features, the elimination of differential diagnoses and, retrospectively, serology are sufficient for diagnosis. The clinical course is usually favorable. Itraconazole is the treatment of choice for symptomatic or complicated forms.
AIDS-Related Opportunistic Infections↗