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PubMed1999

Disseminated histoplasmosis causing reversible gaze palsy and optic neuropathy.

Subacute disseminated histoplasmosis is an uncommon entity. Typical neuro-ophthalmologic manifestations are usually secondary to histoplasmomas or encephalitis. A 45-year-old man noted blurred vision while receiving empiric antituberculosis therapy for fever and diffuse granulomatous disease of unknown origin. Vertical-gaze palsy, right horizontal-gaze paresis, and mild right optic neuropathy were found on neuro-ophthalmologic examination. Further questioning revealed a history of frequent contact with fighting cocks from South America. Magnetic resonance images were consistent with multiple hemorrhagic infarcts, areas of inflammation, or both, and cerebral angiography showed changes consistent with vasculitis. A previously obtained biopsy specimen from the duodenum was restained and found to be positive for fungal elements. Serum antigen titers for Histoplasma capsulatum demonstrated evidence of active infection. This case is a rare example of a supranuclear ocular motility disturbance and optic neuropathy secondary to an occlusive vascular process in a patient with subacute disseminated histoplasmosis.

Diagnostic Errors↗
PubMed1999

Disseminated histoplasmosis 19 years after renal transplantation.

Infections with fungi like Histoplasma are rarely seen in immunocompromized patients. We report the case of a renal transplant recipient who presented with fever and was diagnosed to have disseminated histoplasmosis 19 years after transplant. The pitfalls in making a diagnosis in non-endemic areas are discussed. The literature on renal transplantation recipients with histoplasmosis has been reviewed.

Adult↗
PubMedDate not supplied

Disseminated histoplasmosis presenting as bilateral adrenal masses.

Histoplasma capsulatum is a universal dimorphic fungus found mainly in soil contaminated with excrement of birds and bats. Bilateral adrenal masses with massive tissue destruction are a rare primary presentation of disseminated histoplasmosis. As it behaves as an opportunistic pathogen there is a higher susceptibility for dissemination on those patients with immunodeficiency or immunosuppression. We report a case in an elderly diabetic patient with bilateral adrenal enlargement, diagnosed as histoplasmosis only after surgical exploration, with symptoms probably occurring at least 60 years after the original infection. She was successfully treated with itraconazole.

Adrenal Gland Diseases↗
PubMed1999

[Disseminated histoplasmosis caused by Histoplasma capsulatum with cerebral involvement occurring 13 years after the primary infection].

A 49-year-old man with disseminated histoplasmosis (pulmonary and central nervous system involvement) successfully treated with ketoconazole and fluconazole combination is reported. Histoplasma capsulatum infection of the central nervous system is extremely rare in France partly because the organism is not endemic. Oral treatment with newer triazoles may be useful for central nervous system histoplasmosis, but additional information is needed to establish their effectiveness.

Antifungal Agents↗
PubMed1999

[Outbreak of acute histoplasmosis in Chilean travelers to the ecuadorian jungle: an example of geographic medicine].

Eight Chilean teenagers traveled to Ecuador in January 1999, where they were bitten by mosquitoes, had contact with parakeets and lodged in poorly hygienic places; 6/8 visited for 5-10 minutes the interior of a bat cave. About a week later these 6 began with headache, myalgia and fever that lasted 2-3 weeks. 5/6 had dry cough with no respiratory distress. The index case was seen in the 2nd week of symptoms. A chest x-ray showed multiple nodular infiltrates as in the other five. Two had histoplasma serology, one was negative and the other positive at a low titer; histoplasmin skin test showed induration of 17-27 mm in all six. An acute histoplasmosis with massive exposure was diagnosed and treated with itraconazole for 3 weeks. All became asymptomatic and chest x-rays returned to normal. Histoplasmosis (non existent endogenously in Chile) is, among other geographic and tropical diseases, a risk for Chilean travelers. Awareness of this in the general population and development of expertise in these diseases by local health care providers is required.

Adolescent↗
PubMed2000

[Manifestations of histoplasmosis].

Two patients, a 34-year old man-to-woman transsexual and a 32-year-old man, with aids presented with pulmonary symptoms, fever, serious weight loss and an oral ulcer. A third patient, a 16-year-old boy, had signs of transverse myelitis and meningitis without immunodeficiency. All were South American citizens and had disseminated histoplasmosis. After antifungal treatment they recovered, although the third patient remained a wheelchair user. If pulmonary or miliary tuberculosis is suspected in a patient originating from South America, histoplasmosis should be considered. Oral ulcers and skin lesions can be diagnostic clues. Specific stainings of direct preparations and longer-lasting cultures of various materials, especially of biopsy samples, then provide the diagnosis.

AIDS-Related Opportunistic Infections↗
PubMed1999

Histoplasmosis of the eyelids--a case report.

Systemic histoplasmosis manifesting as an ulcerative eyelid lesion is rare. We describe a successfully treated case of histoplasmosis who presented with an eroding ulcer in the lid.

Adult↗
PubMedDate not supplied

Orofacial manifestations of histoplasmosis in HIV-positive patients: a case report.

Amongst the main opportunistic diseases that affect the HIV-positive patient, histoplasmosis is found. This systemic mycosis caused by the fungus Histoplasma capsulatum has the capacity to disseminate from the lung to the skin and oral mucosa. Oral lesions of histoplasmosis can be found with ulcerated or nodular aspect, being always very painful and infiltrating the mucosa. When they are present in the mouth, they strongly indicate the presence of some kind of immunosuppression. This study shows the disease's evolution in an HIV-positive patient, who presented several ulcerated lesions in the oral cavity and facial skin. The symptomatology and clinical aspects of the lesions were not specific for the disease, and due to this, the diagnosis was obtained by cytological smear and oral biopsy. The results of the exams defined the disseminated picture of the infection. The treatment plan involved the use of amphotericin B for the lesions' remission, and, following this, itraconazole was administered in the maintenance phase.

AIDS-Related Opportunistic Infections↗
PubMed2002

[Outbreak of acute histoplasmosis in a family group: identification of the infection source].

An outbreak of acute histoplasmosis occurring in 4 members of the same family, two women, a girl and a male, is reported. The index case presented acute respiratory symptoms, severe enough to require hospitalization. In the remaining persons, the infection was asymptomatic but was evidenced by reactive histoplasmin serologic tests. Search for the common source of infection led to an enriched soil obtained in a local nursery for growing in-door plants. BALB/c mice were inoculated with suspensions of soils from the potted plants. Histoplasma capsulatum var. capsulatum was isolated from various internal organs of the mice. Although histoplasmosis is observed more frequently in persons with occupations implying risk of exposure and is connected to rural areas, outbreaks and intra-family cases are now common in urban areas. This is due to massive urbanization, deforestation, demolitions and the use of soils enriched with organic compounds, mainly bird/bat excrements. This report calls the attention on the danger involved in using such enriched soils for plant nutrition.

Adult↗
PubMed1975

[Diagnosis and treatment of macular lesions in multifocal chorioiditis (presumed histoplasmosis) (author's transl)].

The authors describe the clinical picture of "presumed histoplasmosis" with the typical disciform mascular lesion which is found in a increasing number of Dutch patients. Although systemic histoplasmosis is not endemic in the Netherlands, the authors feel they are dealing with the same entity. The therapy is elucidated, especially (Argon laser) photocoagulation of favourably situated subretinal neovascularisations. The importance of adequate coagulation technique and frequent (fluographic) follow-up studies in view of possible complications is stressed.

Adult↗
PubMed2002

[Incidental adrenal histoplasmosis].

An adrenal mass found in the course of abdominal ecographic or computed tomography (CT) techniques performed for other reasons is a new diagnostic challenge. The patient in this case was asymptomatic and without previous illness. An ecographic study revealed an enlarged right adrenal gland, 66 by 33 mm. CT showed bilateral irregular enlargement of both adrenal glands. Nonadrenal malignancies and hyperfunctioning tumors were ruled out. A CT-guided biopsy was performed, and the histopathologic study was consistent with the diagnosis of histoplasmosis. The patient lived in an area endemic for this disease, and had daily contact with bird droppings. Histoplasmosis is a rare unsuspected cause of bilateral adrenal masses in the asymptomatic immunocompetent host.

Adrenal Gland Diseases↗
PubMed2003

Mediastinal granuloma complicating histoplasmosis.

Histoplasmosis is common in the Ohio Valley and is mostly asymptomatic. However, in a fraction of patients, significant clinical illness and complications can occur for which treatment options are limited. We describe a case of a young woman with mediastinal granuloma resulting from Histoplasmosis. A brief discussion of the disease and its management follows.

Adult↗
PubMed2001

Spinal African histoplasmosis simulating tuberculous spondylitis.

Spinal histoplasmosis is a rare disease condition that must be differentiated from other common inflammatory lesions of the spine such as tuberculosis. A case is presented of a pathologically proven African spinal hisptoplasmosis in a 39-year-old female. Paraplegia and fever were the patient's clinical findings. Cervical plain radiography demonstrated a lytic destructive process of the lower cervical spine with radiographic signs similar to tuberculosis. The surgical management and chemotherapy of histoplasmosis are briefly discussed.

Adult↗
PubMed2003

[Acute pulmonary histoplasmosis in a Spanish traveller to Nicaragua: an imported disease case].

Pulmonary histoplasmosis is a rare disease in Spain. Moreover, it is difficult to diagnose due to unspecific clinical and radiological symptoms. The isolation of the fungus is essential for a proper diagnosis. Nevertheless, it is very difficult to identify the fungus itself in respiratory stains and we usually need invasive techniques. For all these reasons and taking into account the increase in journeys and immigration, we believe that it is probably underdiagnosed in our country. We report a case of acute pulmonary histoplasmosis in a Spanish traveller and emphasize the importance of the anamnesis and the value of the microbiologist's experience to obtain the diagnosis.

Acute Disease↗
PubMedDate not supplied

[Cutaneous Histoplasmosis and AIDS].

Histoplasmosis is usually a lung infection due to Histoplasma capsulatum var Capsulatum. Skin lesions are present in 10 to 17% of cases and it appears to have higher prevalence in Mexico. We report on three cases, all males with AIDS, of 26, 33 and 44 years of age. They presented fever, lymphadenopathy and weight loss. One had lingual ulcer and the other two, disseminated erythemato-violaceus plaques, papular and fistular lesions. The histopathologic study showed granulomatous lesions and Histoplasma capsulatum was isolated in cultures. All patients were treated successfully with amphotericin B with a total of 1.5 gm accumulative dose. Clinical skin lesions of histoplasmosis and good response to treatment are discussed.

AIDS-Related Opportunistic Infections↗
PubMed2003

Cutaneous histoplasmosis in patients with acquired immunodeficiency syndrome.

Since 1987, the US Centers for Disease Control and Prevention has considered disseminated histoplasmosis an acquired immunodeficiency syndrome (AIDS)-defining illness. Cutaneous manifestations of disseminated disease are diverse and often present as a nondescript rash with systemic complaints. Diagnosis is best established by histopathologic examination with appropriate stains for fungal organisms. Skin lesions often resolve within weeks of initiating treatment. We detail a case of cutaneous histoplasmosis and review its epidemiology, common presentations, diagnosis, and treatment options.

AIDS-Related Opportunistic Infections↗
PubMed2003

Histoplasmosis masquerading as tuberculosis: a case report.

Histoplasmosis is not reported very commonly from India. We report a patient in whom the presenting feature was persistent leucopenia and hepatosplenomegaly and was treated as a case of disseminated tuberculosis. At autopsy, this patient showed all features of progressive disseminated histoplasmosis.

Autopsy↗
PubMed2004

Disseminated histoplasmosis and AIDS at the University Hospital of the West Indies. A case report.

Disseminated histoplasmosis is rare in Jamaica. However, with the increase in the number of immunocompromised patients in the population, the prevalence of this infection is likely to increase. We present a case of disseminated histoplasmosis in a 16-year-old girl with the acquired immune deficiency syndrome who presented to the Paediatric Infectious Diseases Service of the University Hospital of the West Indies, with cervical lymphadenitis progressing to ulcers and abscesses showing granulomatous inflammation likely to be of fungal aetiology. She later presented to the Emergency Room, with respiratory and gastrointestinal symptoms and was admitted to hospital, disoriented and with a persistent fever. She developed nuchal rigidity while in hospital and was anaemic, leukopaenic and thrombocytopaenic. She died of gastrointestinal bleed ten days post admission. She was the oldest known survivor of mother-to-child-transmission of human immunodeficiency virus in Jamaica. The slow growing fungus, Histoplasma capsulatum, was isolated from the patient's blood three weeks after the specimen was sent to the laboratory.

AIDS-Related Opportunistic Infections↗