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PubMed2004

Successful discontinuation of secondary prophylaxis for histoplasmosis after highly active antiretroviral therapy.

Whether maintenance antifungal prophylaxis against histoplasmosis should be continued life-long in patients with immune restoration after highly active antiretroviral therapy (HAART) remains unclear. We report a case of disseminated histoplasmosis involving the skin, lung, gastrointestinal tract, mesentery, and retroperitoneum in a 33-year-old man with acquired immunodeficiency syndrome. His symptoms improved after use of amphotericin B and itraconazole in addition to ileostomy to relieve the intestinal obstruction. After the start of HAART, he was able to discontinue itraconazole as maintenance therapy without relapse for 24 months.

AIDS-Related Opportunistic Infections↗
PubMedDate not supplied

Immune responses in histoplasmosis, a prototype of respiratory mycoses.

The cellular and molecular mechanisms of host defenses to histoplasmosis, a prototype of respiratory fungal infections are described. Although, cell-mediated acquired immunity is considered as a hallmark of protective immunity to histoplasmosis, the recent findings provide mounting evidence on the importance of natural cellular immunity in host resistance to fungal infections. The natural immunity to Histoplasma capsulatum infection is primarily mediated by natural killer cells, endothelial cells and platelets but mechanisms of intercellular communication and their interactions with the pathogen are not clearly defined.

Blood Platelets↗
PubMed2005

Disseminated histoplasmosis: a comparative study between patients with acquired immunodeficiency syndrome and non-human immunodeficiency virus-infected individuals.

We studied 52 patients with disseminated histoplasmosis, 30 with the acquired immunodeficiency syndrome (AIDS) (cohort 1) and 22 not co-infected with the human immunodeficiency virus (cohort 2). Demographic, clinical, laboratory, mycologic findings, as well as antifungal therapy and highly active antiretroviral (HAART), were analyzed. Skin lesions were significantly higher in cohort 1 than in cohort 2 (P = 0.001). Anemia, leukopenia, and an elevated erythrocyte sedimentation rate were also more pronounced in cohort 1 than in cohort 2 (P < 0.001). Histoplasma capsulatum was isolated more often in cohort 1 than in cohort 2 (P < 0.05) patients, but antibodies to H. capsulatum were detected more frequently in cohort 2 than in cohort 1 (P < 0.05). Itraconazole treatment was less effective in cohort 1 than in cohort 2 (P = 0.012). In cohort 1 patients, HAART improved response to antifungals when compared with individuals not given HAART (P = 0.003), who exhibited higher mortality rates (P = 0.025). Cohort 1 patients who were given dual antifungal and anti-retroviral therapies responded as well as the non-HIV patients in cohort 2, who were treated only with itraconazole. These results indicate the need to promote restoration of the immune system in patients with AIDS and histoplasmosis.

Acquired Immunodeficiency Syndrome↗
PubMed2005

[Histoplasmosis in a renal transplant patient].

The case of a Spanish kidney transplant patient who developed disseminated histoplasmosis approximately one year and a half after transplantation without having previously visited or travelled to endemic areas of histoplasmosis is presented. To our knowledge this is the first case of this disease in a kidney transplant patient in Spain without epidemiologic antecedent. The study of anti-histoplasm antibodies by complement fixation of the donor and recipient did not safely clarify the mechanism of contagion.

Histoplasmosis↗
PubMed1991

Histoplasmosis: a masquerader of sarcoidosis.

Although endemic along the Ohio and Mississippi River valleys in the United States, histoplasmosis may occur in many parts of the world. The multisystem involvement, the presence of non-caseating granulomas, and an elevated angiotensin converting enzyme in histoplasmosis cause diagnostic confusion with sarcoidosis. A careful epidemiologic history, serological tests, and tissue cultures are helpful in establishing the correct diagnosis.

Diagnosis, Differential↗
PubMed2006

[Histoplasmosis among travellers to Central America].

BACKGROUND: In April 2004, the Norwegian Institute of Public Health was notified about an outbreak of a respiratory illness among participants on a cultural-historical theme tour to Central America. One patient was examined in a Swedish hospital where the clinician suspected histoplasmosis, which later was verified by serology and by culture of Histoplasma capsulatum. In order to describe the outbreak and identify the possible source of infection, a clinical and epidemiological study was conducted. MATERIAL AND METHODS: A questionnaire on symptoms, treatment and participation in various activities was sent to all the tour participants. Reminders were sent by e-mail. In addition, some participants underwent a more detailed clinical examination. RESULTS: 19 of the 21 travellers completed the questionnaire. All travellers had visited several caves inhabited by bats in El Salvador and Guatemala. During the last 10 days of the journey, 16 of the respondents (84%) acquired a respiratory illness that lasted for more than 3 weeks. The diagnosis was confirmed by serology in 8 of the 14 tested cases. Antibacterial therapy was given to 11 patients and antifungal therapy to 3 patients. Only one patient was hospitalised. INTERPRETATION: The described outbreak of histoplasmosis was probably caused by exposure to Histoplasma capsulatum during a visit in bat-infested caves. Due to the increasing popularity of adventure and theme travels, this disease may become more frequent in our population. The condition should be considered in travellers with prolonged respiratory illness after visits to caves or other closed environments with little circulation of air that are potentially contaminated with bat or bird droppings. Persons with immunosuppression may develop severe illness, and should consider avoiding places with increased risk.

Adult↗
PubMedDate not supplied

[Bilateral nodular pulmonary histoplasmosis: cytohistological correlation].

Nodular bilateral pulmonary histoplasmosis: cyto-histological correlation. A case of nodular pulmonary histoplasmosis is reported. A 29 year old man was admitted to hospital with temperature and general weakness following a short stay in a tropical country. Laboratory investigation showed an increased E.S.R. and a routine chest-roentgenogram revealed multiple bilateral nodular lesions confirmed by CT scan. Smears obtained from fine-needle-aspiration biopsy showed the presence of epithelioid cell's clusters with a few giant-cells in a background of inflammatory elements and necrotic debris. The cytological picture was consistent with an inflammatory process with necrotizing granulomatous features. The clinical evolution and the radiological picture progression caused, nevertheless, suspicion of a metastatic tumor. The histological examination of a resected peripheral nodule confirmed the inflammatory nature of the process, revealing the presence of multiple roundish encapsulated conidia 2-4 microns in diameter scattered within a granulomatous and necrotic tissue. The fungi are clearly pinpointed by using special stains like Grocott method. Serological and microbiological investigations are necessary in order to confirm the diagnosis.

Adult↗
PubMed1992

Disseminated histoplasmosis in patients receiving low-dose methotrexate therapy for psoriasis.

BACKGROUND: Low-dose methotrexate sodium therapy used for nonmalignant disease has been associated with a variety of opportunistic infections with pathogens occurring in patients with defective cellular immunity. This article describes the unusual development of disseminated histoplasmosis as a probable complication of immunosuppression resulting from use of methotrexate. OBSERVATIONS: We report the cases of three patients in whom disseminated histoplasmosis developed while receiving low-dose methotrexate therapy for psoriasis. Disease manifestations were unusually severe in two of the three patients. All three cases were disseminated, and two cases resulted in illnesses requiring intensive medical treatment. Each patient responded appropriately to antifungal treatment, although one patient has required long-term suppressive treatment because of persistent Histoplasma antigenuria. These cases illustrate the risk for opportunistic fungal infections in patients receiving low-dose methotrexate therapy for nonmalignant diseases. CONCLUSIONS: Histoplasma should be added to the list of pathogens to be suspected in patients receiving such therapy.

Acute Disease↗
PubMed1991

[Pulmonary histoplasmosis due to Histoplasma capsulatum. A case].

The authors report a case of benign multinodular pulmonary histoplasmosis, occurring in a 65 year old woman coming back from Guatemala. The disease presented with both fever and cough. The diagnosis was made on a lung biopsy (by thoracotomy) that showed granulomas with giant cells, lymphocytes and central necrosis, and histoplasma capsulatum yeasts on Gomori Grocott coloration. The authors recall the main radiological forms of the disease, and the difficulties of the diagnosis. When not disseminated, histoplasmosis usually has a good prognosis and does not require any treatment.

Aged↗
PubMed1991

Disseminated histoplasmosis with bilateral adrenal enlargement: diagnosis by computed tomography-directed needle biopsy.

Disseminated histoplasmosis is a rare and potentially fatal disease caused by the dimorphic soil fungus Histoplasma capsulatum. We describe a 67-year-old man with diabetes who presented with a 6-month history of fever, weight loss, and mental deterioration; using computed tomography (CT), we found hepatosplenomegaly and bilateral adrenal masses. CT-directed adrenal biopsy showed yeast forms consistent with H capsulatum. Therapy with ketoconazole was accompanied by adrenal insufficiency (treated successfully with prednisone and fludrocortisone) and produced an excellent therapeutic response. We address the differential diagnosis of bilateral adrenal enlargement, and we discuss the clinical features, diagnosis, and treatment of disseminated histoplasmosis, a disease that includes parts of the Southwestern United States in its endemic region.

Adrenal Glands↗
PubMed1990

[Generalized histoplasmosis in 3 patients with an HIV infection].

Three patients with generalized histoplasmosis and the acquired immunodeficiency syndrome (AIDS) are described. Symptoms of generalized histoplasmosis in patients with AIDS are not specific and concomitant opportunistic infections frequently occur. Two patients suffered from an infection by Mycobacterium tuberculosis, one patient had Pneumocystis carinii pneumonia, and one had cerebral toxoplasmosis. One patient had serological results positive for Histoplasma capsulatum. Two of the three patients showed rapid clinical improvement on amphotericin B but this was temporary and all patients died within 5 months.

Adult↗
PubMed1990

Progressive disseminated histoplasmosis in the acquired immunodeficiency syndrome: a model for disseminated disease.

Progressive disseminated histoplasmosis (PDH) is a relatively common infectious illness in human immunodeficiency virus (HIV)-infected patients. In Houston, Texas, (which is moderately endemic for histoplasmosis) the frequency of PDH is 5% among patients with acquired immunodeficiency syndrome (AIDS), almost as high as that of those with cryptoccal disease. In highly endemic areas, the frequency of PDH in AIDS is even greater, up to 75% in some areas. It is likely that as the HIV epidemic continues to penetrate to more remote, highly endemic areas, more and more cases of PDH will occur. It is also clear that PDH may develop in HIV-infected patients who presently live in nonendemic areas, but who previously resided in endemic areas. It is important that all physicians who care for HIV-infected patients become thoroughly familiar with the clinical manifestation of this illness. Timely diagnosis depends on a high degree of diagnostic suspicion since the illness seldom presents with primary respiratory symptoms. It is prudent to consider PDH in the differential diagnosis of any systemic, wasting, febrile illness in HIV-infected individuals, especially if currently or in the past they have resided in areas endemic for the fungus. Similarly, whenever PDH is diagnosed in any patient who is in a high-risk group for HIV infection, prompt testing for HIV should be performed.

Acquired Immunodeficiency Syndrome↗
PubMed1990

Diagnosis and treatment of pulmonary histoplasmosis in a horse.

A 2-year-old Trakehner filly with pulmonary histoplasmosis is presented. Clinical signs included weight loss, intermittent fever, dyspnea and depression. Diagnosis was based on thoracic radiography, transtracheal wash cytology and lung aspirate cytology. A 5-week regimen of Amphotercin-B administered intravenously resulted in clinical recovery and return of the animal to normal activity. A brief review of histoplasmosis in man and animal is included.

Amphotericin B↗
PubMed1986

[Multifocal inner choroiditis: pseudohistoplasmosis. The European form of the presumed American histoplasmosis].

We studied nine patients with the picture of presumed ocular histoplasmosis. All patients had the characteristic triad: punched out peripheral lesions, peripapillary atrophic scar and disciform process in the posterior pole. All patients had negative test for histoplasmosis (electrosyneresis). Four patients were observed for a long period (8, 8, 7 and 4 years). In two cases we could observe the first step of the basic choroidal lesions. One of these patients fundus was previously normal. Age, female to male ratio and in one case mild inflammatory lesions were similar to a new entity: multifocal choroiditis. The cause of European disseminated inner choroiditis remains unknown. There may be one or multiple causative agents including unidentified fungus.

Adolescent↗
PubMed1988

Cutaneous histoplasmosis in the acquired immune deficiency syndrome--a report of three cases from Trinidad.

Three cases are reported of patients with the Acquired Immune Deficiency Syndrome (AIDS) and cutaneous histoplasmosis. Their initial presentation was that of a generalised maculopapular rash. Two patients were bisexual males and the third was an unmarried female. The range of opportunistic infections seen in AIDS patients in Trinidad is mentioned and clinicians are alerted to the fact that in areas endemic for Histoplasma capsulatum maculopapular rash in patients with AIDS may suggest disseminated histoplasmosis. The value of skin biopsy is mentioned.

Acquired Immunodeficiency Syndrome↗
PubMed1989

[Histologic diagnosis of African histoplasmosis (the first case of the disease in the USSR)].

The findings obtained from histological examination of a biopsy specimen enabled a case of African histoplasmosis to be first recorded in the USSR. The disease was detected in an African student who had had a long-term latent period. The diagnosis was culturally and clinically verified. The problems of the histological differential diagnosis of African histoplasmosis are also discussed.

Adult↗
PubMed1989

Disseminated histoplasmosis. Typical presentation with involvement of the adrenal glands.

A 67-yr-old Indonesian patient with disseminated histoplasmosis is described. He had general malaise and fever for 6 months; an oral ulcer, bilateral adrenal gland enlargement and partial adrenal insufficiency were found. An adrenal aspirate contained Histoplasma capsulatum. The literature on adrenal involvement in disseminated histoplasmosis is reviewed and it is concluded that bilateral enlargement, demonstrated by sonography or computed tomography, in a patient with general malaise is an important clue to the diagnosis.

Adrenal Glands↗