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At least 649 records · Page 36Linked to original sources
PubMed1993

[Disseminated histoplasmosis in a patient with acquired immunodeficiency syndrome].

A twenty nine year old male homosexual presented with malaise, weight loss, fever and profuse sweating. An ill defined abdominal mass was found during physical examination in the right lower quadrant and chest X rays disclosed a pleural effusion. HIV antibodies and hepatitis B surface antigen were positive and immunological parameters were altered. Light and electron microscopic examination of operative biopsies of the abdominal mass revealed the presence of Histoplasma capsulatum. Treatment with Amphotericin B was started with a favorable response and the patient was discharged. He was readmitted with a septic shock and died. Necropsy showed pulmonary histoplasmosis. This is the first case of disseminated histoplasmosis in a patient with AIDS described in Chile.

Acquired Immunodeficiency Syndrome↗
PubMed1994

Gastrointestinal histoplasmosis in HIV infection: two cases of colonic pseudocancer and review of the literature.

Primary gastrointestinal infection is an uncommon manifestation of histoplasmosis. It is almost always associated with disseminated disease and/or an immunocompromised host. The ileum and cecum are the most common sites involved. We report two cases of primary gastrointestinal histoplasmosis in HIV-seropositive men who presented with annular constricting right colon lesions.

Adult↗
PubMed1993

Histoplasmosis in the acquired immunodeficiency syndrome (AIDS): treatment with itraconazole and fluconazole.

The manifestations of histoplasmosis in 20 patients with the acquired immunodeficiency syndrome are presented. In this series, patients were treated with either itraconazole or fluconazole. Twelve patients received treatment with itraconazole at 400 mg/day, including two patients who had not responded to treatment with fluconazole at 100 mg/day. Of the responses, seven were classified as remissions (mean treatment duration of 24 months), two as improvements, and three as failures. Ten patients received fluconazole. Of the responses, three were classified as remissions (mean treatment duration of 12 months), one as improvement, and six as failures. Of the 10 patients treated with fluconazole, five received doses of 100 mg/day, and five were given doses of 400 or 800 mg/day. The differences in outcome among the five patients receiving the lower dose of fluconazole (one remission, one improvement, and three failures) and the five patients given the higher doses of fluconazole (two remissions and three failures) were negligible. One other patient showed signs of histoplasmosis while receiving fluconazole at 50 mg/day for treatment of thrush. Three failures (two treated with itraconazole and one with fluconazole) followed lapses in azole therapy because of associated conditions. Azole therapy was well tolerated. The treatment responses in this pilot series appear promising in comparison with those reported in the literature with amphotericin B or ketoconazole.

Acquired Immunodeficiency Syndrome↗
PubMed1993

[Hemophagocytic syndrome associated with histoplasmosis in the acquired immunodeficiency syndrome: description of 3 cases and review of the literature].

Three cases of haemophagocytic syndrome (HPS) due to histoplasmosis in patients with the acquired immunodeficiency syndrome (AIDS) are described. At admission all had pancytopenia and the bone marrow aspirate showed typical haemophagocytosis and the presence of intracellular inclusions compatible with Histoplasma capsulatum. One patient had also cerebral toxoplasmosis. One patient died shortly after admission from multiple organ failure. Two patients survived, one treated with fluconazole and another with amphotericin-B with good response and progressive increase in their blood cell counts. We suggest that haemophagocytic syndrome due to disseminated histoplasmosis should be included in the causes of pancytopenia in patients with AIDS. Bone marrow aspirate is the best method for diagnosis.

AIDS-Related Opportunistic Infections↗
PubMed1995

Intestinal histoplasmosis in AIDS patients: report of three cases observed in France and review of the literature.

We report three cases of colonic histoplasmosis observed in a non-endemic area in patients with AIDS. The patients presented with fever, abdominal pain and an abdominal mass in the right lower quadrant. Diagnosis was obtained using Gomori-Crocott staining of endoscopic or surgical biopsies. One patient died without specific treatment and two patients had a complete remission when treated with intravenous amphotericin B but suffered a relapse when given oral itraconazole. Thus, physicians in areas where intestinal histoplasmosis is not endemic should be aware of the condition. Diagnosis can easily be obtained using Gomori-Crocott staining of colonoscopic biopsies; this should avoid unnecessary laparotomies and allow specific treatment to be instituted rapidly.

AIDS-Related Opportunistic Infections↗
PubMed1996

Opportunistic fungal infections in patients with HIV disease: combating cryptococcosis and histoplasmosis.

Both cryptococcosis and histoplasmosis are life-threatening diseases in patients with advanced HIV infection. Cryptococcal disease in patients with AIDS is usually a systemic illness with an insidious onset of meningoencephalitis. Development of potent oral antifungal agents has simplified therapy, although patients with cryptococcal meningitis are at high risk for relapse. Histoplasmosis is usually disseminated in AIDS patients. Definitive diagnosis requires culture of the pathogen from blood or other specimens. Although availability of azole compounds has broadened treatment options, relapse is common after treatment of acute disease, and lifelong suppressive oral therapy is needed. Antifungal prophylaxis is not considered cost-effective at this time.

AIDS-Related Opportunistic Infections↗
PubMed1995

[Multiple bone lesions of a type of disseminated African histoplasmosis in a Togolese immunocompetent child].

The authors report one case of disseminated African's histoplasmosis with numerous bones in Togolese immunocompetent child. The left tibia and fibula, the collarbones and the acromion were the bones mostly affected. The chronic fistulate lesion of the left leg associated with skin lesion allowed to evoke the diagnosis, this being confirmed by histological examination. The authors review the different diagnosis which will be discussed considering the radiographic appearance of african's histoplasmosis.

Acromion↗
PubMedDate not supplied

[Histoplasmosis of the central nervous system. Report of 2 cases and review of the literature].

The involvement of the central nervous system by histoplasma is an infrequent complication. The clinical diagnosis is difficult because the microscopic examination and the culture of the spinal fluid are frequently negative. In this article we report two cases of meningitis by Histoplasma capsulatum in patients with acquired immunodeficiency syndrome. The first case is a meningitis without evidence of disseminated histoplasmosis in a patient who had been treated with amphotericin B. The histologic appearance was that of a granulomatous inflammation of the meninges and the underlying nervous tissue. The second case is a disseminated histoplasmosis with involvement of the central nervous system. This consists of macrophages filled with histoplasma invading the meninges and underlying nervous tissue without associated inflammation.

AIDS-Related Opportunistic Infections↗
PubMed1997

[The value of immunological assays in the diagnosis of meningeal histoplasmosis].

INTRODUCTION: Between 1985 and 1995, 3,860 cerebrospinal fluid (CSF) samples from patients with mycotic meningitis were analyzed. METHODS: Direct examination, cultures, complement fixation (CF) and immunodiffusion (ID) with Histoplasma capsulatum were carried out. RESULTS: Seventy four samples from 31 patients (three of them with AIDS) were reactive at the immunological assays. Cultures were positive in five patients. In 26 patients the clinical diagnosis together with positive CSF assays gave indirect evidence of meningeal histoplasmosis. ID and CF reactivity were 93.5% and 100% respectively. For 23 patients who had simultaneous examination of blood and CSF the double positivity was 78.2%. CONCLUSIONS: Because of the direct isolation of Histoplasma capsulatum is a difficult one, the diagnosis of subacute or chronic meningeal histoplasmosis may be confirmed by indirect immunological assays.

Adolescent↗
PubMed1997

[Acute pulmonary histoplasmosis as an imported disease].

A previously healthy 44-year-old male traveller presented with a dry cough, fever and an abnormal chest X-ray after a stay in Guatemala, where he had explored bat caves. Acute pulmonary histoplasmosis was diagnosed after culture of Histoplasma capsulatum from bronchial washings. A favourable response was seen upon treatment with itraconazole for six weeks. Acute pulmonary histoplasmosis should be considered in a healthy traveller returning with fever from the USA or subtropical areas.

Adult↗
PubMedDate not supplied

[Histoplasmosis in the region of the hard palate simulating a lesion caused by Leishmania].

A case of histoplasmosis at the oral cavity simulating mucocutaneous leishmaniasis is reported. The initial suspicion of leishmaniasis was not confirmed due to lack of amastigotes and no reactivity of the Montenegro's skin test. Diagnosis of histoplasmosis was done by Grocott's stained smears and isolation of Histoplasma capsulatum in Sabouraud's-agar slants. Treatment with Amphoterecin B led to complete remission of the lesion.

Diagnosis, Differential↗
PubMed1998

Blockade of endogenous TNF-alpha exacerbates primary and secondary pulmonary histoplasmosis by differential mechanisms.

We investigated the mechanisms by which endogenous TNF-alpha modulates host defenses during experimental primary and secondary pulmonary infection with Histoplasma capsulatum (Hc). Neutralization of TNF-alpha in vivo resulted in increased CFU and 100% mortality in naive and immune mice challenged with Hc intranasally. Levels of IFN-gamma and granulocyte macrophage-CSF were elevated in TNF-alpha-neutralized naive mice, whereas IL-4, -6, -10 and TGF-beta did not differ from controls. In contrast, in secondary histoplasmosis, significant elevations of IL-4 and -10 were observed in TNF-alpha-depleted mice. Alveolar macrophages (Mphi) did not exert fungistatic activity against Hc after exposure to recombinant murine TNF-alpha, recombinant murine IFN-gamma, or both. The increase in susceptibility to primary Hc infection was associated with diminished production of reactive nitrogen intermediates by alveolar Mphi from TNF-alpha-depleted mice, whereas production of nitric oxide during secondary histoplasmosis was similar in both groups. Upon secondary challenge, TNF-alpha-depleted mice were rescued by concomitant neutralization of IL-4 and IL-10, but not either cytokine alone. Thus, TNF-alpha is critical for controlling primary and secondary infection with Hc, and the mechanisms that lead mice to succumb to primary or secondary infection when endogenous TNF-alpha is blocked are different.

Animals↗
PubMed1998

Acute pulmonary histoplasmosis: progressive pneumonia resulting from high inoculum exposure.

Histoplasmosis is endemic in certain areas of North, Central, and South America, especially within the Ohio and Mississippi River Valleys of the United States. We describe a case of histoplasmosis in a farm-dwelling resident of Kentucky who probably had multiple prior opportunities for exposure. However, during the gathering of topsoil containing chicken droppings for use as fertilizer, he was likely to have been exposed to such a high inoculum of the organism that he developed a severe pulmonary infection. He presented with a one-week history of malaise, myalgias, fever to 103 degrees F, and headaches. A chest X-ray showed bilateral reticulonodular infiltrates. He was initially treated for community-acquired pneumonia. When his symptoms did not resolve, a bronchoscopy was performed. Washings from the broncho-alveolar lavage grew Histoplasma capsulatum, and he responded well to itraconazole therapy. This case is presented to emphasize risks from high-inoculum exposure and the hazard imposed by harvesting certain types of organic material for use as fertilizer.

Acute Disease↗
PubMed1997

[Rapid diagnosis of cutaneous leishmaniasis and histoplasmosis by direct microscopic tests].

BACKGROUND: Cutaneous leishmaniasis and disseminated histoplasmosis can be diagnosed by direct examination of pathology specimens after Giemsa staining. CASE REPORT: An HIV-infected man developed cutaneous leishmaniasis and disseminated histoplasmosis with buccal lesions concomitantly. Smears stained with the RAL 555 kit provided the diagnosis of these two diseases. DISCUSSION: This case illustrates how direct microscopic examinations can provide inexpensive, rapid and safe diagnosis of infectious diseases. Direct microscopic examinations are routine practice in a tropical dermatology unit.

Cytodiagnosis↗
PubMed1996

[Progressive disseminated histoplasmosis in AIDS patients].

The clinical histories of 12 AIDS patients whose histoplasmosis diagnosis has been confirmed by histopathological studies were reviewed aimed at knowing the main clinical and microbiological aspects of the disseminated progressive histoplasmosis. In every case it appeared as a febrile and waste disease with an elevated hepatomegaly frequency and generalized adenopathies. More than 50% of the patients had anemia and an accelerated erythrocyte sedimentation. The chest X-ray showed pulmonary lesions in 50% of the patients, whereas, the abdominal ultrasound allowed to observe hepatomegaly and splenomegaly in 58.3 and 41.6% of the patients, respectively. A low sensitivity was found in the culture of different clinical specimens as well as in the antibody detection techniques. It is discussed the need to improve tha laboratory diagnosis methods, particularly those which make possible the antigen detection in a fast and specific way.

AIDS-Related Opportunistic Infections↗
PubMed2002

Disseminated Histoplasmosis Mimicking Felty's Syndrome.

The successful treatment of rheumatoid arthritis often requires the use of immunosuppressive medications. Although these agents have different potential toxicities, they share in common the potential for permitting the development of opportunistic infections. We describe 2 patients with chronic rheumatoid arthritis treated with immunosuppressive agents who developed progressive neutropenia with documented splenomegaly. The differential diagnosis included Felty's syndrome versus bone marrow suppression from their immunosuppressive medication. Although both patients had the triad of Felty's syndrome, high titer seropositive rheumatoid arthritis with splenomegaly and neutropenia, the diagnosis of this syndrome relies on excluding other potential causative factors. Further investigation revealed that both patients had disseminated histoplasmosis with bone marrow involvement, which most likely represented reactivation from prior exposure to Histoplasma capsulatum. Opportunistic infections such as disseminated histoplasmosis can mimic other disease processes, including Felty's syndrome, and are important to consider when there is a change in the clinical status of patients with rheumatic disease who are immunocompromised.

Journal Article↗
PubMed1992

Diagnosis of histoplasmosis in a dog by cytologic examination of CSF.

A mixed inflammatory cell pleocytosis was identified in a cytocentrifuged sample of cerebrospinal fluid (CSF) and diagnosis of histoplasmosis was made on the basis of finding Histoplasma capsulatum organisms within macrophages. This dog had disseminated histoplasmosis with multiple organ involvement including the central nervous system (CNS) and eye.

Journal Article↗