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At least 703 records · Page 39Linked to original sources
PubMed1984

Disseminated histoplasmosis associated with the acquired immune deficiency syndrome.

Disseminated histoplasmosis developed in a previously healthy man as the initial manifestation of the acquired immune deficiency syndrome. Following apparently successful therapy with intravenous amphotericin B, he presented two months later with a subacute pneumonitis syndrome diagnosed by bronchoscopy as Pneumocystis carinii pneumonia. He showed response to intravenous trimethoprim/sulfamethoxazole with resolution of his symptoms and clearing of chest radiographic findings. While he was receiving antibiotics, oral candidiasis developed and has persisted for more than two months despite topical therapy and discontinuation of all antibiotics.

Acquired Immunodeficiency Syndrome↗
PubMed1985

Hypercalcemia in disseminated histoplasmosis. Aggravation by vitamin D.

Hypercalcemia associated with disseminated histoplasmosis in an elderly male is described. Serum calcium levels increased during vitamin D supplementation, supporting the proposed mechanism of hypercalcemia in granulomatous diseases. Rapid clinical deterioration and death occurred shortly after administration of steroids for relative adrenal insufficiency. Vitamin D and calcium supplements may aggravate the hypercalcemia of granulomatous disease and should be avoided.

Calcium↗
PubMed1976

Presumed ocular histoplasmosis.

A 21-year-old woman with the presumed ocular histoplasmosis syndrome developed a subretinal neovascular membrane at a site previously demonstrated to be free of atrophic scarring on fluorescein angiography.

Adult↗
PubMed1977

Hemorrhagic peripapillary lesions in presumed ocular histoplasmosis.

Eight eyes of five patients with hemorrhagic peripapillary histoplasmosis demonstrated prolonged symptomatic periods and recurrent bleeding episodes, although final visual acuity was equal to or better than 6/12 (20/40) in five eyes (63%). Fluorescein angiography demonstrated new subretinal neovascular growth at the margins of atrophic scars. In the late stages additional retinal pigment epithelium was lost and a white subretinal mass developed adjacent to the atrophic zone. Argon laser photocoagulation was used in two cases to destroy this neovascular tissue, but caused a permanent arcuate defect in one.

Adult↗
PubMed1977

Follow-up study in eyes with choroidal neovascularization caused by presumed ocular histoplasmosis.

Sixty-four eyes of 60 patients with ocular histoplasmosis, and choroidal neovascularization documented by fluorescein angiography, and not treated with photocoagulation, were followed for an average of 29 months. The primary determinant of visual outcome was the proximity of the neovascular membrane to the fovea. Sixty-four percent of eyes with membranes 0.25 disk diameter or greater from the fovea had a final visual acuity of 6/12 (20/40) or better, and 71% of such eyes maintained or improved initial visual acuity. All eyes with subfoveal neovascularization had a poor visual result. Other factors related to visual prognosis included initial visual acuity, size of the neovascular membrane, size of sensory retinal detachment, and presence of hemorrhage.

Adolescent↗
PubMed1978

The prevalence of HLA-B7 in presumed ocular histoplasmosis in patients with peripheral atrophic scars.

Patients identified in the Walkersville, Maryland, epidemiologic study of presumed ocular histoplasmosis as having only peripheral atrophic scars showed no increase in frequency of HLA-B7 over a control population. Because this antigen is increased in patients with a history of active macular or peripapillary lesions, these findings indicate an inherent predisposition in some patients to develop posterior pole lesions after an ocular infection with Histoplasma capsulatum. The precise mechanisms by which the histocompatibility complex participates in the pathogenesis of these lesions is unknown, but our data are compatible with previous suggestions that alterations in the immune response of these individuals are in some way important in the development of disciform scarring in the posterior pole.

Eye Diseases↗
PubMed1980

Peripapillary neovascular membranes in presumed ocular histoplasmosis.

We studied 39 eyes with ocular histoplasmosis and peripapillary neovascular membranes for an average of 12 months. On the basis of clinical findings, 19 were selected for treatment with photocoagulation. Of the treated eyes, 12 (63%) had a visual result of 6/12 (20/40) or better. Of the 20 untreated eyes, six were clinically untreatable and 14 were electively followed up. All but one of the eyes electively followed up had a good visual result. Proximity of the neovascular membrane to the fovea was the most important prognostic factor in determining visual outcome. All eyes with membranes less than 1/4 disk diameter from the fovea lost central vision. All membranes greater than one disk diameter had excellent results. The indications for treatment were prolonged serous or hemorrhagic detachment of the fovea, documented progression of the membrane, and possibly, loss of central vision in the fellow eye from peripapillary disease. Residual and recurrent neovascularization were significant treatment complications.

Adult↗
PubMed1981

Treatment of macular subretinal neovascularization with the red-light krypton laser in presumed ocular histoplasmosis syndrome.

A patient with presumed ocular histoplasmosis and decreased visual acuity in one eye had subretinal neovascularization and retinal hemorrhage in the macular area. Argon-laser treatment to eradicate the subretinal neovascular membrane was contraindicated because of the proximity of the hemorrhagic lesion to the fovea. We used a red-light krypton laser (647 nm) because the light is not absorbed by the hemoglobin in the retinal hemorrhage or by the macular luteal pigment (xanthophyll), and because it is transmitted into the choroid, allowing treatment within the macular zone with less damage to the internal retinal elements. After treatment, the subretinal neovascular membrane completely disappeared and the macular hemorrhage cleared. To the best of our knowledge, this is the first time that a histoplasmic macular subretinal neovascular membrane has been treated with the red-light krypton laser.

Eye Diseases↗
PubMed1982

Histopathology of presumed ocular histoplasmosis.

A 46-year-old man with the clinical picture of presumed ocular histoplasmosis had its right eye removed because of an associated choroidal malignant melanoma. Histopathologically, the choroidal foci disclosed the different stages of inflammatory evolution; from granulomatous foci with caseation, macrophages, and giant cells, to nongranulomatous lesions composed of lymphocytes, and finally to the healing stage of fibrohyaline scarred lesions. The granulomatous lesions contained PAS-positive and Grocott-positive bodies and dead Histoplasma organisms. Electron microscopy demonstrated that the dead fungi did not disappear from the tissue and were detected nine years after the initial infection.

Adult↗
PubMed1985

Subretinal neovascularization after experimental ocular histoplasmosis in a subhuman primate.

Subretinal neovascularization was demonstrated in a subhuman primate eye (Macaca speciosa) one year after the internal carotid injection of yeast-phase Histoplasma capsulatum. In this animal model of ocular histoplasmosis, initial injection of viable H. capsulatum results in the development of self-limiting acute multifocal choroiditis. Acute lesions resolve within six months, forming chorioretinal scars that are clinically similar to human histo spots. Detailed ultrastructural study of a peripapillary scar 30 months after the injection showed the presence of subretinal neovascularization located between Bruch's membrane and degenerated retinal inner segments. These vessels appeared to be continuous, had tight junctional complexes, and a well-developed basal lamina with occasional pericytes. Failure of fluorescein angiography to demonstrate the presence of this neovascular net may be explained by the presence of tight junctions within the subretinal capillaries.

Animals↗
PubMed1992

Clinical manifestation of mediastinal fibrosis and histoplasmosis.

We treated 20 patients thought to have mediastinal fibrosis secondary to Histoplasma capsulatum. All but 1 were symptomatic. The most common symptoms were dyspnea (8), hemoptysis (6), postobstructive pneumonia (5), and superior vena caval obstruction (2). Nine patients had severe stenosis of the trachea, carina, or main bronchus. Special stains identified Histoplasma capsulatum in surgical specimens in 9 patients. Surgical procedures were done for 18 of 20 patients (resection of subcarinal mass, 6; right middle and lower lobectomy, 5; carinal pneumonectomy, 4; esophagoplasty, 4; sleeve resection, 3 (with right main bronchus in 1, right lower and middle lobectomy in 1, and carina in 1); right upper lobectomy, 1; middle lobectomy, 1; and bronchoplasty of left main bronchus, 1. There were 4 deaths, 3 after complications of carinal pneumonectomy and 1 in a patient with tracheobronchial obstruction that could not be dilated. Two patients were treated with amphotericin and 4 with ketoconazole. Sclerosing mediastinitis secondary to histoplasmosis presents tremendous surgical challenges because of the intense fibrosis encountered. Bronchoplastic procedures are possible in spite of the intense fibrosis. High mortality rates after carinal resection may be encountered. The exact role of antifungal therapy is as yet undefined.

Adolescent↗
PubMed1979

Maxillary African histoplasmosis mimicking malignant jaw tumour.

An account is given of an unusual presentation of solitary Histoplasmosis duboisii of the jaw simulating a malignant neoplasm. This report is of interest for two reasons; firstly, the rarity of such a presentation and secondly, the extensive search of the literature which has failed to produce another case. The rationale for our treatment is also briefly discussed.

Adolescent↗
PubMed1983

Oral histoplasmosis: diagnostic complication and treatment.

Intraoral histoplasmosis is difficult to diagnose, both because the clinician fails to be aware of it and because the lesion has clinical similarities to other disease entities, creating a misleading clinical impression. Effective communication between clinician and pathologist is essential, if one is to arrive at an accurate diagnosis and provide the best treatment. A new antimycotic agent, ketoconazole, is now available for oral administration. Studies indicate that it has major therapeutic advantages and significantly lower toxicity than comparable antimycotic agents.

Antifungal Agents↗
PubMedDate not supplied

Further studies on the treatment of African histoplasmosis with ketoconazole.

Five patients with African histoplasmosis were treated with ketoconazole. Three of these were children with disseminated disease and 2 were adults with localized cutaneous disease. Both patients with cutaneous disease responded to treatment, although one was lost to follow-up. Of the 3 children with disseminated disease, one was apparently cured, one responded well but subsequently relapsed, and one failed to respond in spite of having blood levels of ketoconazole within the therapeutic range. Further studies are needed to determine the optimum dosage and duration of treatment with ketoconazole for this condition.

Administration, Oral↗
PubMedDate not supplied

Ocular histoplasmosis: clinicopathologic correlation of 3 cases.

The eyes of three patients followed clinically for many years with a diagnosis of macular disciform scarring, secondary to ocular histoplasmosis, were studied histopathologically. A fibrovascular scar interposed between the choroid and retina was observed in all cases. Vessels passing from the choroid through defects in Bruch's membrane into the nodule were demonstrated. Theories of the pathogenesis of the lesion are discussed.

Adult↗
PubMed1984

Computed tomography evaluation of bilateral bronchostenosis caused by sclerosing granulomatous mediastinitis: a complication of histoplasmosis.

A proved case of histoplasmosis with sclerosing granulomatous mediastinitis complicated by severe bilateral bronchostenosis in a 28-year-old woman is reported. The case demonstrates that this relatively benign disease can lead to grave consequences and that computed tomography is extremely useful in the evaluation of this mediastinal lesion, particularly when plain chest radiography is noncontributory.

Adult↗
PubMed1993

Hypoadrenal crisis caused by disseminated histoplasmosis.

We report a case of disseminated histoplasmosis presenting with acute renal impairment due to adrenal insufficiency. The finding of bilateral adrenal gland enlargement on abdominal ultrasound examination led to a diagnostic CT-guided adrenal biopsy. Prolonged therapy with amphotericin and itraconazole resulted in a clinical cure, although the patient still requires adrenal replacement therapy.

Abdomen↗