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PubMed1988

Disseminated histoplasmosis in acquired immunodeficiency syndrome: light and electron microscopic observations.

Two young homosexual men with acquired immunodeficiency syndrome (AIDS) presented with five-lobe pneumonia and maculopapular rash, respectively, and were found to have disseminated histoplasmosis by examination of peripheral blood smears. Bone marrow smears from one patient revealed more numerous Histoplasma capsulatum organisms than peripheral blood smears did. Electron microscopy of peripheral-blood buffy coat demonstrated histoplasma organisms in monocytes and neutrophils as well as tubuloreticular structures in small lymphocytes. A search for Histoplasma capsulatum in peripheral blood smears from patients with AIDS is warranted, especially in endemic midwestern states.

Acquired Immunodeficiency Syndrome↗
PubMed1980

Follow-up study of presumed ocular histoplasmosis syndrome.

One hundred and sixty-two patients with presumed ocular histoplasmosis syndrome were evaluated. New macular scars not present on initial angiogram developed in 9% of eyes. The risk of developing a symptomatic macular lesion in eyes with asymptomatic macular scars was 23%. In eyes with peripapillary scarring, 3.8% developed a peripapillary neovascular membrane. Follow-up was 5.5 years. When the neovascular membrane was touching or outside the foveal avascular zone, the difference between photocoagulated and control eyes was not statistically significant. When only adequately photocoagulated eyes (20) were compared with control eyes (40), the difference was statistically significant (P = 0.04).

Adolescent↗
PubMed1982

A comparative study of argon and krypton laser. Photocoagulation in the treatment of presumed ocular histoplasmosis syndrome.

Ninety eyes from 88 patients with active macular subretinal neovascular membranes of presumed ocular histoplasmosis were treated with photocoagulation: 45 eyes with blue-green argon laser and 45 with red krypton laser. Final visual results are compared between these two series and natural course of the disease. The krypton laser photocoagulated eyes obtained better final visual results when compared with both the argon laser treated series and natural course.

Adult↗
PubMed1984

Subfoveal and juxtafoveal subretinal neovascularization in the presumed ocular histoplasmosis syndrome. Visual prognosis.

The visual prognosis of 148 eyes in patients with an active subfoveal or juxtafoveal subretinal neovascular membrane (SRNVM) in the presumed ocular histoplasmosis syndrome (POHS) was reviewed. Average follow-up was 39 months. One hundred twenty of 148 eyes (81.1%) had a final visual acuity worse than 20/40. One hundred three of 148 eyes (69.6%) had a final visual acuity equal to or worse than 20/200. Systemic and/or periocular steroids had no effect on final visual outcome. Factors affecting final visual outcome are described and prognosis in the fellow eye is discussed.

Adolescent↗
PubMed1996

Managing recurrent neovascularization after subfoveal surgery in presumed ocular histoplasmosis syndrome.

PURPOSE: To report the authors' experience with recurrent neovascularization after subfoveal surgery in the presumed ocular histoplasmosis syndrome (POHS). METHODS: One-hundred seventeen patients with POHS and subfoveal choroidal neovascularization were followed a median of 13 months after submacular surgery. RESULTS: Recurrent neovascularization developed in 51 eyes (44%). The median time to recurrence was 3 months (range, 0.5-28 months). Recurrence location was extrafoveal in 16%, juxtafoveal in 18%, and subfoveal in 66%. Sixteen eyes were treated with laser photocoagulation, 17 eyes underwent repeat submacular surgery, and 18 eyes were observed. The visual outcome for patients with recurrences amenable to laser was better than that for patients who were observed or who underwent surgery. CONCLUSION: Recurrent neovascularization after surgery is common; prompt recognition may allow laser photocoagulation.

Choroid↗
PubMed1997

Surgical removal of subfoveal choroidal neovascularization in presumed ocular histoplasmosis: stability of early visual results.

PURPOSE: The authors assess the stability of visual acuity outcomes after the surgical removal of subfoveal choroidal neovascularization in a large series of patients with presumed ocular histoplasmosis syndrome (POHS). METHODS: A retrospective study of 117 consecutive patients undergoing vitrectomy between February 1990 and December 1994 was performed. All patients underwent the surgical removal of subfoveal choroidal neovascularization due to POHS and had at least 3 months of follow-up. Postoperative Snellen visual acuity was the primary study endpoint. RESULTS: With a median follow-up of 13 months (range, 3-46 months), 35% of patients had postoperative visual acuity of 20/40 or better, and 40% had improvement of three or more Snellen lines after surgery. In a subset of 54 eyes followed for at least 1 year, 91% showed stable or improved vision between the 3- and 12-month time points, and 85% showed stable or improved vision between 3 months and final visit. CONCLUSION: Follow-up of a large number of patients appears to confirm initially encouraging results and to suggest stability of beneficial effect after the surgical removal of subfoveal choroidal neovascularization in POHS.

Adolescent↗
PubMed1998

Surgical removal of extensive peripapillary choroidal neovascularization associated with presumed ocular histoplasmosis syndrome.

OBJECTIVE: This study aimed to report the visual outcome of surgical removal of extensive peripapillary choroidal neovascularization (CNV) due to presumed ocular histoplasmosis syndrome (POHS). DESIGN: Retrospective review of the records of all patients seen at the Barnes Retina Institute who underwent surgical removal of extensive peripapillary CNV associated with POHS and who had at least 12 months of follow-up. PARTICIPANTS: Seventeen consecutive eyes (in 14 patients) undergoing surgical removal of extensive peripapillary CNV associated with POHS were studied. INTERVENTION: Pars plana vitrectomy and surgical removal of CNV were performed. MAIN OUTCOME MEASUREMENTS: Best-corrected Snellen visual acuity, funduscopic examination, and intravenous fluorescein angiography were obtained before surgery and at regular intervals after surgery. RESULTS: In 14 of 17 eyes, the peripapillary CNV was subfoveal, and in 3 eyes, it was extrafoveal. All three eyes with extrafoveal CNV were not eligible for laser treatment according to Macular Photocoagulation Study guidelines because treatment would have spared less than 1.5 contiguous clock-hours of retina temporal to the optic disc. Follow-up ranged from 17 to 57 months, with a median of 32 months. In eyes with subfoveal CNV, best-corrected preoperative Snellen visual acuity ranged from 20/25 to counting fingers at 2 feet with a median of 20/200, and best-corrected final Snellen visual acuity ranged from 20/25 to 20/200 with a median of 20/40. In 7 (50%) of 14 eyes, a final Snellen acuity of 20/40 or better was achieved, and in all cases except 1, visual acuity improved or did not change with surgery. In the three eyes with extrafoveal CNV, best-corrected preoperative Snellen visual acuity ranged from 20/20 to 20/400 with a median of 20/200, and best-corrected final Snellen visual acuity was 20/20 in all cases. In addition, visual acuity improved with surgery. CONCLUSIONS: The data from this small retrospective study suggest that surgical removal may provide visual benefit in selected cases of extensive peripapillary CNV due to POHS.

Adolescent↗
PubMed1984

Disseminated histoplasmosis.

A case of chronic disseminated histoplasmosis, presenting 16 years after returning to Scotland from West Bengal, is reported. The difficulties and pitfalls in diagnosis and management are emphasised.

Aged↗
PubMed1996

Histoplasmosis--a ten year follow-up.

A patient with chronic disseminated histoplasmosis was followed after successful treatment with amphotericin B for 10 years until his death from chronic obstructive airways disease. Necropsy showed that Histoplasma organisms could still be identified in the adrenal and pancreatic abscesses, though none appeared viable on electron microscopy. Excision of such abscesses should be considered in view of their potential as a reservoir of organisms.

Aged↗
PubMed1998

Oral histoplasmosis: a case report.

We report a case of biopsy-proven histoplasmosis in an 81-year-old man with mouth ulcers. The initial infection was probably contracted whilst he was a prisoner of war in Sumatra, and was reactivated during intercurrent illness with congestive cardiac failure and oral corticosteroid treatment for idiopathic thrombocytopaenic purpura. Of particular note is the latent period of 50 years, and a positive cytoplasmic antineutrophil cytoplasmic antibody (cANCA) titre.

Adrenal Cortex Hormones↗
PubMed1999

Acute disseminated histoplasmosis complicated with hypercalcaemia.

A case of acute progressive disseminated histoplasmosis complicated with hypercalcemia is reported and the literature is reviewed. This and the previously reported cases imply that physicians should have a higher index of suspicion for this infection and the probable underlying diseases resulting from impaired cellular-mediated immunity when encountering patients with hypercalcaemia.

Fatal Outcome↗
PubMed1996

Cutaneous cryptococcosis and histoplasmosis coinfection in a patient with AIDS.

Patients with AIDS may have multiple infections at one time, and skin lesions resulting from simultaneous infections with more than one organism have been described. We report a case of disseminated cryptococcal and histoplasmosis infections with cutaneous lesions in a patient with AIDS. In addition, we demonstrate the first case of two coexisting fungal infections in a unique skin lesion. The cutaneous presentation of infectious disorders in HIV-infected patients is often nondescript and not diagnosed by clinical observation alone. Biopsies and cultures are essential for making accurate diagnoses in immunocompromised patients with unusual skin lesions.

AIDS-Related Opportunistic Infections↗
PubMed2003

Association of the HLA-DR15/HLA-DQ6 haplotype with development of choroidal neovascular lesions in presumed ocular histoplasmosis syndrome.

Associations of human leukocyte antigen DR2 (HLA-DR2) and HLA-B7 with presumed ocular histoplasmosis syndrome (POHS) in the United States has been previously described. However, these associations were determined by means of low-resolution, complement-dependent cytotoxicity assays for HLA-A, HLA-B, and HLA-DR molecules. To determine whether POHS is associated with other HLA alleles within the HLA-A, HLA-B, HLA-DR, and HLA-DQ loci, we performed a case control study of 34 patients diagnosed with macular choroidal neovascular membrane secondary to POHS and 45 healthy control individuals. Peripheral blood-derived DNA from the study patients was typed for HLA genes by means of sequence-specific primers that gave low-medium allele resolution. Significant associations were observed between HLA-B7 (X2 = 14.30, pc = 0.004, relative risk = 8.23), HLA-DR15 (X2 = 29.08, pc = 0.000001, relative risk = 27.50), and HLA-DQ6 (X2 = 23.09, pc = 0.00001, relative risk = 27.43) and POHS. Because there are strong linkage disequilibria between HLA-DR15 (a subtype of HLA-DR2) and HLA-B7 as well as HLA-DQ6, the significantly higher association of HLA-DR15 and HLA-DQ6 with POHS as compared to HLA-B7 suggests that the former alleles mediate susceptibility to the disease. In conclusion, there is a significant association between the HLA-DR15/HLA-DQ6 haplotype and development of choroidal neovascular lesions in POHS.

Choroid↗
PubMed1991

Disseminated histoplasmosis in a renal transplant patient: a cause of renal failure several years following transplantation.

A 49-year-old man developed disseminated histoplasmosis 6 1/2 years after transplantation. The organism was initially present in the urine and in a tongue lesion. Treatment with itraconazole was instituted. However, there was further dissemination of the disease and worsening of renal function. Allograft biopsy showed extensive involvement with the organism. Amphotericin B was started, resulting in a rapid resolution of the disease. However, renal function deteriorated, leading to permanent hemodialysis.

Biopsy↗
PubMed1998

Ocular histoplasmosis.

Presumed ocular histoplasmosis syndrome can be as benign as not knowing one has a vision problem or can result in shock and disbelief on losing central vision and dealing with legal blindness.

Eye Infections, Fungal↗
PubMed2000

Experimental histoplasmosis in mice treated with anti-murine interferon-gamma antibody and in interferon-gamma gene knockout mice.

Histoplasma capsulatum is an important fungal pathogen in immunocompromised hosts, including AIDS patients. Experimental evidence suggests interferon-gamma (IFN) plays a role in host defense against H. capsulatum. In these studies we sought to demonstrate the importance of IFN in innate resistance to systemic histoplasmosis. The possible exacerbation of infection in BALB/c mice was assessed by administering 200 microg of hamster anti-IFN antibody prior to infection with H. capsulatum (2 x 10(6) yeasts, i.v.) and by comparing the severity of infection between BALB/c IFN gene knockout mice (GKO) and congenic control animals. In two separate studies, we found that anti-IFN treatment caused a dramatic loss of resistance to lethal infection and resulted in earlier mortality of IFN-depleted animals compared with normal IgG or no treatment (P<0.001). GKO mice were significantly (P<0.001) more susceptible to lethal infection than were control animals, and histological studies corroborated this. These studies clearly demonstrate that IFN is a vital part of the host's innate resistance to systemic infection with H. capsulatum and provide an additional rationale for studying IFN as an immunomodulatory therapeutic for the treatment of this disease.

Animals↗
PubMed1993

Histoplasmosis of the oral cavity, oropharynx and larynx.

A patient with oropharyngolaryngeal histoplasmosis is presented. He has been treated for disseminated tuberculosis (TB) for 10 months, with no improvement. Repeat biopsy of a tongue ulcer, together with a swab of the ulcer base, confirmed the presence of Histoplasma capsulatum. Treatment with amphotericin B resulted in a rapid recovery.

Diagnosis, Differential↗
PubMed1999

Murine models of blastomycosis, coccidioidomycosis, and histoplasmosis.

Animal models have contributed much to the knowledge of fungal infections and their corresponding therapeutic treatments. This is true for animal models of the primary fungal pathogens, Blastomyces dermatitidis, Coccidioides immitis, and Histoplasma capsulatum. This review gives a brief background of human diseases associated with these organisms and describes the development, details, and utility of murine models of blastomycosis, as well as coccidioidomycosis and histoplasmosis.

Animals↗