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At least 775 records · Page 43Linked to original sources
PubMed2002

Differences in histoplasmosis in patients with acquired immunodeficiency syndrome in the United States and Brazil.

Demographic and clinical parameters among patients with acquired immunodeficiency syndrome and histoplasmosis in Brazil and United States were compared. The Brazilian isolates were typed by restriction-fragment length polymorphism analysis and were DNA fingerprinted by random amplification of polymorphic DNA (RAPD)-polymerase chain reaction (PCR). Skin lesions occurred in 66% of Brazilian case patients, compared with 1%-7% of US case patients. Of 21 treated case patients, 4 (19%) died, a rate similar to that of the US case patients (5%-13%). By nuclear gene typing, the Brazilian isolates were equally divided between South American classes 5 and 6, and RAPD-PCR showed 18 distinct genetic fingerprints in 20 isolates. Skin lesions are more common in infection with class 5 or 6 organisms than with class 2 Histoplasma capsulatum. The role of genetic differences in the organism as a cause for the clinical differences requires investigation.

AIDS-Related Opportunistic Infections↗
PubMed2003

Histoplasmosis and acquired immunodeficiency syndrome: a study of prognostic factors.

We aimed to identify prognostic factors for AIDS-associated disseminated histoplasmosis. In a multivariate analysis, we found that dyspnea, a platelet count of <100,000 platelets/mm3, and lactate dehydrogenase levels of >2 times the upper limit of the normal range were significantly independently associated with the death of the patient during the first 30 days of antifungal treatment.

AIDS-Related Opportunistic Infections↗
PubMed2004

Drug-drug interaction between itraconazole and the antiretroviral drug lopinavir/ritonavir in an HIV-1-infected patient with disseminated histoplasmosis.

We describe a drug-drug interaction between coformulated lopinavir/ritonavir and itraconazole in a patient infected with human immunodeficiency virus type 1 who had disseminated histoplasmosis. Coadministration of these agents led to a strong increase in itraconazole concentrations and a decrease in concentrations of its metabolite, hydroxyitraconazole, which is equally active pharmacologically. The dosage of itraconazole was reduced when it was used in combination with lopinavir/ritonavir.

AIDS-Related Opportunistic Infections↗
PubMed2005

Disseminated histoplasmosis in persons with interferon-gamma receptor 1 deficiency.

Mutations in the interferon (IFN)-gamma receptor predispose to infection with bacille Calmette-Guérin, nontuberculous mycobacteria, and Salmonella organisms. We identified a patient with recurrent disseminated Histoplasma capsulatum osteomyelitis who had an autosomal dominant form of IFN-gamma receptor 1 deficiency (i.e., a 4-bp deletion at or near base 818). IFN-gamma-mediated immunity is important in the control of histoplasmosis.

Child, Preschool↗
PubMed1997

Histoplasmosis and kidney disease in patients with AIDS.

Renal disease in patients infected with human immunodeficiency virus (HIV) often presents with significant proteinuria and progressive renal failure; focal glomerulosclerosis is the most common renal pathology identified. To our knowledge, we report the first case of nephrotic-range proteinuria and preserved renal function in an HIV-infected patient in association with disseminated histoplasmosis. The initial level of proteinuria was 12.5 g/24 h. The patient developed a concomitant lesion on his neck, which was biopsied and identified as Histoplasma capsulatum by fungal stains and culture. The serum CF titer of antibody against yeast antigens of H. capsulatum was 1:8. The level of serum albumin decreased to 2.0 g/dL, and the level of serum cholesterol increased to 284 mg/dL. Immunohistochemical staining of renal biopsy tissue demonstrated immune complexes within the mesangium; H. capsulatum antigen was also demonstrated in the mesangium. Therapy with oral itraconazole resulted in marked clinical improvement. The findings in this case emphasize the need to rule out treatable causes of the nephrotic syndrome in AIDS, especially in cases of immune-complex glomerulonephritis.

AIDS-Related Opportunistic Infections↗
PubMed2000

Disseminated histoplasmosis and AIDS: clinical aspects and diagnostic methods for early detection.

Disseminated histoplasmosis in AIDS patients is the focus of this paper. Cutaneous lesions are reported as a frequent clinical sign. Bone marrow aspiration and biopsy, blood cultures (lysis-centrifugation technique), bronchoalveolar lavage, and skin lesion scrapings are the most effective diagnostic methods. The identification of a specific antigen in blood and urine may be a rapid means of evaluation and follow-up of patients with this disease.

AIDS-Related Opportunistic Infections↗
PubMedDate not supplied

Comparison of fluconazole with amphotericin B in treatment of histoplasmosis in normal and immunosuppressed mice.

The activities of fluconazole and amphotericin B against Histoplasma capsulatum were investigated. The minimum inhibitory concentrations ranged from 0.12 to 0.47 microgram/mL for amphotericin B and from 16 to 250 micrograms/mL for fluconazole. Fluconazole given orally twice a day for 6 consecutive days compared favorably with amphotericin B given intraperitoneally once every other day for a total of six doses in the treatment of histoplasmosis in normal and leukopenic mice.

Administration, Oral↗
PubMedDate not supplied

Combination therapy of experimental histoplasmosis and cryptococcosis with amphotericin B and ketoconazole.

Combinations of amphotericin B and ketoconazole had an additive effect in vitro against Histoplasma capsulatum and Cryptococcus neoformans; ketoconazole combined with flucytosine exerted an indifferent effect against C. neoformans. In vivo studies in athymic nude (nu/nu) mice and their heterozygous (nu/+) littermates demonstrated that treatment with the ketoconazole-amphotericin B combination resulted in longer survival of mice with cryptococcosis than did treatment with ketoconazole plus flucytosine. However, mice given ketoconazole plus amphotericin B did not survive significantly longer than those given amphotericin B alone (cryptococcosis) or ketoconazole alone (histoplasmosis). Combination chemotherapy with ketoconazole and amphotericin B may offer a modest therapeutic advantage over therapy with either drug alone.

Amphotericin B↗
PubMed1995

Clinical evidence of spinal and cerebral histoplasmosis twenty years after renal transplantation.

Disseminated infection with Histoplasma capsulatum frequently involves the nervous system, but the CNS process is generally not clinically apparent. We report an unusual case of a renal transplant recipient with long-standing immunosuppression who presented with clinical evidence of mass lesions in both his cerebral cortex and his spinal cord. Findings of CSF examination were normal, but stereotaxic biopsies of his cortical lesions demonstrated yeast forms and cultures of biopsy specimens yielded H. capsulatum. Clinical defects referable to both the cortical and spinal lesions decreased in severity after the patient received antifungal therapy. Our case illustrates that disseminated histoplasmosis can present in myriad ways and that widespread disease in the CNS can be occult in immunocompromised patients.

Aged↗
PubMedDate not supplied

Relationship between pathogenesis and immune regulation mechanisms in histoplasmosis: a hypothetical approach.

The cellular immune response may be the principal mechanism of defense against infection with Histoplasma capsulatum. Subsequently, regulation of cell-mediated immunity could be fundamental to the outcome of disease. Suppressive phenomena-present in the host before infection or brought about by fungal components-would explain the various courses of infection. The fact that high titers of antibodies are associated with a poor cellular response suggests that antibodies may have a role as "regulatory molecules" in histoplasmosis. Antibodies may modulate the expression of the cellular response either by direct inhibition or by activation of the suppressor cell population, thereby interfering with the infectious process.

Animals↗
PubMed1980

Suppression of cryptococcosis and histoplasmosis by ketoconazole in athymic nude mice.

Congenitally athymic nude (nu/nu) mice are more susceptible to disseminated cryptococcosis and histoplasmosis than their heterozygous (nu/ + ) thymus-bearing litter-mates. The therapeutic efficacy of ketoconazole, an orally absorbable antifungal agent, was evaluated in nu/nu and nu/ + mice infected intraperitoneally with Cryptococcus neoformans and Histoplasma capsulatum. Two- to five-week courses of ketoconazole significantly prolonged the survival of nu/nu mice infected with either fungus in dose-dependent fashion, but death eventually followed discontinuance of therapy. More significant protection was seen in nu/ + mice infected with C. neoformans, and markedly lower fungal counts in organs, with some negative cultures, were seen in ketoconazole-treated nu/ + mice infected with H. capsulatum. These studies indicate that ketoconazole is effective against both fungi, although results of treatment are much better in the immunologically intact nu/ + host.

Animals↗
PubMed1987

Repeatedly relapsing disseminated histoplasmosis: clinical observations during long-term follow-up.

We report three patients (followed up for 13, 9, and 12 years) who had multiple episodes of disseminated histoplasmosis. Clinically, all three patients had high yields of positive cultures and all developed corticoadrenal insufficiency; all survived the recurrent relapses. One patient had unilateral progressive panophthalmitis, with ocular cultures positive for Histoplasma capsulatum. These relapses occurred despite conventional treatment with large doses of amphotericin B. Prolonged remissions were associated with using small doses of this drug. One patient had a long-term remission while taking ketoconazole daily for more than four years. These patients did not have conditions associated with immunosuppression. Lymphocyte proliferation to mitogens and, in one patient, to histoplasmin, was markedly reduced at the time of relapse and when tested preceding a relapse. All three patients showed a reversal to normal lymphocyte proliferation at the time of the longest last remission.

Female↗
PubMed1983

A winter outbreak of acute histoplasmosis in northern Michigan.

In January 1980, an outbreak of 138 cases of acute pulmonary disease occurred among employees of a Michigan limestone quarry. The source of exposure was a vessel repair building (relative risk = 5.8) and the time of exposure was January 10 (relative risk = 2.4). Work activities associated with the specific place and time suggested exposure to a pulley which had been stored in a ring-billed gull nesting area as the cause of illness. Histoplasma capsulatum was recovered from the nesting area, the pulley, and the sputum of several patients. Early serologic testing confirmed the diagnosis of acute pulmonary histoplasmosis.

Animals↗
PubMed1985

An outbreak of histoplasmosis in a prison.

An investigation of three suspected cases of pulmonary histoplasmosis among 600 employees at a New York prison in a nonendemic area resulted in identification of 12 additional previously unrecognized cases. The 15 cases presented with diagnostic findings between February 1978 and October 1981; 10 were in prison employees, three in inmates and two in community persons. Unlike other outbreaks, cases presented over several years with chronic pulmonary lesions in the absence of an episode marked by acute respiratory illnesses. Of the 13 prison-associated cases, seven had undergone diagnostic thoracotomies for chest x-ray abnormalities. A skin test survey of a random sample of employees showed 53% to have positive histoplasmin skin tests compared with 11% in a community control population (chi 2 = 23.4, p less than 0.001). Over 63% of employees on the job for two or more years reacted positively compared with only 13% of those employed less than two years. Testing of some inmates showed 84% with residence of two years or more to be positive, compared with 20% for those with less than two years. A review of potential exposure sources revealed three sites where bird dropping accumulations had been cleared in 1978-1979. Four specimens from two of these areas were positive for Histoplasma capsulatum. The affected sites were treated with a 3% formalin solution and there have been no subsequent cases.

Adult↗
PubMedDate not supplied

Factors relating to recurrence of chronic pulmonary histoplasmosis following treatment with amphotericin B.

A retrospective analysis was made of cases of Chronic Pulmonary Histoplasmosis during the admission in which patients received amphotericin B to determine if there were features related to recurrence of the disease. There was significance at the p less than or equal to 0.05 level in that the nonrecurrent cases tended to have a lower initial complement fixation titers using mycelial antigen; had initial complement fixation tests which were likely to result in no reaction using either mycelial or yeast antigen; and had more rapid drops in the complement fixation values using the yeast antigen. Although the present evaluation does not suggest an absolute minimum effective dose of amphotericin B, it would seem plausible to administer a course of at least 2300 mg if the initial complement fixation test was nonreactive but if the drug was tolerated well by the patient and the initial complement fixation test was reactive, the goal should be at least 2500 mg.

Adult↗
PubMed1998

Citrobacter freundii empyema in a patient with occult pulmonary histoplasmosis.

The genus Citrobacter includes three species of organisms that are uncommonly associated with human infection. When they are pathogenic, there are usually one or more associated respiratory, urinary, skin-soft tissue, and central nervous system infections and neonatal sepsis. These infections occur in the wake of significant systemic illness or complicate antibiotic usage. Rarely, infection has been associated with active tuberculosis. The authors report a case of Citrobacter freundii empyema in a patient with occult pulmonary histoplasmosis.

Aged↗
PubMed1981

Gallium-67 imaging in pericarditis secondary to tuberculosis and histoplasmosis.

In recent years, many cases of Ga-67 uptake by the heart have been reported. One such case involved a patient with tuberculous pericarditis. Recently, a patient was referred to us for the investigation of a fever of unknown origin. A Ga-67 scan was performed and showed an intense uptake by the pericardium. The final diagnosis was pericarditis secondary to mediastinal lymph node involvement with tuberculosis and histoplasmosis.

Adolescent↗