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At least 991 records · Page 55Linked to original sources
PubMed1993

Disseminated histoplasmosis mimicking miliary tuberculosis: a case report.

A 35-year-old Chinese man who was known to have insulin-dependent diabetes mellitus was admitted for fever and weight loss. During his hospital stay, he fell to his death from his ward at the twelfth floor. The clinical features, radiological findings and gross organ changes at autopsy closely simulated miliary tuberculosis. Histology, however, revealed extensive necrosis of the adrenal glands, lungs, spleen, kidneys and thyroid associated with the presence of Histoplasma capsulatum organisms. This case highlights the similarity both clinically and pathologically between histoplasmosis and tuberculosis and emphasizes the need to be aware of this infection in a nonendemic area among patients with a compromised immune system.

Adult↗
PubMed1993

Histoplasmosis.

Histoplasmosis is an infection caused by the dimorphic fungus, Histoplasma capsulatum. The initial site of entry is usually the lung, but dissemination to skin occurs in some patients, particularly those with human immunodeficiency virus (HIV) infection in whom it is part of a widespread infection. The organisms have to be distinguished from other yeasts in skin such as Cryptococcus neoformans and small forms of Blastomyces dermatitidis.

Acquired Immunodeficiency Syndrome↗
PubMed1993

[Disseminated histoplasmosis in pediatrics. Report of a case].

We report a case of a female infant, from Acapulco Guerrero, Mexico. She had been sick for 45 days, with diarrhea and general malaise, fever during the last 20 days; at physical examination she was pale, with abdominal distention and hepatosplenomegaly. She had leukopenia, thrombocytopenia and anemia. The microscopic findings in the bone marrow sample were intracytoplasmic and extracellular bodies. Both bone marrow and blood cultures were positive for Histoplasma capsulatum. Seventy three pediatric cases of diseminated histoplasmosis have been described in the medical literature since 1934 to 1988. It is know that only about 1% of the persons that become infected will develop a diseminated disease.

Female↗
PubMedDate not supplied

[Laryngeal histoplasmosis].

A case of laryngeal histoplasmosis is reported. This laryngeal mycosis was diagnosed by histological identification of intracellular hyphae of Histoplasma capsulatum. Laryngoscopy revealed edema, erythema and leukoplakia of the righ vocal cord. Itrakonazole treatment was successful. The relevant literature is reviewed.

Antifungal Agents↗
PubMed1977

Ocular histoplasmosis syndrome.

Ocular histoplasmosis syndrome is prevalent among persons living in the vicinity of the Ohio River Valley. Only a small proportion of patients with ophthalmoscopic evidence of prior Histoplasma capsulatum infection ever develop visual symptoms. Visual morbidity usually follows the development of a macular choroidal neovascular membrane which causes serous or hemorrhagic detachment, or both, of pigment epithelium and sensory retina. Fluorescein angiography is useful in documenting the choroidal neovascular membrane and in demonstrating its precise location with respect to the retinal capillary-free zone. tthe fluorescein angiographic appearance and location are used to determine whether or not such membranes are amenable to argon laser photocoagulation. The true role of photocoagulation in the management of histoplasmic maculopathy awaits the results of a randomized clinical trial.

Adult↗
PubMed1996

[Acute pulmonary histoplasmosis with liver and lung involvement outside the endemic area--differential diagnosis].

A case of acute pulmonary histoplasmosis in a non-endemic setting is described. A 36 year-old male patient was admitted because of fever attacks, weakness and dyspnea on exertion. The chest X-ray revealed bilateral patchy and nodular consolidations and bilateral enlargement of the hilar lymph nodes. On computed tomography of the abdomen the spleen was enlarged with a longitudinal diameter of 12.7 cm. Respiratory insufficiency was demonstrated by an arterial oxygen tension (PaO2) of 7.71 kPa at rest. Pathological values of liver function tests were indicative of liver involvement. A transbronchial lung biopsy was performed. Histologic examination of the biopsy specimen revealed scattered small nonnecrotizing granulomas with epithelioid cells and multinucleated giant cells. Precipitating antibodies to Histoplasma capsulatum were detected by immunodiffusion in bronchoalveolar lavage fluid and blood, IgG antibodies to Histoplasma capsulatum yeast antigens were revealed by enzyme immunoassay. The histoplasmin skin test was negative. The pneumonitis, lymph node and spleen enlargement and the pathological liver function tests resolved within one month without treatment. The PaO2 returned to normal within one week.

Adult↗
PubMed1996

Gastrointestinal histoplasmosis in a patient with acquired immune deficiency syndrome.

In otherwise healthy individuals, disease caused by the fungus Histoplasma capsulatum manifests itself as a self-limiting pulmonary infection. Dissemination of the organisms may occur in a setting of compromised cellular immunity. Gastrointestinal involvement occurs in many such cases, but rarely it is clinically obvious and the disease seldom comes to the attention of the general surgeon. However, with the increasing incidence of acquired immunodeficiency syndromes, general surgeons are managing more of these patients than in the past. In our report, we describe a patient with acquired immunodeficiency syndrome who presented with gastrointestinal histoplasmosis.

Acquired Immunodeficiency Syndrome↗
PubMed1977

The natural history of non-disciform ocular histoplasmosis.

Nineteen of 21 asymptomatic individuals with non-disciform atrophic chorioretinal scars characteristics of the ocular histoplasmosis syndrome and identified in the Walkersville survey were re-examined three years later. During this period, of six subjects with peripapillary scars, one developed symptomatic serous detachment of the peripapillary retina; none of the three with macular or paramacular scars showed any change. Several peripheral scars showed increased pigmentation and others definite enlargement. One patient developed two new atrophic scars.

Adolescent↗
PubMed1996

[Role of guided fine needle punction in the diagnosis of deep-seated Aids-related infections. Report of a case of hepato-nodal histoplasmosis].

A case of disseminated histoplasmosis diagnosed by fine needle aspiration biopsy is reported. The patient suffering from acquired immune deficiency syndrome (AIDS) had enlarged liver, spleen and mesenteric lymph nodes. Cytological smears prepared from a CT scan guided fine needle aspiration biopsy of one of the lymph node and the liver, showed numerous free or intrahistiocytic yeasts consistent with Histoplasma capsulatum. Yeasts and protozoars morphologically close to Histo-plasma capsulatum are reviewed. The indications of fine needle aspiration biopsy for the diagnosis of infections in AIDS patients are emphasized. This method enables to send rapidly material for cultures and to start immediately an appropriate treatment.

AIDS-Related Opportunistic Infections↗
PubMed1998

African histoplasmosis: therapeutic efficacy of itraconazole.

A patient with African form of histoplasmosis was treated for 7 years with ketoconazole, with no response; after a 9-month daily treatment with 100 mg of itraconazole the patient was successfully cured. No evidence of relapse was observed during the 3-year follow-up period.

Antifungal Agents↗
PubMed1976

Histoplasmosis: twenty years experience in a general hospital.

This report summarizes the clinical and laboratory data on 57 patients with histoplasmosis, including 13 with progressive disseminated disease. The experience in general is supportive of that of others in that although infection with Histoplasma capsulatum is prevalent, clinical disease is uncommon and disseminated disease actually rare. The data again emphasize the limitations of diagnostic methods, and in particular point up the need to obtain cultures of biopsy material from mucocutaneous lesions.

Histoplasmosis↗
PubMed1998

Disseminated histoplasmosis in an 'immunocompetent' child.

A rare case of severe disseminated histoplasmosis in a 7-year-old boy with apparently normal immune function is described. Current recommendations for diagnostic investigations, monitoring and the treatment of this disease with amphotericin B and itraconazole are reviewed.

Amphotericin B↗
PubMed1998

Histoplasmosis mimicking vasculitis of the central nervous system.

We describe a case of disseminated histoplasmosis that was erroneously diagnosed as central nervous system vasculitis and treated with immunosuppressive therapy. Our case emphasizes the importance of excluding infections before initiating treatment for presumed central nervous system vasculitis. Clinical clues to underlying Histoplasma infections are also discussed.

Brain Diseases↗
PubMed1998

Proton-beam irradiation of subfoveal choroidal neovascular membranes in presumed ocular histoplasmosis syndrome: a case report.

BACKGROUND: Presumed ocular histoplasmosis syndrome (POHS) refers to a choroidopathy that is characterized by the presence of multiple peripheral atrophic chorioretinal scars, peri-papillary atrophy, and choroidal neovascular membranes (CNVM), usually in or adjacent to the fovea. In the United States, POHS is an important cause of loss of central visual acuity in patients between the ages of 20 and 50 years. A number of treatment options for subfoveal and juxtafoveal CNVMs in POHS have been under investigation, including laser photocoagulation, surgical excision of the CNVM, and radiation therapy. CASE REPORT: A 28-year-old women was referred to our office reporting decreased depth perception and finger-counting vision in the right eye for the duration of 1 month. A diagnosis of POHS with subfoveal CNVM was made and the patient was referred for an experimental protocol of proton-beam irradiation. Four months after her initial visit, the patient returned, reporting blurry vision with a blind spot in her left eye. A subfoveal CNVM in the left eye was subsequently treated with irradiation as well. Seven months after the initial treatment, visual acuities were 20/20 in each treated eye. CONCLUSION: Although is currently an experimental procedure, proton-beam irradiation appears to be a promising treatment for subfoveal CNVM in patients with POHS.

Adult↗
PubMedDate not supplied

[Effect of cyclophosphamide in experimental histoplasmosis in the rat].

Histoplasmosis is a fungal disease caused by the dimorphous fungus Histoplasma capsulatum (Hc). Cyclophosphamide (Cy) was used as an immunomodulator capable of modifying the course of the disease, as well as of regulating the mechanisms involved in T-lymphocyte mediated immune response. Rats were subjected to intracardiac inoculation of Hc followed by a fractionated treatment with a 100 mg/kg body weight dose of Cy on days +4, +5, +6, +7 and +11 pi. Until day 26 pi, treatment with Cy caused 85% mortality whereas no mortality was observed among animals only inoculated with Hc. On day 14 pi, the group of Hc animals showed a delayed hypersensitivity test (DH) of 26.60 + 13.96 as determined by the swelling of the leg. Conversely, DH was significantly depressed in rats inoculated with Hc and treated with Cy: 3.88 +/- 1.00 (p < 0.01). Colony forming units count in this group was 2020 CFU/g of spleen, and 24 CFU/g of spleen (p < 0.01) in controls. A macroscopic study of the organs revealed that the animals in the Hc+Cy group had spleenomegaly and lungs with granuloma and hemorrhagic spots. The controls only presented small lung abscesses. These findings lead to the conclusion that Cy causes a deterioration of cell mediated immune response which results in the manifestation of an acute, fatal experimental mycosis.

Animals↗
PubMed1999

Atypical disseminated cutaneous histoplasmosis in an immunocompetent child, caused by an "aberrant" variant of histoplasma capsulatum var. capsulatum

A case of atypical disseminated cutaneous histoplasmosis in a five-year old, otherwise healthy child, native and resident in Sao Paulo metropolitan area is reported. Cutaneous lesions were clinically atypical. Histologic examination disclosed a granulomatous reaction but no fungal structures could be demonstrated by specific staining nor by immunohistochemical reaction. The fungus was isolated from biopsy material on two different occasions, confirming diagnosis of an unusual fungal infection. The fungus, originally thought to be a Sepedonium sp. due to the large sized, hyaline or brownish colored tuberculated macroconidia and to lack of dimorphism (yeast form at 37 degrees C) produce H and M antigens, visualized by the immunodiffusion with rabbit anti-Histoplasma capsulatum hyperimmune serum. Patient's serum sample was non reactive with H. capsulatum antigen by immunodiffusion, counterimmunoelectrophoresis and complement fixation tests, and immunoenzymatic assay failed to detect the specific circulating antigen. This serum was tested negative by double immunodiffusion when antigen obtained from one of the isolated samples was used. Both cultures were sent to Dr. Leo Kaufman, Ph.D. (Mycoses Immunodiagnostic Laboratory, CDC-Atlanta/USA), who identified them as H. capsulatum by the exoantigen and gen-probe tests. Both clinic and mycologic characteristics of the present case were atypical, suggesting the fungus isolated is an "aberrant variant" of H. capsulatum var. capsulatum, as described by SUTTON et al. in 1997. Treatment with itraconazole 100 mg/day led to cure within 90 days

Journal Article↗
PubMed1976

Disseminated histoplasmosis and necrotizing vasculitis.

A 74-year-old man with congestive heart failure was found to have Histoplasma capsulatum in a lesion of the right nasal septum. His initial treatment with amphotericin B was inadequate because of severe intolerance to the drug. Three months after initial presentation H. capsulatum was detected in his blood and bone marrow. Slightly elevated purpuric lesions on the arms, lower legs and trunk showed the typical features of necrotizing vasculitis. Cutaneous anergy was reversed after treatment with transfer factor. Skin involvement in disseminated histoplasmosis is unusual and there are no previous reports of vasculitis associated with this infection.

Aged↗
PubMed2002

[Diminution of antifungal activity of fluconazole associated with ibuprofen and piroxicam in experimental histoplasmosis of hamsters (Mesocricetus auratus)]

The aim of this study was to determine if tha association of non-steroid antiinflammatory drugs (piroxicam and ibuprofen) with fluconazole, affects the antifungal activity of the azole compound, in an experimental model histoplasmosis in hamsters (Mesocricetus auratus). Sixty hamsters were intracardially inoculated with 4x10(6) yeasts of Histoplasma capsulatum var. capsulatum. Treatments began one week after the challenge and continued for three weeks. The hamsters were divided in six groups of ten animals each and received the following treatment: 1- fluconazole 8 mg/kg/day; 2- ibuprofen 20 mg/kg/day; 3- piroxicam 20 mg/kg/day; 4- fluconazole+ibuprofen; 5- fluconazole+piroxicam and 6- only received the solvent of these drugs. One week after ending the treatment, all the animals were sacrified and the evaluation of the treatments was based on the results of blood cultures, on the determination of colony forming units per gram of spleen, and the histopathologic studies of the same organ. The animals treated with fluconazole plus ibuprofen or piroxicam showed more colony colony forming units per gram (3.9x10(7) and 3.3x10(7)) when compared with the animals treated with fluconazole alone (0.9x10(7)). The histopathologic results of the hamsters that received fluconazole showed well-organized granulomas with few yeast-like elements inside the macrophages. In contrast, those which received fluconazole associated with antiinflammatory drugs presented lax granulomas containing numerous yeast-like elements. These findings let us to conclude that non-steroids antiinflammatory drugs diminish the antifungal efficacy of fluconazole in this animal model.

Journal Article↗