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PubMedDate not supplied

An outbreak of acute pulmonary histoplasmosis in members of a trekking trip in Martinique, French West Indies.

BACKGROUND: Thirteen clustered cases of American histoplasmosis, a deep mycosis caused by Histoplasma capsulatum and acquired through inhalation of airborne spores was reported. Twenty-five persons traveled in Martinique, French West Indies. Thirteen underwent trekking and passed through a mountain tunnel full of bats (tunnel group). The 12 others performed canyoning and did not go through the tunnel (control group). Fifteen days after exposure, 1 patient of the tunnel group developed fever, chills, and cough. METHODS: The index case was diagnosed in the hospital, but 12 cases where initially diagnosed as prolonged influenza. All individuals were contacted and submitted to a phone questionnaire. They were asked about eventual occurrence of influenzalike symptoms, about activities practiced, and the notion of contact with bats. All were invited to have clinical examinations, chest x-ray films, and blood samplings. Serologic testing for histoplasmosis was performed by immunodiffusion. Clinical evidence of infection with H. capsulatum was obtained in all the remaining patients of the tunnel group and in none in the control group. Symptoms occurred with an acute onset in 11 to 23 days: fever and chills, severe asthenia, headaches, digestive tract involvement, and then cough, dyspnea, hepatic involvement. Pulmonary micro- or macronodules and mediastinal adenopathies were seen on radiograph and/or computed tomography scan. RESULTS: H. capsulatum serologic tests were positive in all 13 cases with presence of specific M and or H precipitins, 5 to 13 weeks after exposure, and were negative in control group. All patients were treated with itraconazole 200 mg per day during at least 2 months. Treatment was well tolerated; patients progressively recovered. Clinical and serologic follow-up was obtained for some patients at 1 and 4 years. The present study reports the first large outbreak of histoplasmosis acquired in Martinique. CONCLUSION: Histoplasmosis still occurs and is potentially serious. In patients returning from endemic areas, presenting prolonged influenzalike symptoms, clinicians should look for previous possible exposure to Histoplasma.

Acute Disease↗

PubMed2001

[Two cases of canine histoplasmosis in Japan].

Histoplasmosis is distributed in tropical, subtropical and temperate zones of the world. The disease is one of the imported mycoses in Japan. To date, although more than 30 human and one canine case of histoplasmosis have been reported in Japan, some including that of the canine might have been infected domestically, since the patients have no history of going abroad. The pathogen of histoplasmosis is thus believed to be present in our country. We examined skin biopsies from two dogs in Tokyo and Kumamoto, and found fungal elements 1-2 or 2-4 microEm in diameter in the macrophages. The homology of DNA sequences for the ITS rRNA gene were correspondent to Ajellomyces capsulatus at a rate of more than 97.4%. Therefore, the two dogs were diagnosed as having been infected with Histoplasma capsulatum which is the anamorph of A. capsulatus. Since the dogs had no history of having been outside Japan and had not been brought from an endemic area, they might have been infected domestically. Further epidemiological surveys on canine histoplasmosis may be able to estimate autochthonous human cases in Japan.

Animals↗

PubMed1981

Pathogenesis of experimental histoplasmosis in the bat, Artibeus lituratus.

The pathogenesis of histoplasmosis was studied following intraperitoneal or intranasal infection of the neotropical bat, Artibeus lituratus. Groups of bats received either 10(4) or 10 viable mycelial fragments of Histoplasma capsulatum by intraperitoneal injection, or 10(6) or 10(4) viable mycelial particles by intranasal instillation. Intraperitoneal infection with the high dose resulted in rapid dissemination of the fungus to spleen, liver, lung and intestine, culminating in the death of some bats within 2-3 weeks. As few as 10 viable units of H. capsulatum produced systemic disease in about half of the bats, with the spleen and liver most frequently involved. In both groups the disease was characterized by gross pathologic abnormalities, numerous viable fungi in the tissue, and histologic lesions compatible with a chronic inflammatory process. Following intranasal exposure to 10(6) viable fungi, the primary pulmonary infection disseminated to the spleen, liver, and intestine within 2 weeks. Gross lesions were rarely observed in the viscera, and only one death resulted from the disease. The chronic disseminated nature of histoplasmosis in A. lituratus, especially following the more natural route of infection, suggests the means by which these bats could acquire and harbor H. capsulatum in nature. The frequent involvement of the gastrointestinal tract provides the mechanism by which these reservoirs might seed their environment with the fungus. The similarities between the pathogenesis of histoplasmosis in humans and bats provide a strong rationale for the use of this model in basic histoplasmosis research.

Animals↗

PubMed1999

Outbreak of histoplasmosis among cavers attending the National Speleological Society Annual Convention, Texas, 1994.

In June 1994, 18 people developed serologically confirmed histoplasmosis following cave exploration associated with the annual National Speleological Society Convention in Bracketville, Texas. Six others had an undiagnosed illness suspected to be histoplasmosis. Two persons were hospitalized. We conducted a survey of convention attendees and a nested case-control study of those entering caves. We also conducted a histoplasmin skin test survey of a subgroup of the society, the Texas Cavers Association, who were attending a reunion in October 1994. Among the national convention attendees, exposure to two caves was identified as responsible for 22 (92%) of the 24 cases; 12 (75%) of 16 people exploring one cave (Cave A) and 10 (77%) of 13 exploring a separate cave (Cave B) developed acute histoplasmosis. Additional risk-factors included fewer years of caving experience, longer time spent in the caves, and entering a confined crawl space in Cave A. Of 113 participants in the separate skin test survey, 68 (60%) were found to be skin test positive, indicating previous exposure to Histoplasma capsulatum. A positive skin test was significantly associated with male sex and more years of caving experience. Those less experienced in caving associations should be taught about histoplasmosis, and health care providers should pursue histories of cave exposure for patients with bronchitis or pneumonia that does not respond to initial antibiotic therapy.

Adolescent↗

PubMed1999

[Disseminated histoplasmosis detected by lingual and tonsillar erosions in an immunocompetent patient].

BACKGROUND: Histioplasmosis is a usually asymptomatic fungal infection. In the immunocompetent patient, it leads to chronic disseminated infection. Mucosal involvement is common and can provide the diagnosis. CASE REPORT: A metropolitan Frenchman with a history of alcoholism and smoking and living in Guyana consulted for lingual and tonsil erosion. Squamous cell carcinoma was suspected but not confirmed at pathology. The patient had a bi-apical infiltration on the chest x-ray and was treated empirically for tuberculosis. The diagnosis of histoplasmosis was reached when rare Histoplasma capsulatum were evidenced from a buccal swab. Itraconazole led to cure in 6 months. DISCUSSION: This case illustrates the importance of mucosal signs in the diagnosis of disseminated histoplasmosis in immunocompetent subjects. Histoplasmosis is rarely the cause of active infection in immunocompetent subjects. In these patients, the fungal infection generally progresses to chronic dissemination. Mucosal signs are frequent in this form but are rare in case of cutaneous histoplasmosis. Itraconazole (200 mg/d) is indicated for 6 months.

Alcoholism↗

PubMedDate not supplied

[Histoplasmosis: not only a tropical disease].

Histoplasmosis is a fungal infection resulting from inhalation of spores from the fungus Histoplasma capsulatum; it is known to be endemic in various parts of the world, especially in North and Latin America, and can produce a spectrum of illness, from subclinical infection to progressive disseminated disease. The majority of infected persons have an asymptomatic, self-limiting illness. Clinical pneumonia occurs in those with exposure to a large number of infecting spores. Disseminated histoplasmosis usually occurs in immunosuppressed patients or in patients with chronic illness. Diagnosis is best made by visualization of yeast in tissue or by culture. In most cases, amphotericin B is the initial drug of choice, followed by one of the azoles for lifelong maintenance therapy. Itraconazole is the drug of choice for treatment of disseminated histoplasmosis in less severe cases, while fluconazole therapy for histoplasmosis is only moderately effective.

AIDS-Related Opportunistic Infections↗

PubMed2004

Outbreak of histoplasmosis among industrial plant workers--Nebraska, 2004.

In February 2004, the Nebraska Health and Human Services System (NHHSS) notified CDC about an outbreak of histoplasmosis among workers at a local agricultural processing plant (plant A). Three workers at the plant had acute, febrile, respiratory illness; two had serologic evidence of histoplasmosis. NHHSS and CDC conducted an investigation to determine the source of transmission and the extent of the outbreak. This report summarizes the findings of that investigation, which confirmed occupationally acquired histoplasmosis. Additional measures might be necessary to minimize risk for histoplasmosis among persons who work in the agricultural industry in areas where it is endemic.

Agriculture↗

PubMedDate not supplied

Histoplasmosis presenting as pneumoperitoneum in patients with acquired immune deficiency syndrome: case reports and review of the literature.

Histoplasmosis is a rare, but important, disease process in patients with the acquired immune deficiency syndrome (AIDS). Initially reported in this patient population in 1982, over 100 cases of histoplasmosis have been reported throughout the United States. Most of these patients present with disseminated disease. Untreated, histoplasmosis will be the direct cause of death in over 80% of patients, but treatment with itraconazole can reduce this mortality to less than 25%. We present two cases of histoplasmosis in AIDS patients presenting as pneumoperitoneum.

AIDS-Related Opportunistic Infections↗

PubMed2005

Histoplasmosis of the larynx.

Primary histoplasmosis of the larynx is not a common disease. Most cases of laryngeal histoplasmosis results from hematogenous spread of disseminated histoplasmosis usually originating from pulmonary infection by Histoplasma capsulatum. We report a 52-year-old male chronic smoker who had prolonged hoarseness and was initially diagnosed with laryngeal carcinoma. However, biopsy of the laryngeal mucosa confirmed the diagnosis of histoplasmosis. There were no signs of pulmonary or systemic involvement. Treatment with intravenous amphotericin B was given for a week and oral ketaconazole was given for a month with complete resolution of symptoms.

Diagnosis, Differential↗

PubMed1987

Disseminated histoplasmosis in cats: 12 cases (1981-1986).

Anemia, weight loss, lethargy, fever, anorexia, and interstitial lung disease were the predominant clinical findings in 12 cats with disseminated histoplasmosis. Some cats were examined because of dysfunction or lesions of bone, eyes, or skin. In most cases, the clinical signs were observed by the owner for 4 weeks or less before seeking veterinary care. Young cats were most commonly affected, with 7 of the 12 cats less than or equal to 1 year old. Identification of Histoplasma organisms in bone marrow aspirates was used to confirm the diagnosis of histoplasmosis in 11 of the 12 cats. Histoplasma infection of multiple organs was found at necropsy. In this study, disseminated histoplasmosis had a higher prevalence in cats than in dogs at the same veterinary medical teaching hospital. Feline disseminated histoplasmosis was not associated with FeLV infection. Treatment was attempted in 7 of the 12 cats.

Animals↗

PubMed1985

Cerebrospinal fluid Histoplasma antibodies in central nervous system histoplasmosis.

We have evaluated the Histoplasma antibody response in the cerebrospinal fluid (CSF) in nine patients with central nervous system histoplasmosis and 98 controls. While the CSF Histoplasma antibody response identified eight of the nine patients, CSF cultures were positive in only two. Of controls with histoplasmosis but without meningitis (13 patients), or without histoplasmosis (85 patients), elevated CSF antibodies were detected by complement fixation in seven, by IgG radioimmunoassay in 17, and by IgM radioimmunoassay in five. Measurement of the CSF Histoplasma antibody response appears useful for identifying meningitis in patients with histoplasmosis, although cross-reactions occur in half of patients with other forms of chronic fungal meningitis. Patients with these other infections can usually be identified by tests for CSF Coccidioides antibodies, or cryptococcal antigens.

Antibody Formation↗

PubMed1980

Scars without wounds: spectrum of delayed manifestations of histoplasmosis outside of the endemic area.

This short series represents a spectrum of histoplasmosis usually described only in places where the infection is nearly universal. In fact, most of the patients in this series were born in such places (17 of 19 patients with complicated presentations; 2 had recent suspicious exposures). As young adults, they had moved away to pursue military life, usually in coastal areas where the evidence of infection with H. capsulatum is a statistical rarity. The implications of these observations are straightforward. At the clinical level, they focus on histoplasmosis as a possible cause of pulmonary, mediastinal, or other lesions of obscure etiology, whether or not the patient has recently lived in "the endemic area". The simple determination of CF gamma titers may heighten the index of suspicion, especially when not confounded by skin testing with histoplasmin, a practice which rarely provides useful information. [Table: see text] With regard to pathogenesis, it seems noteworthy that common form of histoplasmosis was not seen in this brief experience. That is the "marching cavity" described by Goodwin and Des Prez, and other forms of chronic cavitary disease. The absence of such lesions is consonant with the view that they require continuous exogenous infection for their development. As for the forms of histoplasmosis which were seen in this series, it appears that most of the illnesses developed outside of what is usually considered endemic areas. The term endemic, as construed medically, has been defined as "restricted to and constantly present in a particular country or locality". Such a construction is unduly pedantic and rigid for clinicians. A more probabilistic view is needed, with attention to the possible role of inapparent infection early in life and of environmental foci of infection in places where the organism is not notoriously present. The mobile nature of our society makes it likely that the radiographic manifestations of once-regional diseases such as this one will be encountered more generally than in the past.

Adolescent↗

PubMed1980

[A case of disseminated histoplasmosis due to Histoplasma capsulatum (author's transl)].

A case is reported of American histoplasmosis due to Histoplasma capsulatum presenting as a hepatic granulomatosis. The patient was a young adult from Haiti and investigations revealed the presence of an ulcerous enterocolitic suggesting tuberculosis or Crohn's disease. The condition became worse after antituberculous therapy and corticoids, and operation was necessary. Extemporaneous histological examination, of the colonic ulcerations showed Histoplasma capsultaum yeasts. The patient, who had a cellular immunity deficiency, died during antifungal treatment with amphotericin B of the disseminated histoplasmosis is rare: 1 case in 5000 American histoplasmosis cases. Digestive tract lesions, usually detected during operation or autopsy, are found in about 20% of cases. In the present observations the diagnosis of American histoplasmosis was based on the country of origin of the patient, but this was not confirmed: the immunological reactions were and remained negative and no yeasts were demonstrated after staining of pre-operative biopsy specimens (colon and liver particularly). Also, serial sections conducted after the diagnosis had been established demonstrated the presence of Histoplasma capsulatum in the colon sample removed during colonoscopy.

Adult↗

PubMed1995

Involvement of anterior chamber angle structures in disseminated histoplasmosis: report of three cases.

This study describes the involvement of anterior chamber (AC) angle structures in patients with disseminated histoplasmosis. The postmortem eyes from three patients (aged 33, 41, and 42 years, respectively) with disseminated histoplasmosis, two of whom had acquired immunodeficiency syndrome, were examined by light microscopy using hematoxylin-eosin, periodic acid-Schiff (PAS), and Gomori's methenamide silver (GMS) stains. Electron microscopy studies of the choroid were performed in one eye. Significant numbers of budding yeast forms of Histoplasma capsulatum measuring 2-5 microns in diameter were observed within the trabecular meshwork, Schlemm's canal and in the deep intrascleral plexuses. All eyes showed massive involvement of the choroidal vasculature, including the choriocapillaris. The organisms were observed freely as well as in small clusters within the cytoplasm of circulating monocytes. The vessels of the limbal conjunctiva (two eyes) and ciliary body (three eyes) contained many Histoplasma organisms. In one eye, several budding yeast were noted in an iris vessel and in occasional histiocytes within the ciliary muscle. Blood smears containing Histoplasma organisms were observed in two cases. None of the patients had an ophthalmologic examination prior to death. Involvement of the intravascular structures of the eye as well as the AC angle was observed in three patients with disseminated histoplasmosis. The fungus most likely reached the AC angle structures by direct hematogenous dissemination or via the aqueous humor by migration from vessels in the ciliary body and iris. An abnormal retrograde blood flow into the AC angle structures may have also played an important role. We suggested that the intraocular pressure be monitored in cases of suspected disseminated histoplasmosis to detect functional alterations indicative of a blockage in the outflow channels.

Acquired Immunodeficiency Syndrome↗

PubMed1994

Diagnosis of histoplasmosis by antigen detection during an outbreak in Indianapolis, Ind.

In this study we examine the sensitivity of Histoplasma capsulatum var capsulatum antigen detection for the diagnosis of histoplasmosis. This was a retrospective review of the sensitivity of antigen detection in patients who were diagnosed as having self-limited, chronic pulmonary, or disseminated histoplasmosis during an outbreak in Indianapolis, Ind. All patients had clinical and laboratory evidence of histoplasmosis, and specimens of urine or serum that were obtained from the patients were tested for H capsulatum var capsulatum antigen. Of the 195 patients who were studied, the following forms of the infection were found: disseminated (n = 108), self-limited (n = 70), chronic pulmonary (n = 14), and asymptomatic (n = 3). Antigen was detected in 92%, 21%, and 39% of the patients with the disseminated, chronic pulmonary, and self-limited forms of histoplasmosis, respectively. Tests for the antigen are most useful in patients with clinical findings of disseminated infection. Antigen detection also may be useful in those patients with more severe pulmonary involvement, especially during the first month of illness when serologic tests for antibodies may be negative.

AIDS-Related Opportunistic Infections↗

PubMed1996

[African histoplasmosis in a patient with HIV-2 infection].

9 months after immigration into Switzerland, a 38-year-old male patient from Liberia/West Africa developed granulomatous and subsequently ulcerative nodules in the face. The heterosexual patient, with no history of i.v. drug abuse, tested positive for HIV-2. Histology of a skin biopsy revealed superficial colonization by numerous fungal elements described as spores and hyphae that were compatible with the initial isolation of Candida parapsilosis. The definite diagnosis of African histoplasmosis was established 3 weeks later after review of the PAS-stained direct smear and after cultures had grown a cream-colored mold subsequently identified as Histoplasma capsulatum var. duboisii. There were no signs of disseminated disease. The lesions cleared under therapy with itraconazole (200 mg q 24h for 2 weeks, subsequently 100 mg q 24h) as well as ketoconazole and Aqua Dalibour (A. zinco-cuprica) locally for 2 months. Follow-up was not possible. Despite alarmingly increasing numbers of HIV-positive patients in Africa, the general incidence of African histoplasmosis seems to be stable with only a few cases per year. To our knowledge only four cases of disseminated African histoplasmosis have been reported in HIV-positive patients; localized cutaneous infection as in our patient, seems to be the exception. The low incidence of this infection is in contrast to the substantial number of HIV-positive patients with disseminated histoplasmosis by H. capsulatum var. capsulatum in the United States.

AIDS-Related Opportunistic Infections↗

PubMed1996

Histoplasmosis in the acquired immunodeficiency syndrome.

Opportunistic infections are common and major causes of morbidity in patients with AIDS. Endemic mycoses pose serious risks for patients in certain parts of the world. Histoplasmosis occurs in 2-5% of patients with AIDS in the Ohio and Mississippi River valleys of the United States and in over 25% of patients from a few cities. Antigen testing has become a highly useful method for diagnosing histoplasmosis rapidly, evaluating the response to treatment and diagnosing relapse. Treatment with amphotericin B or itraconazole is effective (90% or higher) if the patient is not seriously ill at the time of diagnosis but the mortality approaches 50% for those with multiorgan failure. Itraconazole blood levels should be monitored and drugs that impair the absorption or accelerate the metabolism of itraconazole should be avoided. Prophylaxis with itraconazole may be appropriate in areas with an incidence of histoplasmosis. A recently completed study in cities which have unusually high rates of histoplasmosis will provide greater insight into the role of prophylactic antifungal therapy.

AIDS-Related Opportunistic Infections↗

PubMed2001

Pulmonary Histoplasmosis.

Most patients with pulmonary histoplasmosis experience a self-limited illness that rarely requires treatment. However, patients who inhale a large burden of organisms from the environment and those who are immunosuppressed may develop severe, life-threatening pneumonia. Chronic histoplasmosis occurs almost exclusively in patients with severe chronic obstructive pulmonary disease. Complications of pulmonary histoplasmosis are mostly related to persistent mediastinal lymphadenopathy. Mild to moderate forms of pulmonary histoplasmosis should be treated with itraconazole. Patients with severe pulmonary involvement should initially receive amphotericin B; after the patient's condition has improved, therapy can be changed to itraconazole. Preventive measures should be used to protect workers from exposure to large numbers of Histoplasma capsulatum organisms.

Journal Article↗