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At least 379 records · Page 21Linked to original sources
PubMed1994

Disseminated histoplasmosis: a cause of infection-associated hemophagocytic syndrome.

PURPOSE: We report a case of infection-associated hemophagocytic syndrome in the setting of disseminated histoplasmosis. PATIENTS AND METHODS: A 6-year-old boy with chronic mucocutaneous candidiasis developed a fulminant hemophagocytic syndrome. Evaluation for an infectious cause included bacterial, mycobacterial, viral, and fungal cultures, serological assessment, and histological examination of bone marrow and bronchoalveolar lavage fluid. RESULTS: Culture of bone marrow aspirate, blood, and bronchoalveolar lavage showed disseminated histoplasmosis as the cause for this patient's hemophagocytic syndrome. The patient was treated with amphotericin B with complete resolution of his hemophagocytic syndrome. CONCLUSIONS: Disseminated histoplasmosis is another cause of IAHS in children with an underlying immunodeficiency. Diagnostic difficulties associated with the hemophagocytic syndromes of childhood are discussed.

Bone Marrow↗
PubMed1993

[Disseminated histoplasmosis in children].

Disseminated histoplasmosis is a rare and severe form of the infection due to the fungus Histoplasma capsulatum. This form of disease is seen mainly in patients with some sort of immune deficiency either primary or secondary, in children under two years and in elderly people. An autopsy review at the Hospital Infantil de México Federico Gómez disclosed eight cases of lethal disseminated histoplasmosis in an eight year period. All patients were malnourished, one of them also had a primary immunodeficiency an another had acquired immune deficiency syndrome. The age range was from two months to seven years; five patients were males. The organs more frequently affected were lungs, liver and spleen. In seven patients the diagnosis was established at postmortem study. The patients came from Morelos, Veracruz, Guerrero and Chiapas, regions considered endemic for histoplasmosis. A careful analysis of the clinical symptoms together with a detailed information of the living environment of patients, will lead to an accurate diagnosis and management of children with this disease.

AIDS-Related Opportunistic Infections↗
PubMed1976

Comparison of immunodiffusion and complement fixation tests in the diagnosis of histoplasmosis.

The immunodiffusion and complement fixation tests for histoplasmosis were compared on 2,090 initial sera from 70 proven cases of histoplasmosis, 177 routine chest hospital patients, and 1,843 coal miners from outside the major endemic area for histoplasmosis. The complement fixation test using histoplasmin as antigen detected antibodies in the sera of 72.8% of the 70 proven cases, while the complement fixation test using yeast antigen detected antibodies in 94.3% of the case sera, and the immunodiffusion test using histoplasmin antigen detected antibodies in 90% of the sera. The tests were also compared for sensitivity, specificity, and ease of performance.

Antibodies, Fungal↗
PubMed1993

Disseminated histoplasmosis in a patient with acquired immunodeficiency syndrome (AIDS): a case report.

A 27 year old female with AIDS and disseminated histoplasmosis is presented. The clinical features include fever, weight loss, productive cough, splenomegaly and moderate pallor. The initial working diagnosis was pulmonary tuberculosis. The diagnosis of disseminated histoplasmosis was made terminally from bone marrow aspirate examination. Disseminated histoplasmosis with its varied clinical picture is likely to be missed in a patient with AIDS, and therefore a high index of suspicion is necessary for diagnosis.

AIDS-Related Opportunistic Infections↗
PubMed1996

Disseminated histoplasmosis in renal allograft recipients.

Histoplasmosis, an opportunistic fungal infection endemic in the Ohio and Mississippi river valleys, is caused by a dimorphic fungus Histoplasma capsulatum. Most infections are asymptomatic or self-limited febrile illness. Immunosuppressed renal transplant recipients are susceptible to a disseminated disease. We report 5 cases of disseminated histoplasmosis seen in our institute over a period of 25 years amongst 1074 renal transplant recipients. The duration of immunosuppression prior to the diagnosis of infection ranged from 84 days to 14 years. All patients had pulmonary involvement. Three patients received an antilymphocyte preparation and 1 patent received intravenous pulse steroids in the 3 months prior to the onset of infection. Histopathologic examination of the involved organ(s) provided rapid diagnostic information allowing early treatment with amphotericin B. All infections resolved with no relapses to date. In conclusion immunosuppressed patients are more prone to disseminated histoplasmosis. Early recognition and prompt treatment with amphotericin B resolved the infection without relapse.

Adult↗
PubMedDate not supplied

Focal lesion of African histoplasmosis presenting as a malignant gastric ulcer.

We describe the case of a localized lesion of African Histoplasmosis, presenting as a gastric ulcer, with radiological and endoscopic features suggesting malignancy, that was submitted to surgery. Histologic examination of the resected specimen revealed typical yeasts of Histoplasma duboisii. There where no clinical, radiological or endoscopic signs of disseminated disease and conventional antifungal therapy was not prescribed. The patient has been followed for 11 years now, without evidence of relapse. There are few reports of gastrointestinal Histoplasmosis, and even fewer specifically caused by H. Duboissii Previous descriptions of gastric ulcer in immunocompetent hosts are related to disseminated forms of American Histoplasmosis. Although focal digestive lesions have been found in African patients, there is no available data on the incidence of gastric ulcer as a presenting sign of the disease.

Focal Infection↗
PubMed1996

[Disseminated histoplasmosis and AIDS. Report of 4 cases].

Disseminated histoplasmosis is frequent in patients with HIV infection from endemic zones of Africa and South America. It is infrequent in Europe. Four cases diagnosed as disseminated histoplasmosis among a total of 1,100 AIDS cases reported from 1984 to 1994 were reviewed. Four males with a mean age of 40 years were reviewed. Two were from Argentina, one from Gambia with HIV-2 infection and the remaining case was a Spanish man who had made numerous travels to endemic zones. Prolonged fever without an apparent focci in the previous weeks was the clinical manifestation at the onset in all the cases. Diagnosis was performed by bone marrow aspirate (1 case), histologic study of the cutaneous lesions (1 case) and on autopsy with the diagnosis not being suspected during life (2 cases). Tracheal ulcers and hyperferritinemia are the main peculiarities of the two cases presented. Antifungal treatment with amphotericin B and secondary prophylaxis with itraconazole were effective in one of the cases. It is important to take histoplasmosis into account in the differential diagnosis of prolonged fever in patients with HIV infection from endemic zones.

Acquired Immunodeficiency Syndrome↗
PubMed1997

Microbiologic and histologic diagnosis of histoplasmosis in Taiwan.

Histoplasmosis is one of the most common opportunistic fungal infections in immunocompromised patients in endemic areas. We report the first two microbiologically documented cases of histoplasmosis in Taiwan. The first patient, with acquired immunodeficiency syndrome and a depleted CD4+ lymphocyte count, presented with a history of prolonged fever, papular skin rashes, pancytopenia and elevation of liver enzymes. He was diagnosed and treated initially for systemic toxoplasmosis, but the microbiologic and pathologic findings of the autopsied specimens disclosed disseminated infection caused by Histoplasma capsulatum. The second patient, an elderly man receiving corticosteroids for adrenal insufficiency, manifested with laryngeal histoplasmosis and was successfully treated with ketoconazole.

AIDS-Related Opportunistic Infections↗
PubMed1997

Histoplasmosis in the head and neck.

Histoplasmosis is a fungal infection which when disseminated can be potentially fatal, especially in the immunocompromised patient. Disseminated histoplasmosis can present with orolaryngeal manifestations which often mimic carcinoma or tuberculosis. A high index of suspicion and diagnosis with biopsy is needed. Two recent cases are presented and the literature reviewed. As the number of immunocompromised patients increases, more cases of histoplasmosis in the head and neck will be encountered. Early treatment can reduce morbidity and mortality.

Aged↗
PubMed1997

[African histoplasmosis with ganglionic localisation. Apropos of 1 case in an HIV negative patient].

This study concerns one case of ganglionary African histoplasmosis observed in a pregnant woman. The diagnosis of this histoplasmosis case has been based on histological presentation. This patient has a HIV negative serologic reaction. The histoplasmosis clinical presentation is like tuberculosis, so its diagnosis is difficult. The prevalence of this pathology is unknown in our region but it is increasing since the discovery of AIDS.

Adult↗
PubMed1992

Disseminated histoplasmosis: aspects of oral diagnosis.

This paper reports two cases of histoplasmosis in Natal: histoplasmosis is a granulomatous mycosis caused by H. capsulatum. The Indian mynah may possibly have a rôle in the epidemiology of this disease. In-vitro culture of the organism is the definitive step in confirming the diagnosis of histoplasmosis. The overgrowth of contaminants often precludes culturing; but a clinical regimen of topical antifungal agent and mouthwash may improve the chances of culturing H. capsulatum.

Adult↗
PubMed1998

Disseminated histoplasmosis presenting with cutaneous lesions in a patient with acquired immunodeficiency syndrome.

OBJECTIVE: Presentation of a case of disseminated histoplasmosis, observed in a non-endemic area, in which cutaneous lesions and fever were the dominant clinical signs of the infection. CASE: A 54-year-old homosexual man with acquired immunodeficiency syndrome (AIDS) related Kaposi's sarcoma presented with cutaneous lesions and fever due to disseminated histoplasmosis. The patient was successfully treated with itraconazole 200 mg/day. He died after 8 months from AIDS dementia complex: disseminated histoplasmosis relapse was not observed. CONCLUSION: The case shows that infection with Histoplasma capsulatum must be considered by dermatologists in HIV/AIDS patients, even in non-endemic areas.

AIDS-Related Opportunistic Infections↗
PubMed1998

[Histoplasma capsulatum histoplasmosis: apropos of 1 case observed in the internal medicine department of the CHU of Treichville (Abidjan)].

The advent of AIDS has resulted in an increase in diseases which were previously rare. In HIV-infected subjects, histoplasmosis takes a disseminated and particularly severe form, with a fatal outcome in our country, the more so because the clinical presentation resembles tuberculosis and is generally treated as such. The authors report a case of disseminated histoplasmosis in a patient dually-reactive to HIV-1 and HIV-2, in whom the clinical presentation was fever, mediastinal lymphadenopathy and pulmonary infiltrates. The diagnosis of histoplasmosis was made at autopsy.

Acquired Immunodeficiency Syndrome↗
PubMed1998

Intestinal obstruction and peritonitis resulting from gastrointestinal histoplasmosis in an AIDS patient.

Gastrointestinal histoplasmosis complicated by intestinal obstruction and peritonitis has not been reported. We report a case of gastrointestinal histoplasmosis in a 27-year-old patient with acquired immunodeficiency syndrome (AIDS). The patient was a Chinese man from Thailand with a history of intravenous drug use and unprotected sex with female prostitutes. He was admitted for prolonged fever, abdominal pain, and diarrhea. Colonoscopy revealed volcano-like ulcers and tumors, while computed tomography of the abdomen showed a colon tumor and hypoattenuated lymphadenopathy of the retroperitoneum. Histopathologic examination as well as cultures of colon biopsy specimens and an aspirate from the retroperitoneal lymphadenopathy revealed Histoplasma capsulatum. Intestinal obstruction and peritonitis requiring surgical intervention developed, despite amphotericin B therapy. Histoplasmosis should be included in the differential diagnosis in AIDS patients who present with colon tumors, retroperitoneal lymphadenopathy, and peritonitis.

Acquired Immunodeficiency Syndrome↗
PubMed2004

Histoplasmosis with tenosynovitis of the hand and hypercalcemia mimicking sarcoidosis.

We report on an otherwise healthy 47-year-old male who developed subacute tenosynovitis of the hand associated with night sweats and inguinal lymphadenopathy. He had a past history of granulomatous mediastinal lymphadenitis with positive histoplasmosis serology 11 years previously. Carpal tunnel exploration with biopsy demonstrated granulomatous inflammation. Granulomatous inflammation, hypercalcemia, and an elevated serum angiotensin converting enzyme (ACE) level suggested the diagnosis of sarcoidosis, however histoplasmosis infection could eventually be diagnosed. This unusual presentation of histoplasmosis underscores the fact that the diagnosis of sarcoidosis requires careful exclusion of other causes of granulomatous inflammation, particularly infectious agents. Even in the setting of an elevated ACE level and hypercalcemia, the possibility of an infectious etiology must be considered before establishing a diagnosis of sarcoidosis.

Journal Article↗
PubMed2004

Photodynamic therapy with verteporfin in ocular histoplasmosis: uncontrolled, open-label 2-year study.

OBJECTIVE: To evaluate the safety, effect on visual function, and fluorescein angiographic appearance of subfoveal choroidal neovascularization (CNV) through 2 years after photodynamic therapy with verteporfin (Visudyne; Novartis AG, Basel, Switzerland) in patients with ocular histoplasmosis syndrome (OHS). DESIGN: Open-label, 3-center, uncontrolled clinical study. PARTICIPANTS: Ocular histoplasmosis syndrome patients with subfoveal CNV (N = 26) with a greatest linear dimension no larger than 5400 microm with classic or occult CNV extending under the geometric center of the fovea, and best-corrected visual acuity letter score of approximately 20/40 to 20/200. METHODS: The methods were similar to those described in the 1-year results with follow-up examinations every 3 months continuing through the second year. During the second year, additional therapy was recommended if fluorescein angiography showed leakage at a scheduled visit. MAIN OUTCOME MEASUREMENTS: Visual function measurements included the changes from baseline in visual acuity and contrast sensitivity scores. Lesion size and leakage from classic and occult CNV were assessed at month 12 and month 24. Safety assessments also were made. RESULTS: A 24-month examination was completed in 22 of the 26 enrolled participants (85%). At the 24-month examination, median improvement from baseline in visual acuity of the 22 patients evaluated was 6 letters; median contrast sensitivity improved by 3.5 letters. At the 24-month examination, 10 patients (45%) gained 7 or more letters of visual acuity from baseline, whereas 4 patients (18%) lost 8 or more letters, including 2 patients (9%) who lost at least 15 letters. There was absence of fluorescein angiographic leakage from classic CNV in 17 of the 20 evaluable lesions (85%), and leakage from occult CNV was absent in all eyes. No serious ocular adverse events were reported, and no serious systemic event was considered to be associated with treatment. CONCLUSIONS: Median visual acuity improved and fluorescein angiographic leakage decreased after verteporfin therapy in this small, uncontrolled clinical study of patients with subfoveal CNV resulting from OHS. Verteporfin therapy seemed to be relatively safe in these patients. The selected cases feature fluorescein angiographic examples of CNV that are important in determining when to apply verteporfin therapy.

Adult↗
PubMed2000

A preliminary study of photodynamic therapy using verteporfin for choroidal neovascularization in pathologic myopia, ocular histoplasmosis syndrome, angioid streaks, and idiopathic causes.

OBJECTIVE: To evaluate short-term safety and the effects on visual acuity and fluorescein angiography of single or multiple sessions of photodynamic therapy with verteporfin for choroidal neovascularization (CNV) not related to age-related macular degeneration (AMD), including pathologic myopia, the ocular histoplasmosis syndrome, angioid streaks, and idiopathic causes. DESIGN: A nonrandomized, multicenter, open-label, dose-escalation phase 1 and 2 clinical trial. SETTING: Four ophthalmic centers in Europe and North America providing retinal care. PARTICIPANTS: Thirteen patients with subfoveal CNV due to pathologic myopia, the ocular histoplasmosis syndrome, angioid streaks, or idiopathic causes. METHODS: Standardized protocol refraction, visual acuity testing, ophthalmic examinations, color photographs, and fluorescein angiograms were used to evaluate the results of photodynamic therapy treatments with verteporfin. Follow-up ranged from 12 weeks for patients who were treated once to 43 weeks for patients who were treated up to 4 times. RESULTS: Verteporfin therapy was well tolerated in patients with CNV not related to AMD. No deterioration in visual acuity was observed; most patients gained at least 1 line of vision. Reduction in the size of leakage area from classic CNV was noted in all patients as early as 1 week after verteporfin therapy, with complete absence of leakage from classic CNV in almost half of the patients. Improvement in visual acuity after verteporfin therapy was greatest (+6, +8, and +9 lines) in 3 patients with relatively poor initial visual acuity (between 20/200 and 20/800). Up to 4 treatments were found to have short-term safety even with retreatment intervals as short as 4 weeks. CONCLUSIONS: Treatment of CNV not related to AMD with verteporfin therapy achieves short-term cessation of fluorescein leakage from CNV in a small number of patients without loss of vision. Further randomized clinical trials including a larger number of patients are under way to confirm whether verteporfin therapy is beneficial for subfoveal CNV not related to AMD.

Adult↗