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At least 397 records · Page 22Linked to original sources

PubMed2003

Detection of histoplasma capsulatum DNA in lesions of chronic ocular histoplasmosis syndrome.

OBJECTIVE: To evaluate choroidal lesions in histological sections from the enucleated eye of a patient with chronic ocular histoplasmosis syndrome for the presence of Histoplasma capsulatum DNA. METHODS: Laser-capture microdissection was used to procure cells from macular and midperipheral choroidal lesions in a deparaffinized hematoxylin-eosin-stained section prepared from the enucleated left eye of a patient with an ipsilateral choroidal melanoma and bilateral chronic histoplasmosis syndrome. The captured cells were initially subjected to polymerase chain reaction (PCR) amplification using a pair of primers unique to each end of the nucleotide sequences that are complementary to the DNA known to flank the internal transcribed spacer regions of the ribosomal RNA genes of H capsulatum. This product was then reamplified using a second set of internally situated nested primers. The results were compared with a positive control sample of H capsulatum DNA and with a negative microdissected sample from noninflamed choroid in the same slide. RESULTS: Products of H capsulatum DNA were identified in both samples of microdissected tissue and the positive control. They were absent in the negative control. CONCLUSION: The observations provide molecular biological evidence linking the chronic choroidal lesions to earlier infection by H capsulatum.

Choroid↗

PubMed1981

Lymphocyte transformation in presumed ocular histoplasmosis.

Lymphocytes from individuals with inactive macular disciform lesions of presumed ocular histoplasmosis challenged with three histoplasmin antigens incorporated tritiated thymidine at a significantly higher rate than histoplasmin-stimulated lymphocytes of matched control and peripheral scar groups. This finding is consistent with the etiologic association of the disciform ocular syndrome and previous systemic infection with Histoplasma capsulatum. The disciform group had a higher mean response than the other two groups to pokeweed mitogen but not to phytohemagglutinin and had higher mean counts per minute to the specific antigens Toxoplasma gondii, Blastomyces dermatitidis, Cryptococcus neoformans, Mycobacterium tuberculosis, M battery, and M gaus, but not to Candida albicans. These data would suggest that individuals with the disciform lesion of presumed ocular histoplasmosis have a hyperreactive cellular immune response; this response may play an important role in the development of the disciform.

Adult↗

PubMed1983

Argon laser photocoagulation for ocular histoplasmosis. Results of a randomized clinical trial.

The Ocular Histoplasmosis Study (OHS) is a multicenter controlled clinical trial designed to determine whether argon laser photocoagulation is useful in preventing severe visual acuity loss in eyes with choroidal neovascular membranes (NVMs) 200 to 2,500 microns from the center of the foveal avascular zone and evidence of ocular histoplasmosis. Eligible patients were assigned to photocoagulation (n = 124) or to observation only (n = 121) groups. Recruitment of patients who have extrafoveal NVMs for the OHS has been terminated because more untreated eyes than treated eyes had experienced severe visual acuity loss. At the most recent follow-up visit (median follow-up, 18 months), 34.2% (39/114) of untreated eyes v 9.4% (11/117) of treated eyes had lost six or more lines of visual acuity from the baseline level. The superiority of argon laser photocoagulation was evident in all subgroups and at every point in follow-up time, indicating that patients who meet the eligibility criteria will benefit from treatment. Follow-up of all patients continues in order to assess long-term results of treatment.

Adolescent↗

PubMed1987

Krypton laser photocoagulation for neovascular lesions of ocular histoplasmosis. Results of a randomized clinical trial. Macular Photocoagulation Study Group.

The Ocular Histoplasmosis Study-Krypton Laser is a multicenter controlled clinical trial designed to determine whether krypton red laser photocoagulation is of value in preventing visual acuity loss in eyes with ocular histoplasmosis that have either choroidal neovascularization 1 to 199 micron from the center of the foveal avascular zone (FAZ) or choroidal neovascularization 200 micron or further from the FAZ center with blood and pigment extending within 200 micron of the FAZ center. Patients were assigned to photocoagulation (n = 143) or to observation only (n = 145). Recruitment of patients with such lesions has been stopped because more untreated eyes than treated eyes had experienced severe visual acuity loss. At one year after randomization, 24.8% (31/125) of untreated eyes, in contrast with 6.6% (8/121) of treated eyes, had lost six or more lines of visual acuity; by three years after randomization, the corresponding values were 24.6% (15/61) and 4.6% (3/64). The superiority of treatment was evident at every point in time after six months. There were no subgroups in which there was convincing evidence that treatment was harmful. Follow-up of all patients continues to assess long-term results of treatment.

Choroid↗

PubMed1993

Ultrastructural features of surgically excised subretinal neovascular membranes in the ocular histoplasmosis syndrome.

We evaluated the ultrastructural features of seven surgically excised submacular neovascular membranes from seven patients with the ocular histoplasmosis syndrome. Excised neovascular membranes were composed of fibrovascular tissue interposed between Bruch's membrane and the retinal pigment epithelium. Cellular components present in the membranes included, in decreasing order of frequency, retinal pigment epithelium, vascular endothelium, photoreceptor cells, macrophages, erythrocytes, ghost erythrocytes, fibrocytes, myofibroblasts, glial cells, smooth-muscle cells, and lymphocytes. Extracellular constituents of the neovascular membranes included 20 to 25-nm collagen fibrils, fibrin, 10-nm collagen fibrils, and fragments of Bruch's membrane and choroid. Our findings are consistent with the concept that subretinal neovascular membranes in the ocular histoplasmosis syndrome represent a nonspecific healing response to a local stimulus or injury.

Adolescent↗

PubMed1994

Adenocarcinoma of retinal pigment epithelium arising from a juxtapapillary histoplasmosis scar.

A 66-year-old woman underwent a transocular fine-needle aspiration biopsy for an enlarging mass arising from a juxtapapillary histoplasmosis scar in the left eye. The cytologic study revealed pigmented malignant cells, suggesting that the lesion was either a malignant choroidal melanoma or an adenocarcinoma of the retinal pigment epithelium. The eye was enucleated and histopathologic studies revealed findings suggestive of an adenocarcinoma of the retinal pigment epithelium. Immunohistochemical stains were positive for cytokeratin and were negative for melanoma-specific antigen, supporting an epithelial origin of the neoplasm. It is possible that the tumor developed as a neoplastic transformation of a reactive proliferation of the retinal pigment epithelium in a histoplasmosis scar. The possible association between a chorioretinal scar and the development of a tumor of the pigment epithelium is discussed herein.

Adenocarcinoma↗

PubMed1995

Long-term results of laser treatment in the ocular histoplasmosis syndrome.

OBJECTIVE: To determine the long-term visual outcome, rate of persistent choroidal neovascularization, and rate of recurrent choroidal neovascularization in eyes undergoing laser photocoagulation for choroidal neovascularization secondary to ocular histoplasmosis syndrome. DESIGN AND PATIENTS: One hundred one eyes with 5 to 16 years of follow-up that presented with choroidal neovascularization secondary to ocular histoplasmosis were retrospectively evaluated. Patients were grouped according to location of choroidal neovascularization and assignment to observation or laser photocoagulation. MAIN OUTCOME MEASURES: Visual acuity outcome and loss for all groups were compared. The rates of persistent and recurrent choroidal neovascularization for the treated eyes were also evaluated. RESULTS: Visual acuity of 20/40 or better was obtained in 71% of eyes with treated extrafoveal choroidal neovascularization and 68% with treated juxtafoveal choroidal neovascularization. Recurrent choroidal neovascularization was observed in 23% of treated eyes during a mean follow-up of 9.6 years. CONCLUSION: Results support the long-term benefit of photocoagulation and need for careful follow-up.

Adolescent↗

PubMed1990

Scar carcinomas of the lung in a histoplasmosis endemic area.

Seventeen cases of pulmonary scar carcinomas were found in 112 surgically resected pulmonary carcinomas from 1985 through 1988 in a hospital situated in a histoplasmosis endemic area. These carcinomas can be divided into two types: Type I, mucinous; and Type II, non-mucinous (Clara cell). Each type of carcinoma constitutes a discrete group in reference to gross features, histologic and ultrastructural cell types, and the nature of the scar. The scar in Type I carcinomas appears mostly desmoplastic. The majority of Type II carcinomas appear to have arisen around a preexisting histoplasmosis granuloma which contains yeast organisms on microscopic examination. Pulmonary scar carcinoma is not a single discrete clinicopathologic entity. It appears that peripheral carcinomas of different histogenesis are incorporated in this category.

Adenocarcinoma, Mucinous↗

PubMed1982

Histoplasmosis presenting with joint pain and hilar adenopathy. "Pseudosarcoidosis".

During 2 recent epidemics of histoplasmosis in Indianapolis, 7 patients with hilar adenopathy and joint complaints were identified who were initially considered to have sarcoidosis, but in whom histoplasmosis was ultimately diagnosed on the basis of a positive culture for Histoplasma capsulatum or serologic studies. Articular features were the sole presenting complaints in 3 of these patients. All had arthralgias, which were generalized or confined to the lower extremities and were additive rather than migratory. Only 1 patient had joint swelling. Two had erythema nodosum. In all but 1 patient, the articular symptoms resolved rapidly and completely with minimal therapy. The data emphasize that sarcoidosis is a diagnosis of exclusion and that granulomatous infectious diseases must be excluded in patients with hilar adenopathy and joint disease.

Adult↗

PubMed1991

Correlation of Histoplasma capsulatum polysaccharide antigen with the severity of infection in murine histoplasmosis.

We sought to determine if Histoplasma capsulatum polysaccharide antigen (HPA) levels correlate with the extent of infection in murine of histoplasmosis. Separate groups of mice were inoculated intratracheally with varying numbers of H. capsulatum yeast cells. After 1 week, HPA levels and fungal burden (quantitative culture of lung and spleen and histopathologic stain of lung) were determined in lung and spleen, and HPA levels in serum. HPA levels, cultures and histopathological stain results of lung and spleen tissue showed a direct correlation with increasing inoculum size. HPA levels in serum also correlated with the size of inoculum. H. capsulatum antigen in lung correlated with silver stain scores of lung tissue, (R = 0.948, P less than 0.001) and with quantitative culture scores of lung, (R = 0.929, P less than 0.001). HPA levels in spleen tissue also correlated with spleen culture scores, (R = 0.724, P less than 0.001). These results indicate that determination of HPA level in serum and tissue may be a useful test in evaluating the severity of diseases as well as efficacy of antifungal therapy in histoplasmosis.

Animals↗

PubMed1979

Histoplasmosis mimicking childhood non-Hodgkin lymphoma.

Cell surface markers are becoming increasingly important in the diagnosis of malignant lymphoid diseases. We present a case of pulmonary histoplasmosis with a pleural effusion. The differential diagnosis included non-Hodgkin lymphoma because the pleural fluid cells were cytologically identical to convoluted lymphoblasts; the cells also formed rosettes with sheep erythrocytes at 37 degrees C, suggesting that they were malignant thymus-derived lymphoblasts. Since cultures of pleural fluid were negative for bacteria and fungi, the correct diagnosis of histoplasmosis was made only after conventional histology identified Histoplasma capsulatum organisms in pleural nodules. Thus, until we have a better understanding of the significance of cell surface markers, we should continue to rely on conventional histology for the diagnosis of lymphomas.

Child↗

PubMed1995

Disseminated histoplasmosis presenting as myositis and fasciitis in a patient with dermatomyositis.

A 54-year-old man with dermatomyositis initially responsive to corticosteroids and methotrexate developed severe myalgias, increasing weakness, and fevers. Laboratory studies were suggestive of disseminated histoplasmosis, and muscle biopsy revealed myositis, fasciitis, and yeast in the perimysial connective tissue. Histoplasma capsulatum was cultured from skeletal muscle. Despite antifungal therapy, necrotizing fasciitis progressed to gluteal abscess formation. Disseminated histoplasmosis may present atypically in immunocompromised hosts as fasciitis and myositis. Patients with dermatomyositis could be particularly vulnerable to soft tissue invasion by fungi due to their underlying microangiopathy.

Abscess↗

PubMed1994

Disseminated histoplasmosis in a non-immunocompromised host.

Histoplasma infections in Europe are rare, and acute disseminated histoplasmosis has only been observed in immunocompromised persons. We describe a case of acute disseminated histoplasmosis in a young, nonimmunocompromised European woman. The probable source of infection was Sri Lanka or the Maldives. At presentation she was severely ill with fever, lymphadenopathy, anemia, thrombocytopenia, hepatosplenomegaly, and polyserositis. Histologically, myelofibrosis and osteosclerosis were observed with extramedullary hematopoiesis. Histoplasma capsulatum yeasts were detected in bone marrow trephine biopsy by methenamine silver staining. Treatment with conventional and liposomal amphotericin B and subsequent itraconazole led to rapid and complete recovery.

Acute Disease↗

PubMed1975

Pulmonary alveolar proteinosis and histoplasmosis: report of three cases.

Pulmonary alveolar proteinosis (PAP), in addition to acute generalized histoplasmosis, was found at autopsy of three adult males, 23, 51, and 52 years of age. All three patients became ill in the same region of Venezuela, south of Lake Maracaibo, an area considered highly endemic for histoplasmosis. The PAP may be due to an environmental factor.

Adrenal Cortex↗

PubMed1980

Immunology of histoplasmosis: humoral and cellular activity from a polysaccharide-protein complex and its deproteinized fraction in experimentally immunized mice.

In a previous publication it was reported that a polysaccharide-protein complex (PPC), sensitive to beta-glucosidase, was isolated from Histoplasma capsulatum. This complex was strongly reactive in an agar gel diffusion assay with sera from patients with histoplasmosis, but was unreactive with sera from patients with coccidioidomycosis. Here, the studies with human sera have been expanded and attempts were made to determine the response of mice immunized with nonviable H. capsulatum or Coccidioides immitis to PPC or its deproteinized fraction (D-PPC) using more sensitive tests for antibody and including also test for cell-mediated immunity. Histoplasmin and coccidioidin were compared with PPC or its deproteinized fraction (D-PPC) in all assays. In a counterimmunoelectrophoresis (CIE) assay, PPC and D-PPC reacted only with sera from patients with histoplasmosis, whereas cross reactions were noted with histoplasmin and coccidioidin using heterologous sera. Cross-reaction were observed with all four antigen preparatins and both types of antisera using a microcomplement fixation assay. The assay for macrophage migration inhibitory factor (MIF) was also relatively nonspecific, in that inhibition occurred with cells from animals sensitized with Histoplasma or Coccidioides using both homologous and heterologous antigens. In the footpad assay, histoplasmin and coccidioidin were highly cross-reactive in animals sensitized with the heterologous fungus, but the PPC and D-PPC from H. capsulatum elicited significant reactions only in animals sensitized with Histoplasma.

Animals↗

PubMed1995

Epididymal histoplasmosis diagnosed by isolation of Histoplasma capsulatum from semen.

An autochthonous case of epididymal histoplasmosis masquerading as tuberculosis in a 55-year-old male patient is reported from India. It was diagnosed by culture of Histoplasma capsulatum from semen and by demonstration of the fungus upon re-examination of epididymal biopsy sections previously misinterpreted as tuberculous granuloma. The patient's main complaints were painful epididymal swelling, occasional fever and cough. He was treated successfully by excision of epididymis and vas deferens combined with amphotericin B therapy. This is believed to be the first case of epididymal histoplasmosis to be reported outside the American continent and the fourth of its type reported in the English literature. The case is also noteworthy in that H. capsulatum was isolated for the first time from semen, and it underlines the importance of mycological culture of semen specimens for diagnosis of genitourinary infections of obscure etiology.

Biopsy↗

PubMed1998

Disseminated histoplasmosis successfully treated with liposomal amphotericin B following azathioprine therapy in a patient from a nonendemic area.

Histoplasma infections in Europe are rare, and acute disseminated histoplasmosis has been observed only in immunocompromised persons. An unusual case of autochthonous disseminated histoplasmosis in a 22-year-old Spanish man who had been treated with azathioprine and prednisone for 4 weeks before admission is reported. The development of an acute form of the disease may represent an endogenous reactivation of a latent infection as a complication of immunosuppression resulting from the use of these drugs. This case illustrates the potential risk of this opportunistic fungal infection in patients receiving azathioprine therapy, an association that has been rarely described before.

Adult↗

PubMed1996

Disseminated histoplasmosis in an adopted infant from El Salvador.

UNLABELLED: An HIV-negative 4-month-old infant recently adopted from El Salvador was admitted for high fever. Hepatosplenomegaly, anaemia, leucopenia, thrombocytopenia, increased transaminases, and diffuse interstitial pulmonary infiltration were present on admission. Granulomas were seen in bone marrow and liver biopsies without any organism. Disseminated histoplasmosis was diagnosed 2 weeks later when bone marrow and blood cultures taken on admission became positive for Histoplasma capsulatum and when histoplasmic antigen was detected in blood. The outcome was good after treatment with amphotericin B followed by itraconazole which was administered for a 6-month period without significant toxicity. CONCLUSION: Disseminated histoplasmosis is very rarely seen in Europe but should be suspected in case of unexplained fever in immigrants from the endemic areas in the world, particularly when hepatosplenomegaly and pancytopenia are present. Bone marrow examination and culture, blood cultures, and antigen testing are the mainstays of the diagnosis.

Adoption↗