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PubMed2003

[Oral histoplasmosis 34 years after return of Africa].

INTRODUCTION: Histoplasmosis is a tropical fungal infection sharing many similarities with tuberculosis: the transmission by air dropplets, the usually asymptomatic primary-infection, the disseminated infection encountered among immunosuppressed patients and the granulomatous pathological lesions. In France, histoplasmosis is uncommon and may be misdiagnosed as tuberculosis. OBSERVATION: A 78 years old male patient presents with a raspberry-like lesion of the mouth causing difficulties to eat and weight loss of 14 kg. The diagnosis of tuberculosis is evoked because of the presence of a giant-cell granuloma in one of the biopsies. The histoplasmosis serology, requested because the patient stayed in Africa, is positive. Revisions of the pathology put into evidence the presence of spores in histiocytes confirming diagnosis of histoplasmosis. The treatment with itraconazole is effective. CONCLUSION: Histoplasmosis is a differential diagnosis of tuberculosis, especially in endemic regions. The histoplasmosis serology can be useful. The reference in diagnosis examinations keeps being the microscopic observation of spores and their mycological growth.

Africa↗

PubMed2002

Incidence of histoplasmosis following allogeneic bone marrow transplant or solid organ transplant in a hyperendemic area.

Questions have arisen regarding the risk of developing symptomatic Histoplasma capsulatum infection among patients who undergo transplant-related immunosuppression in areas endemic for histoplasmosis. Our medical center is located in a hyperendemic area for histoplasmosis, where three large outbreaks occurred since 1978. We undertook a retrospective chart review of 137 patients who received allogeneic bone marrow transplant and of 449 patients who received solid organ transplant from January 1994 to December 1996 in order to assess the incidence of active histoplasmosis. Charts were reviewed before and after transplantation for clinical outcomes, H. capsulatum serologies and antigen results, and microbiological and radiological results. After a mean follow-up duration exceeding 16 months, no patient was diagnosed with histoplasmosis. In the absence of an outbreak, histoplasmosis is a rare infection following the immunosuppression of allogeneic bone marrow or solid organ transplantation even in a hyperendemic area. Pre-transplant serologies or chest radiographs consistent with prior infection were not associated with post-transplant histoplasmosis.

Adult↗

PubMed2001

Laboratory diagnosis of histoplasmosis: update 2000.

Histoplasmosis is a common infection in endemic regions of North and Latin America, causing a broad spectrum of clinical findings. Although acute pulmonary infection, chronic pulmonary, and progressive disseminated histoplasmosis are the most commonly recognized clinical manifestations, pericarditis, rheumatologic syndromes, esophageal compression, and sarcoid-like manifestations are well-recognized complications of histoplasmosis. Although excellent laboratory methods for diagnosis are available, diagnosis in many cases is missed or delayed because histoplasmosis is not considered in the differential. Physicians must be aware of the clinical syndromes and take advantage of epidemiologic clues. Furthermore, clinicians must be familiar with the uses and limitations of a battery of serologic and mycologic tests. Cultures, fungal stains, antigen detection, and serologic tests for antibodies are useful for diagnosis of histoplasmosis. All are reasonably specific and can serve as the basis for diagnosis in patients with compatible clinical findings. Each has certain limitations that must be recognized if they are to be used correctly. The approach to diagnosis of histoplasmosis will be reviewed.

Diagnostic Tests, Routine↗

PubMed1986

Diagnosis of disseminated histoplasmosis by detection of Histoplasma capsulatum antigen in serum and urine specimens.

The diagnosis of Histoplasma capsulatum infection by serologic testing for the presence of antibodies is limited by a high rate of false positive and false negative results and by the requirement that the patient have a normal immune response. We have developed a radioimmunoassay for the detection of H. capsulatum antigen in urine and serum specimens. Antigenuria was noted in 20 of 22 episodes of disseminated histoplasmosis that occurred in 16 patients, in 6 of 32 patients with self-limited infection, in 2 of 32 patients with cavitary histoplasmosis, and in 4 of 8 patients with a sarcoid-like illness caused by H. capsulatum. The detection of antigen in urine was reproducible in 38 of 41 (93 percent) retests of specimens. H. capsulatum antigen was also detected in the serum during 11 of the 22 episodes of disseminated histoplasmosis, in none of the 12 episodes of other types of histoplasmosis in patients with antigenuria, in 1 of the 33 patients with histoplasmosis who lacked the urinary antigen, and in none of the 50 controls. Antigenemia and antigenuria decreased after initiation of antifungal therapy and recurred in patients who had a relapse. We conclude that this radioimmunoassay for H. capsulatum antigen represents a useful new method for the rapid diagnosis of disseminated histoplasmosis.

Antigens, Fungal↗

PubMed2001

Gastrointestinal histoplasmosis in patients with AIDS: case report and review.

Histoplasmosis is the most common endemic mycosis in individuals with AIDS, occurring in 2%-5% of this population. Infection is more likely to be disseminated than in immunocompetent individuals and generally presents insidiously with nonspecific symptoms. The gastrointestinal tract is involved in 70%-90% of cases of disseminated histoplasmosis, yet gastrointestinal histoplasmosis per se is infrequently encountered in patients with AIDS. The diagnosis of gastrointestinal histoplasmosis is often not suspected, particularly in areas of nonendemicity, and a delay in diagnosis may lead to increased morbidity and risk of death. Since antifungal therapy improves outcome for >80% of AIDS patients with histoplasmosis, it is essential that caregivers be aware of the varied presentations of gastrointestinal histoplasmosis in order to diagnose and to treat this potentially life-threatening infection effectively.

AIDS-Related Opportunistic Infections↗

PubMed1997

Prospective study of histoplasmosis in patients infected with human immunodeficiency virus: incidence, risk factors, and pathophysiology.

Histoplasmosis is a common opportunistic infection in patients with human immunodeficiency virus (HIV) infection who reside in areas where Histoplasma capsulatum is endemic. We undertook a prospective study of a cohort of 304 HIV-Infected patients in Kansas City from October 1990 through March 1993 to define the incidence-specific risk factors, and pathophysiology of histoplasmosis. The annual incidence of histoplasmosis was 4.7%; 74% of the patients with histoplasmosis were symptomatic (all of whom had disseminated disease). A history of exposure to chicken coops, a positive baseline serology for complement-fixing antibodies to Histoplasma mycelium antigen, and a baseline CD4+ lymphocyte count of < 150/microL were associated with an increased risk for histoplasmosis. Histoplasmin reactivity and the presence of pulmonary calcifications were not useful markers for patients at high risk. Symptomatic infection occurred in 9.9% of patients with evidence of prior exposure to H. capsulatum, in 4.0% of patients without documented prior exposure, and in 3.0% of patients who were anergic; these findings suggest that the pathophysiology of histoplasmosis in patients with AIDS involves reactivation of latent infection in some cases and dissemination of exogenously acquired infection in other cases.

AIDS-Related Opportunistic Infections↗

PubMed1994

Histoplasmosis: recognition and treatment.

Histoplasmosis has become an important mycosis in regions of endemicity in North and Central America. Traditionally, treatment has been reserved for patients with disseminated or chronic pulmonary histoplasmosis. The availability of safe and effective oral regimens, however, has offered alternatives to amphotericin B. Administration of amphotericin B is highly effective as therapy and produces a rapid clinical response; it remains the treatment of choice for patients with severe or moderately severe manifestations of histoplasmosis. Ketoconazole and itraconazole are well tolerated and are effective alternatives to amphotericin B for treatment of patients with milder illnesses or for use following response to amphotericin B. The determination of fluconazole's role in therapy for histoplasmosis awaits completion of ongoing trials. Continued research is needed to develop better-tolerated fungicidal alternatives to amphotericin B and oral agents with better absorption and drug interaction profiles than those of itraconazole and ketoconazole. Preventive strategies should be explored to reduce the frequency of histoplasmosis among individuals from regions of endemicity who are at high risk for more severe manifestations of histoplasmosis.

Amphotericin B↗

PubMed1998

Histoplasmosis-like choroiditis in a nonendemic area: the northwest United States.

PURPOSE: Histoplasmosis is not endemic in the U.S. northwest, but a type of multifocal choroiditis resembling ocular histoplasmosis occurs there. This study was designed to find a group of affected patients and study their clinical characteristics and immunologic responses to Histoplasma antigens. METHOD: Ten patients were found in the authors' files whose geographic histories made it unlikely that they had ever been exposed to Histoplasma capsulatum and yet they had features of ocular histoplasmosis. They were recalled for examination and testing by lymphocyte-stimulation assay for previous exposure to histoplasmosis. RESULTS: The clinical features of these patients resembled those of patients with ocular histoplasmosis, but their histories and the results of the assay did not support H. capsulatum as the cause of the ocular disease. CONCLUSION: This study confirmed that there is a type of choroiditis that resembles ocular histoplasmosis but is due to another agent or agents.

Adolescent↗

PubMed1994

Histoplasmosis during childhood.

To define the clinical presentation of histoplasmosis among hospitalized children, we reviewed the charts of patients treated for histoplasmosis at Vanderbilt University Children's Hospital during the years 1968 through 1988. Thirty-five patients with histoplasmosis diagnosed by culture, pathologic examination, or serologic testing were identified, including 29 patients (83%) with pulmonary/mediastinal infection, 5 (14%) with disseminated disease, and 1 (3%) with primary cutaneous histoplasmosis. The most common symptoms included fever, present in 26 patients (74%), and cough, present in 20 (57%). Of 26 patients with fever, 18 (69%) had fever of > 2 weeks' duration and 7 (27%) had temperatures > or = 40.5 degrees C (> or = 105 degrees F). Abnormal physical findings were few, but 19 patients (54%) had wheezing. Chest radiographs were obtained in all cases except one; 31 (91%) showed abnormalities, including adenopathy in 25 cases (74%) and infiltrates in 19 (56%). Histoplasmin skin tests were positive for 22 (96%) of the 23 patients tested. No cases of classic disseminated histoplasmosis of infancy were identified. Histoplasmosis should be considered in the differential diagnosis when children living in endemic areas are evaluated for persistent fever, cough, and/or wheezing, particularly if adenopathy is seen on the chest radiograph.

Adult↗

PubMed1976

The value of the skin test and complement fixation test in the diagnosis of chronic pulmonary histoplasmosis.

Histoplasmin skin test results in patients with chronic pulmonary histoplasmosis from Missouri and Texas were compared to results in a previous study of U.S. Navy recruits. When consideration was given to geographic areas from which persons from each group were admitted to the study, it was found that the recruits were as likely to have a positive skin test as were those with the disease. In a similar manner, the Texas histoplasmosis patients were compared to groups of patients from that state with chronic obstructive pulmonary disease and with pulmonary tuberculosis. Again, no significant differences were found. It was concluded that the histoplasmin skin test is not of value in the diagnosis of chronic pulmonary histoplasmosis. Histoplasmosis complement fixation test data from the chronic pulmonary histoplasmosis group were compared to data from the chronic obstructive pulmonary disease and pulmonary tuberculosis groups. The usefulness of the complement fixation test in chronic pulmonary histoplasmosis is limited, as with any test, by false-positive and false-negative reactions. A decision theory method was used to define the limits of usefulness.

Chronic Disease↗

PubMed2003

[Canine histoplasmosis in Japan].

Histoplasmosis is a fungal infection caused by Histoplasma capsulatum and is distributed a worldwide. Although the disease has been treated as an imported mycosis, some autochthonous human, 1 equine and 4 canine cases suggested that the disease is endemic. Histoplasmosis is classified depending on the variety of causative agent. Histoplasmosis farciminosi known as pseudofarcy, is manifested only in Perissodactyla where it invades lymph nodes and lymph ducts, and is recognized by isolation from horses. Historically, Japan was one of the endemic areas of pseudofarcy before World War II, and more than 20,000 cases were recorded in horses used by the military. Interestingly, Japanese canine histoplasmosis uniformly showed skin ulcers and granulomatous lesions on the skin without pulmonary or gastrointestinal involvement, both of which were very similar to pseudofarcy. It was diagnosed as histoplasmosis by the detection of internal transcribed spacer legions of rRNA gene of H. capsulatum from paraffin embedded tissue samples. Furthermore, the fungal isolate from the human case with no history of going abroad or immigrating was identified as H. capsulatum var. farciminosum by a gene sequence. These facts indicated that pseudofarcy is not only an infectious disease in horses, but also a zoonotic fungal infection. Japanese autochthonous canine histoplasmosis might be a heteroecism of pseudofarcy because of its likeness to the human case, the similarity of clinical manifestations and the historical background at this stage.

Animals↗

PubMed1991

Histoplasmosis relapse in patients with AIDS: detection using Histoplasma capsulatum variety capsulatum antigen levels.

OBJECTIVE: To assess the accuracy of Histoplasma capsulatum variety capsulatum polysaccharide antigen testing for the identification of histoplasmosis relapse in patients with the acquired immunodeficiency syndrome (AIDS). DESIGN: A retrospective study using stored specimens. SETTING: A referral center and several private hospitals. PATIENTS: Twenty episodes of histoplasmosis relapse were evaluated in 17 patients with AIDS from November 1987 to August 1990. Controls included 30 patients with AIDS and histoplasmosis who did not have a relapse during maintenance therapy and who were initially tested during the same week as the patients with relapse. A second control group included seven patients with AIDS and histoplasmosis who were evaluated for relapse on 23 occasions; relapse, however, was excluded on each occasion. MEASUREMENTS: To avoid interassay variability, specimens were tested for H.c. var. capsulatum polysaccharide antigen with the same radioimmunoassay. MAIN OUTCOME MEASURE: The change in the H.c. var. capsulatum polysaccharide antigen level during successful as opposed to unsuccessful maintenance therapy for the prevention of histoplasmosis relapse. MAIN RESULTS: For the 20 episodes of relapse (17 patients), H.c. var. capsulatum antigen levels increased by at least 2 radioimmunoassay units in 12 of 14 serum specimens tested (85.7%; 95% Cl, 57.2% to 98.2%) and in 17 of 18 urine specimens tested (94.4%; Cl, 72.7% to 99.9%). Antigen levels increased in the urine or serum in 1 of 83 specimens (1.2%; CI, 0.03% to 6.6%) obtained on 56 occasions (1.8%; CI, 0.04% to 9.6%) from controls (specificity, 98.2%; CI, 90.4% to 99.96%). In three cases of relapse, antigen levels increased before clinical relapse, antigen levels increased before clinical relapse was suspected. Complement fixation titers increased by at least 2 dilutions in 4 of 11 cases (36.4%; CI, 10.9% to 69.2%) but in 0 of 9 control patients (CI, 0% to 28.3%). CONCLUSION: An increase in H.c. var. capsulatum polysaccharide antigen levels of 2 units or more strongly suggests histoplasmosis relapse. The presence of increasing titers of anti-H.c. var. capsulatum antibodies by complement fixation is less accurate for the diagnosis of relapse.

Acquired Immunodeficiency Syndrome↗

PubMed2002

Serum LDH level as a clue to the diagnosis of histoplasmosis.

The purpose of this study was to determine whether serum lactate dehydrogenase (LDH) level could be used as an adjunct clinical marker to differentiate between histoplasmosis and Pneumocystis carinii pneumonia (PCP). In a retrospective, case-controlled study, 30 patients with a diagnosis of histoplasmosis (all but 1 with disseminated disease) were compared with 120 patients with PCP (33 patients with definitive PCP, 87 with presumed PCP). Groups were matched for CD4+ lymphocyte counts, sex, and year of diagnosis. The mean LDH level for patients with histoplasmosis was 1068 +/- 197 IU/L; for PCP, it was 375 +/- 23. An LDH level of more than 450 IU/L was 9.33 times more likely to be associated with a diagnosis of histoplasmosis than with PCP (odds ratio [OR], 9.33; 95% confidence interval [CI], 3.50-25.47; P < .01), and an LDH level of more than 600 IU/L was 9.41 times more likely to be so (OR, 9.41; 95% CI, 3.43-26.31; P < .01). An LDH level of 450 IU/L or greater had a sensitivity and specificity of 70% and 80%, respectively; a value of 600 IU/L or greater had sensitivity and specificity of 50% and 89%. Thus, serum LDH levels of 600 IU/L or greater are suggestive of histoplasmosis rather than PCP in appropriate clinical settings. Serum LDH may serve as an adjunct laboratory marker in the diagnosis of histoplasmosis. Elevated levels may prompt the physician to look for a diagnosis other than PCP early in the course of the illness.

AIDS-Related Opportunistic Infections↗

PubMed1992

Articular histoplasmosis.

Rheumatic manifestations of histoplasmosis are uncommon. Polyarthritis or arthralgias may occur as a part of a sensitization process in primary acute histoplasmosis. Infectious arthritis may accompany disseminated histoplasmosis or occur as solitary monoarthritis. Treatment of the latter traditionally consists of surgical excision followed by amphotericin B. Reports of clinical experience with the newer triazole compounds in treating articular histoplasmosis are lacking. We describe a patient with solitary monoarticular histoplasmosis of the knee who was successfully treated with oral fluconazole and required no surgical intervention. Specific issues that pertain to clinical presentation and management of articular histoplasmosis are discussed.

Administration, Oral↗

PubMed2004

Histoplasmosis associated with exploring a bat-inhabited cave in Costa Rica, 1998-1999.

Between October 1998 and April 1999, 51 persons belonging to two separate groups developed acute pulmonary histoplasmosis after visiting a cave in Costa Rica. The first group consisted of 61 children and 14 adults from San Jose, Costa Rica; 44 (72%) were diagnosed with acute histoplasmosis. The second group comprised 14 tourists from the United States and Canada; 9 (64%) were diagnosed with histoplasmosis. After a median incubation time of 14 days, the most common symptoms were headache, fever, cough, and myalgias. Risk factors for developing histoplasmosis included crawling (odds ratio [OR] = 17.5, 95% confidence interval [CI] = 2.3-802) and visiting one specific room (OR = 3.4, 95% CI = 1.0-12.3) in the cave. Washing hands (OR = 0.1, 95% CI = 0.01-0.6) after exiting the cave was associated with a decreased risk of developing histoplasmosis. Histoplasma capsulatum was isolated from bat guano collected from inside the cave. Persons who explore caves, whether for recreation or science, should be aware of the risk bat-inhabited caves pose for developing histoplasmosis, especially if they are immunocompromised in any way.

Adolescent↗

PubMed2004

Colonic histoplasmosis presenting as colon cancer in the nonimmunocompromised patient: report of a case and review of the literature.

Histoplasma capsulatum is an important pathogen that is the most commonly diagnosed endemic mycosis in the gastrointestinal tract of immunocompromised hosts. Failure to recognize and treat disseminated histoplasmosis in AIDS patients invariably leads to death. Gastrointestinal manifestations frequently involve the terminal ileum and cecum, and depending on the layer of bowel wall involved present as bleeding, obstruction, perforation, or peritonitis. Because they can be variable in appearance, they may be mistaken for Crohn's disease or malignant tumors. Four distinct pathologic patterns of GI histoplasmosis have been described that all have differing clinical presentations. We report a case of a non-AIDS patient who presented with a near-obstructing colonic mass suspicious for advanced malignancy but was found to have histoplasmosis on final pathology. The patient underwent successful operative resection, systemic anti-fungal therapy, and extensive workup for immunosuppressive disorders, which were negative. The patient was from an area in Mexico known to be endemic for histoplasmosis. This is the first report of a colonic mass lesion occurring in a non-AIDS patient, and review of the worldwide literature regarding GI histoplasmosis reveals excellent long-term survival with aggressive therapy. We discuss the surgical and medical management of colonic histoplasmosis in this report.

Adenocarcinoma↗

PubMed1987

[Disseminated histoplasmosis due to Histoplasma capsulatum in a patient with acquired immunodeficiency syndrome (AIDS)].

Very commonly encountered in the United States, histoplasmosis is rare in Europe, where only 27 patients have so far been infected by this mycosis. In Africa, two varieties of histoplasmosis have been observed: those due to H. capsulatum and H. duboisii. Histoplasmosis due to H. capsulatum is one of the twelve secondary infectious diseases listed in the surveillance definitions of AIDS. This complication has been described only in approximately 20 patients with AIDS; all patients had stayed on the American Continents. We report the case of a 30-year-old African male who lived in Switzerland and in Zaïre. With AIDS and multiple Kaposi's sarcoma, the patient died from disseminated histoplasmosis due to H. capsulatum; a peripheral blood smear obtained a few hours before death revealed numerous typical yeast forms of H. capsulatum inside polymorphonuclear leukocytes. Post-mortem examination and cultures confirmed the diagnosis of disseminated histoplasmosis. Histoplasmosis should be suspected in AIDS patients even in Europe, especially where they have stayed in endemic areas. Examination of blood smears and bonemarrow aspirate may allow early recognition of the disease and permit appropriate treatment with amphotericin B and ketoconazole.

Acquired Immunodeficiency Syndrome↗

PubMedDate not supplied

[Histoplasmosis].

Histoplasmosis are deep mycoses of present interest: they are part of fungal diseases of A.I.D.S. American histoplasmosis at Histoplasma capsulatum is a world wide disease, particularly present in the U.S.A., time to time observed in Africa south of the Sahara primarily among Europeans. African histoplasmosis at H. duboisii is typically an African continent disease. H. capsulatum is a telluric fungus and man is contaminated from soil to his respiratory tract. It depends on his immunitary status that he develops either a non symptomatic affection or a severe one, even a fatal one. Epidemiology of H. duboisii is still full of unknowns. Pathological manifestations of each disease are very different: American histoplasmosis displays three stages: primary infection, spread attacks spontaneously fatal, chronic pulmonary form simulating sometimes a pseudo-tumor, pathologic manifestations of African histoplasmosis, studied from 206 cases already published, are primarily related to skin, glands and bones attack, displaying either a localized form or an immediately spread form. Diagnosis is based on finding the fungus in different samples, on research of sera-antibodies, often on anatomopathological investigations. At the present time, ketoconazole is the treatment. Histoplasmosis at H. capsulatum as well as at H.duboisii might appear outside endemic zones several years after contamination.

Africa↗