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Disseminated Histoplasmosis


Presentation

  • We report three cases with such atypical presentation. Our first patient presented with bowel perforation, the second with left-sided pleural effusion and the third with submandibular abscess.[ncbi.nlm.nih.gov]
  • In India, disseminated histoplasmosis often presents with pyrexia of unknown origin with a presentation similar to 'disseminated tuberculosis' involving the adrenal glands and bone marrow.[ncbi.nlm.nih.gov]
  • We report an unusual initial presentation of progressive disseminated histoplasmosis presenting as acute tenosynovitis in a systemic lupus erythematosus (SLE) patient.[ncbi.nlm.nih.gov]
  • This case presentation underscores the broad spectrum of clinical presentations as well as the potential for diagnostic confusion with protozoa such as Leishmania or Trypanosoma species during histopathologic examination if special stains for fungal organisms[ncbi.nlm.nih.gov]
  • Usually, it is present in immunocompromised individuals and immunocompetent individuals in the endemic zones. We report an unusual presentation of progressive disseminated histoplasmosis.[ncbi.nlm.nih.gov]
Splenomegaly
  • This case highlights consideration of disseminated histoplasmosis in patients presenting with diffuse adenopathy along with hepatomegaly and/or splenomegaly in the right clinical setting.[ncbi.nlm.nih.gov]
  • On the basis of a comparative analysis of those who died and survived, the absence of splenomegaly and hepatomegaly and the presence of H. capsulatum in the peripheral blood were considered as risk factors for death.[ncbi.nlm.nih.gov]
  • A higher fever ( 38.5ºC), maculopapular/papular rash, splenomegaly, hepatomegaly, wheezing, hemoglobin 9.5g/dL, platelets 80,000/µL, CD4 count 75/µL, aspartate aminotransferase (AST) level 2.5 times the upper limit of normal (ULN), lactate dehydrogenase[ncbi.nlm.nih.gov]
  • He fulfilled 5 of 8 diagnostic criteria: fever 38.5 C, splenomegaly, 2 cytopenias, ferritin level 500 ng/mL, and evidence of hemophagocytosis in the bone marrow.[bloodjournal.org]
  • […] gamaglutamil-transferase: 552U/l, oxaloacetic transaminase: 839U/l, glutamic pyruvic transaminase: 348U/l, ferritin: 372,522ng/ml, triglycerides: 462mg/dl, fibrinogen: 213, chest tomography with ground glass pattern and areas of consolidation, abdominal ultrasound with splenomegaly[revistanefrologia.com]
Fever
  • The patient's fever continued despite several days of treatment with meropenem, minocycline, and micafungin.[ncbi.nlm.nih.gov]
  • We report a rare case of histoplasmosis that was manifested as persistent fever and abnormal liver function in a 45-year-old immunocompetent female from Jiangsu Province. Investigations revealed anemia and thrombocytopenia.[ncbi.nlm.nih.gov]
  • RESULTS: One hundred seventeen patients with fever were included, and 48 (41%) cases of DH were determined by Histoplasma capsulatum identification.[ncbi.nlm.nih.gov]
  • Histoplasmosis was acquired in South America; its manifestations included prolonged fever, splinter hemorrhages, erythema multiforme, arthritis, and mediastinal lymphadenopathy.[ncbi.nlm.nih.gov]
  • A 34-year-old, HIV-positive man living in Texas presented with a 2-week history of fever, malaise, myalgias, oral ulcers, and papules on his chest, back, face, and extremities, including the palms. Initially secondary syphilis was suspected.[ncbi.nlm.nih.gov]
Weight Loss
  • We present a case of a 64-year-old man with a prolonged history of fatigue, weight loss, fever, and kidney failure. Kidney biopsy showed severe granulomatous interstitial nephritis with numerous giant cells.[ncbi.nlm.nih.gov]
  • The patient in the present case report was immunocompetent child and had fever, bone pains, gradual weight loss, lymphadenopathy and hepatosplenomegaly.[ncbi.nlm.nih.gov]
  • We present the case of an 18-year-old male patient admitted with complaints of fever and rapid weight loss since 3 months. Patient had multiple umbilicated papular to nodular lesions over chin and forehead region.[ncbi.nlm.nih.gov]
  • A 64-year-old man presented with gradual onset of confusion, ataxia and 25-pound weight loss over 3 months. MRI of the brain revealed two enhancing cerebellar lesions suspicious for metastases.[ncbi.nlm.nih.gov]
  • We report the case of a 33-year-old immunocompetent male who presented with fever and weight loss. Based on investigations, the patient showed pancytopenia, hepatosplenomegaly, bone marrow involvement and marked colonic involvement.[ncbi.nlm.nih.gov]
Chills
  • Symptoms Chills Cough Fever Headache Joint pain Mental status changes Muscle aches and stiffness Nausea, vomiting Possible rash (erythema nodosum) Skin lesions Visual changes (chorioretinitis) Signs and tests A physical examination may show abnormalities[ufhealth.org]
  • […] symptoms develop, onset occurs 3-14 days after exposure. [14] Acute is defined as less than 1 month of symptoms, whereas subacute refers to more than 1 month of symptoms but less than 3 months. [1] Fever, headache, malaise, myalgia, abdominal pain, and chills[emedicine.medscape.com]
  • MARIO MADRUGA, MD, MARK WALLACE, MD, ANGELA WABULYA, MD, and NA’IM FANAIAN, MD Orlando Health, Orlando, Fla MARY HILAL, MS4 Florida State University For 3 days, a 28-year-old woman with a history of polymyositis and possible dermatomyositis had fever, chills[consultant360.com]
  • The patient had been well until September 2014, at which point a fever, chills, generalized weakness, and a weight loss of 10 kg developed. The patient came to an outpatient clinic at our hospital and was admitted for further evaluation.[kjim.org]
  • Fever and other systemic findings are characteristic (chills, fever, anorexia, malaise, diarrhea, weight loss, hepatosplenomegaly, anemia, leukopenia, thrombocytopenia). Sepsis syndrome with ARDS can be seen.[clinicaladvisor.com]
Malaise
  • A 34-year-old, HIV-positive man living in Texas presented with a 2-week history of fever, malaise, myalgias, oral ulcers, and papules on his chest, back, face, and extremities, including the palms. Initially secondary syphilis was suspected.[ncbi.nlm.nih.gov]
  • The acute form may produce fever, worsening cough, weight loss, malaise, and dyspnea. Approximately 5-20% of patients have CNS involvement.[emedicine.medscape.com]
  • Acute primary histoplasmosis is a syndrome with fever, cough, myalgias, chest pain, and malaise of varying severity. Acute pneumonia (evident on physical examination and chest x-ray) sometimes develops.[merckmanuals.com]
  • Fever and other systemic findings are characteristic (chills, fever, anorexia, malaise, diarrhea, weight loss, hepatosplenomegaly, anemia, leukopenia, thrombocytopenia). Sepsis syndrome with ARDS can be seen.[clinicaladvisor.com]
Pathologist
  • The role of the forensic pathologist is also crucial because the post-mortem diagnosis of histoplasmosis (never considered in the differential diagnosis during prior hospitalization) highlights the importance of a meticulous and thorough autopsy to elucidate[ncbi.nlm.nih.gov]
  • European infectious diseases physicians, microbiologists and pathologists must be aware of histoplasmosis, particularly when facing HIV-infected immigrants from endemic areas.[ncbi.nlm.nih.gov]
  • Each aspiration and biopsy slide is reviewed by at least two hemato-pathologists independently. Results Total seven patients met the inclusion criteria. Five out of 7 patients were male. The mean age was 35 years.[mjhid.org]
  • Due to its heterogeneous clinical presentation, a close interaction between clinicians across the borders of their subdisciplines and between pathologists and microbiologists is mandatory for establishing the right diagnosis.[karger.com]
Intestinal Perforation
  • We reported a severe opportunistic infection in JSLE patient with adenopathy and multiple intestinal perforations.[ncbi.nlm.nih.gov]
Oral Ulcers
  • Oral ulcers are common in HIV-infected patients, with a broad differential, including viral, bacterial, fungal, mycobacterial and neoplastic aetiologies.[ncbi.nlm.nih.gov]
  • A 61-year-old female with a history of advanced HIV disease and chronic hepatitis B was presented with an 8-week history of painful oral ulcers.[ncbi.nlm.nih.gov]
  • A 34-year-old, HIV-positive man living in Texas presented with a 2-week history of fever, malaise, myalgias, oral ulcers, and papules on his chest, back, face, and extremities, including the palms. Initially secondary syphilis was suspected.[ncbi.nlm.nih.gov]
  • Skin lesions and oral ulcers are seen in more than one-third of patients. Predisposing factors like exposure to birds, farming, mining, diabetes were observed in few patients.[ncbi.nlm.nih.gov]
  • Here, we want to illustrate the case of a 67-year-old man who presented with persistent oral ulcers, hoarseness, dysphagia, diarrhea, and weight loss to our Department of Otorhinolaryngology in December 2014.[karger.com]
Vascular Disease
  • Volume 2 covers tumors, the phacomatoses, and vascular disease.[books.google.com]
  • Coronary Artery Disease or Peripheral Vascular Disease No change in standard management. E. Diabetes or other Endocrine issues No change in standard management. F. Malignancy No change in standard management. G.[clinicaladvisor.com]
Tachycardia
  • Examination findings included resting tachycardia and melenic stool. Blood pressure was 95/50 mm Hg. Multiple raised, soft, bluish 0.3 to 1 cm lesions were noted on the trunk and extremities.[consultant360.com]
Blepharitis
  • This report describes a case of concomitant histoplasmosis and candidiasis in an Eclectus parrot (Eclectus roratus) characterized by severe granulomatous glossitis, blepharitis and osteomyelitis with numerous intrahistiocytic and extracellular yeasts[ncbi.nlm.nih.gov]
Cutaneous Manifestation
  • Cutaneous manifestations of histoplasmosis are rare and are seen predominantly in persons with advanced human immunodeficiency virus (HIV) infections.[ncbi.nlm.nih.gov]
  • We present illustrative images from a Mexican 58-year-old man who had the occupation of cockfighting from childhood and presented with chronic progressive disseminated histoplasmosis with primarily cutaneous manifestations.[ncbi.nlm.nih.gov]
Splinter Hemorrhage
  • To the best of our knowledge no splinter hemorrhages had previously been reported in a patient with histoplasmosis.[ncbi.nlm.nih.gov]
Neck Mass
  • She was admitted for 16 days because of neck masses of 3 years duration, generalized body swelling of 3 months and reduction in urinary output of 2 months. She tested negative for human immunodeficiency virus antibodies.[ncbi.nlm.nih.gov]
Neglect
  • It is a neglected disease in many countries, particularly Latin America, including Brazil. It is related with environmental factors, even in urban areas, where the incidence has increased.[ncbi.nlm.nih.gov]
  • There is a need to undertake well-designed, analytical studies utilizing appropriate diagnostic modalities to understand the epidemiology of this neglected disease in proper perspective.[ncbi.nlm.nih.gov]
  • HIV/AIDS is not a neglected disease. Histoplasmosis is not considered a neglected disease in North America. However, in South America, it should be.[journals.plos.org]
Altered Mental Status
  • A 70-year-old man with history of heart transplant performed in 1986, presented with altered mental status. CT scan of brain showed ring-enhancing lesions, raising suspicion for metastatic malignancy.[ncbi.nlm.nih.gov]

Workup

Bicytopenia
  • Complete blood count revealed bicytopenia. An excisional biopsy of the skin lesions had revealed cutaneous histoplasmosis. On further investigations for bicytopenia, histoplasmosis had been diagnosed on bone marrow trephine biopsy.[ncbi.nlm.nih.gov]
Lymphocytic Infiltrate
  • Histopathologic examination revealed a lymphocytic infiltrate with numerous intra-histiocytic fungal organisms. GMS and PAS stains were positive, consistent with the diagnosis of histoplasmosis.[ncbi.nlm.nih.gov]

Treatment

  • Hcc PCR became negative in the blood under treatment, and then oral switch by itraconazole was introduced. Antiretroviral treatment was reintroduced after a 3-week histoplasmosis treatment.[ncbi.nlm.nih.gov]
  • This, we believe, is the first reported treatment of HLH with anakinra in a patient with AIDS and acute disseminated histoplasmosis.[ncbi.nlm.nih.gov]
  • The medical treatment was based on fluconazole. Even though a regression of the symptoms was observed, the patient died. In disseminated African histoplasmosis, an early laboratory diagnosis must be carried out for accurate treatment.[ncbi.nlm.nih.gov]
  • Our patient responded well to the treatment.[ncbi.nlm.nih.gov]
  • Considering the recent diagnosis and treatment of CLL, initial suspicion was relapsed disease. However, considering the immune deficiency associated with CLL and its treatment, infectious aetiologies were strongly considered.[ncbi.nlm.nih.gov]

Prognosis

  • Considering appropriate diagnosis and timely therapy, the reported patient had good prognosis despite being diagnosed with disseminated histoplasmosis.[ncbi.nlm.nih.gov]
  • Mortality rates remain high for untreated patients, but early diagnosis, proper antifungal treatment and early initiation of antiretroviral therapy have improved the prognosis.[ncbi.nlm.nih.gov]
  • Demographic characteristics, clinical presentation, risk factors, laboratory findings, diagnostic yield, treatment received and prognosis were noted and compared between the two groups.[ncbi.nlm.nih.gov]
  • KEYWORDS: French Guiana; HIV; Histoplasmosis; diagnosis; opportunistic disease; prognosis[ncbi.nlm.nih.gov]
  • […] not reliable, the detection of the urine antigen for this fungus is one of the fastest and most sensitive methods: it finds 90% of patients with disseminated infection and 75% with acute pulmonary histoplasmosis. 5 With the appropriate therapy, the prognosis[revistanefrologia.com]

Etiology

  • HLH is a syndrome of pathologic immune activation characterized as primary or secondary in etiology. This patient had HLH secondary to disseminated histoplasmosis in the setting of severe immune deficiency.[bloodjournal.org]
  • Previous studies in endemic areas supported the hypothesis that new infection/reinfection, rather than reactivation, is the main etiology of symptomatic histoplasmosis. No previous reports have presented clinical evidence of reactivation.[ncbi.nlm.nih.gov]
  • Histoplasma capsulatum (H. capsulatum), the etiologic organism for histoplasmosis, infects humans via the respiratory tract. After the organism reaches the alveolar space, it replicates in macrophages and spreads in the reticuloendothelial system.[clinicaladvisor.com]
  • Conclusion Disseminated Histoplasmosis is not an uncommon etiology of fever of prolonged duration even in immuno-competent individual in India, and should be kept as a differential diagnosis.[mjhid.org]

Epidemiology

  • Published literature lacks systematic studies on disseminated histoplasmosis in India, and previous reviews on its epidemiology in India were conducted two decades back.[ncbi.nlm.nih.gov]
  • Despite being considered as having a predominantly rural epidemiology, many patients reported living in urban areas such as Goiânia and Aparecida de Goiânia.[ncbi.nlm.nih.gov]
  • We need tests; we need treatments; but first of all, we physicians need to integrate our South American epidemiology in our diagnostic algorithms.[journals.plos.org]
  • Although the approximate epidemiology of histoplasmosis in Honduras has not been reported, surveys conducted in Latin American countries near Honduras have estimated the incidence of histoplasmosis to range from 0.1 to 0.29 cases per 100,000 persons [[kjim.org]
  • Ashbee HR, Evans EGV, Ashbee HR, Evans EGV, Viviani MA, Dupont B, et al: Histoplasmosis in Europe: report on an epidemiological survey from the European Confederation of Medical Mycology Working Group. Med Mycol 2008;46: 57–65.[karger.com]
Sex distribution
Age distribution

Prevention

  • Ketoconazole has been used to prevent relapse, but available information suggests that up to 50 percent of AIDS patients relapse even with ketoconazole treatment. A more effective therapy to prevent recurrence is needed.[clinicaltrials.gov]
  • A timely diagnosis, with appropriate therapies, could have prevented death.[ncbi.nlm.nih.gov]
  • For a scenario where 12% of patients died, 60% were aware of their human immunodeficiency virus (HIV) infection and adherence was only 50%, primary prophylaxis would prevent 1 death and 9 cases of histoplasmosis for a cost of 36,792 Euros per averted[ncbi.nlm.nih.gov]
  • Early antifungal treatment should be initiated in order to prevent DH severe outcomes.[ncbi.nlm.nih.gov]
  • Antigen detection in the urine was found to be more sensitive: IMMY ALPHA ELISA detected 13 positive cases (16.7%) and the in-house ELISA test developed by the Centers for Disease Prevention and Control (CDC) detected 14 (17.9%).[ncbi.nlm.nih.gov]

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