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Hepatic Histoplasmosis
Histoplasmosis of Liver

Presentation

Acute presentation was seen in two patients, one of them presented with septic shock and ARDS. [ispub.com]

The disseminated disease can present with rheumatological, dermatological, and GI involvement. [acgcasereports.gi.org]

Case Presentation A 60-year-old female patient presented to the medical outpatient department with a history of a cough for more than two months, intermittent fever, and dyspnea on exertion. [cureus.com]

It has varied presentations, including pulmonary, progressive disseminated, chronic cavitary, and primary cutaneous forms. [e-ijd.org]

[…] a history of recent travel to a histoplasmosis endemic area presenting with epigastric pain. [journals.lww.com]

Immune System

  • Splenomegaly

    Ancillary extrahepatic features include portal lymph nodes and splenomegaly. Promoted articles (advertising) [radiopaedia.org]

    Amyloidosis of the liver and spleen usually presents with hepatomegaly or splenomegaly. [ctisus.com]

    […] self-limited in immunocompetent patients, but disseminates in immunocompromised (very young, very old, HIV+) to liver, spleen, bone marrow, nodes, lung, rarely to skin Disseminated disease: strongly associated with AIDS; patients have fever, weight loss, splenomegaly [pathologyoutlines.com]

    Many dogs have a protracted course of weight loss to emaciation, chronic cough, persistent diarrhea, fever, anemia, hepatomegaly, splenomegaly, lymphadenopathy, and nasopharyngeal and GI ulceration. [msdvetmanual.com]

    In schistosomiasis, progressive portal scarring is the rule (“pipestem fibrosis”); hepatic function usually remains well preserved, but increasing portal hypertension leads to marked splenomegaly and risk of variceal hemorrhage. [hepatitiscentral.com]

Entire Body System

  • Fever

    syphilis, cat-scratch fever). [hepatitiscentral.com]

    Non-productive cough shortness of breathing, hemoptysis night fever with sweating muscle and joint pain weight loss malaise Severe disseminated or systemic infection: consolidated lungs hepatosplenomegaly, hepatic insufficiency high fever anaemia and [onlinebiologynotes.com]

    Signs include dyspnea, abnormal lung sounds in about 50% of cats (< 50% of dogs), fever, lethargy, and severe diarrhea. [k2publishing.ca]

    Four months prior to admission, he developed daily fevers with chills and night sweats. He reported left-sided crampy abdominal pain worse prior to bowel movements. [med.ucla.edu]

    Symptoms include weight loss, night sweats, a mild fever, and a general feeling of illness (malaise). Most people recover without treatment within 2 to 6 months. [merckmanuals.com]

  • Weight Loss

    Clinical signs may be nonspecific but often include respiratory difficulty, fever, depression, anorexia, and weight loss. [msdvetmanual.com]

    Weight loss, anorexia, jaundice, vomiting, diarrhea, polyuria/polydipsia, abdominal effusion, and abdominal pain are typical signs of liver disease or injury. [k2publishing.ca]

    Abstract A 56-year-old man with persistently elevated liver enzyme levels, fatigue, lethargy and a 9.0 kg weight loss over six months underwent a percutaneous liver biopsy that demonstrated multiple granulomas. [ncbi.nlm.nih.gov]

    Symptoms The most common symptoms for cats are lack of appetite, weight loss, and difficulty breathing. [petmd.com]

    He had difficulty tolerating oral intake, and described an 80-pound weight loss over this 4-month period. [med.ucla.edu]

  • Pain

    During admission the patient developed fever and severe right upper quadrant pain associated with an elevation in transaminases and inflammatory markers (peak ALT 206, peak CRP 218). [journals.lww.com]

    Abdominal pain and distention (75%) and anorexia (75%) were the main manifestations of the GI system. However, empirical antibiotic treatment was ineffective in improving symptoms. [wjgnet.com]

    Signs include fever, anorexia, hepatomegaly, disseminated intravascular coagulation (DIC), jaundice, and abdominal pain with or without effusion. [k2publishing.ca]

    Otherwise, he denied any shortness of breath or chest pain. His abdominal pain was cramping and worse in his left lower quadrant and suprapubic regions. [uscapknowledgehub.org]

    Clinically, patients have impaired liver function, anemia, and bone pain. [ctisus.com]

  • Asymptomatic

    Pulmonary histoplasmosis is difficult to diagnose, more so in the regions where tuberculosis is endemic, and many infected patients remain asymptomatic. [cureus.com]

    Approximately 90% of patients with acute pulmonary histoplasmosis are asymptomatic. [emedicine.medscape.com]

    Primary histoplasmosis is usually asymptomatic; 99% remains subclinical. 1% of immunocompetent individuals with low-level exposure develop symptoms. Inquire about prior or recent travel... [5minuteconsult.com]

    The spectrum of this illness ranges from asymptomatic infection to severe disseminated disease. [aafp.org]

    Symptoms and Signs Most histoplasmosis infections are asymptomatic or so mild that patients do not seek medical attention. Histoplasmosis has 3 main forms. [msdmanuals.com]

  • Anemia

    Due to the severe anemia that is common with babesia, liver enzymes typically become elevated. Thrombocytopenia can occur along with the life-threatening anemia. [k2publishing.ca]

    Hematologic abnormalities (anemia and thrombocytopenia) and pulmonary abnormalities were present in half the patients, and renal abnormalities and oral mucosal lesions were present in slightly less than half. [annals.org]

    White cells Normal to increased Red cells Anemia in severe infections Platelets Not remarkable Small oval y... [5minuteconsult.com]

    […] back-references to 573.8 : Cholestasis 576.8 due to total parenteral nutrition (TPN) 573.8 Cyst (mucus) (retention) (serous) (simple) falciform ligament (inflammatory) 573.8 liver 573.8 Deformity 738.9 Degeneration, degenerative Gangrene, gangrenous (anemia [icd9data.com]

    Many dogs have a protracted course of weight loss to emaciation, chronic cough, persistent diarrhea, fever, anemia, hepatomegaly, splenomegaly, lymphadenopathy, and nasopharyngeal and GI ulceration. [msdvetmanual.com]

Respiratoric

  • Dyspnea

    Signs include dyspnea, abnormal lung sounds in about 50% of cats (< 50% of dogs), fever, lethargy, and severe diarrhea. [k2publishing.ca]

    Manifestations are worsening cough and dyspnea, progressing eventually to disabling respiratory dysfunction. Dissemination does not occur. [msdmanuals.com]

    With a larger inoculum, patients may exhibit dyspnea with hypoxia. [aafp.org]

    Case Presentation A 60-year-old female patient presented to the medical outpatient department with a history of a cough for more than two months, intermittent fever, and dyspnea on exertion. [cureus.com]

    Clinical Presentation The most common presentation of the patients was fever, cough, dyspnea and weight loss. Table 1 show the clinical and laboratory presentation. [ispub.com]

  • Hemoptysis

    Non-productive cough shortness of breathing, hemoptysis night fever with sweating muscle and joint pain weight loss malaise Severe disseminated or systemic infection: consolidated lungs hepatosplenomegaly, hepatic insufficiency high fever anaemia and [onlinebiologynotes.com]

    Smokers with structural lung disease have higher probability of developing chronic cavitary histoplasmosis. [ citation needed ] After healing of lesions, hard calcified lymph nodes can erode the walls of airway causing hemoptysis. [ citation needed ] [en.wikipedia.org]

    Recurrent hemoptysis is a common symptom and respiratory failure often ensues. [antimicrobe.org]

    Hemoptysis and hematemesis due to a broncholith: Granulomatous mediastinitis. South Med J 1996; 89 (2):243–245. 21. Felson, B, Klatte, EC. Complications of the arrested primary histoplasmic complex. JAMA 1976; 236 (10):1157–1161. 22. [nature.com]

    […] nodules. 1 Mediastinal granuloma, pericarditis, and rheumatologic syndromes (i.e., arthritis) are possible sequelae following acute infections of pulmonary histoplasmosis ( Table 1 ). 4, 5 Actively inflamed mediastinal lymph nodes cause chest pain, cough, hemoptysis [aafp.org]

  • Painful Cough

    chills, pleuritic chest pain, weight loss, malaise, myalgias, and sweats. [aafp.org]

    Symptoms of fever, chills, sweats, headache, myalgia, anorexia, cough, and chest pain characterize these illnesses ( 10 ), and respiratory failure and death may ensue ( 103 ). [antimicrobe.org]

Cardiovascular

  • Chest Pain

    pain, weight loss, malaise, myalgias, and sweats. [aafp.org]

    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. [msdmanuals.com]

    Patients present with fever, cough and chest pain; and chest radiograms show mediastinal lymphadenopathy with infiltrates. Heavy exposure causes more extensive pulmonary involvement, sometimes accompanied by respiratory insufficiency ( 55 ). [antimicrobe.org]

    Otherwise, he denied any shortness of breath or chest pain. His abdominal pain was cramping and worse in his left lower quadrant and suprapubic regions. [uscapknowledgehub.org]

  • Hypotension

    Severe pneumonia is rare, but patients with AIDS may develop severe acute pneumonia with hypoxia suggesting Pneumocystis jirovecii infection, as well as hypotension, mental status changes, coagulopathy, or rhabdomyolysis. [msdmanuals.com]

    Amphotericin B Amphotericin B therapy is the treatment of choice for patients with AIDS who are admitted to the hospital with moderate to severe histoplasmosis.(5) In particular, a patient with presumptive or confirmed DH presenting with hypotension, [hivinsite.ucsf.edu]

Workup

An initial workup by her primary care physician, including complete metabolic panel, liver function tests, complete blood count, upper endoscopy/colonoscopy, and abdominal computed tomography (CT) scan, was non-revealing. [acgcasereports.gi.org]

Microbiology

  • Chlamydia

    Differential diagnosis of other microbial infections like tuberculosis, pulmonary infections caused by atypical Mycobacteria, legionellosis, infections caused by Mycoplasma spp, Chlamydia spp, blastomycosis, cryptococcosis, sporotrichosis, paracoccidioidomycosis [cureus.com]

Treatment

Significant updates on bariatric surgery, Barrett's esophagus, endoscopic ultrasound, endosonography, treatment of liver disease, and much more keep you current on the latest advances. [books.google.com]

Without treatment, this form is fatal in more than 90% of people. Even with treatment, death may occur rapidly in people with AIDS. [merckmanuals.com]

If flucytosine is not given or treatment is interrupted, consider lengthening induction treatment at least 2 weeks. [drugs.com]

Public health education on transmission, combined with proper diagnosis and treatment are crucial [ 3 ]. [omicsonline.org]

Treatment DH is a progressive infection in patients with AIDS, necessitating treatment if the diagnosis is strongly suspected or confirmed. [hivinsite.ucsf.edu]

Prognosis

Patients with acute liver failure generally have a good prognosis if the disease is diagnosed early and treatment is started immediately. However, patients with chronic liver disease have a variable prognosis. [k2publishing.ca]

[…] 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]

The overall prognosis is excellent. Proper disposal of human feces and careful animal husbandry are mandatory in the control of muscular sarcocystosis. [omicsonline.org]

The course and prognosis of histoplasmosis. Amer. J. Med. Seminar on Mycotic Infections. 27 & 28: 19. Google Scholar 3. Schwarz, J., Bingham, E. & Roubenoff, D. 1955. The communicability of experimentally induced histoplasmosis. Amer. J. clin. [link.springer.com]

Etiology

Etiology The causes of liver granulomas are legion. [hepatitiscentral.com]

MISCELLANEOUS CONDITIONS Sarcoidosis Sarcoidosis is a multisystem disease of unknown etiology. Noncaseating granulomas are characteristic of this process and can affect any organ of the body. [ctisus.com]

Ileocecal fistulizing disease has been reported, as has pseudotumor mimicking malignancy. 12,14 Endoscopic findings have the potential to mimic inflammatory bowel disease, and in the case of negative antigen testing, pathologic exclusion of infectious etiology [acgcasereports.gi.org]

Presence of miliary shadows in chest imaging is often attributed to tuberculosis without further etiological investigation in our country. Patients are started on empirical anti-tubercular therapy (ATT). [lungindia.com]

Etiology The risk of infection is mostly related to environmental exposure and underlying immune status. Living in endemic areas with contaminated soil increases the risk of exposure. Inoculum size plays a role. [emedicine.medscape.com]

Epidemiology

Surgical Pathology of the Gastrointestinal System: Bacterial, Fungal, Viral, and Parasitic Infections provides pertinent clinical, diagnostic, and epidemiologic information that will be valuable to the practicing surgical pathologist. [books.google.com]

Definition / general Infection is caused by inhalation of airborne spores of Histoplasma capsulatum, a dimorphic saprophytic fungus found in soil contaminated with bird or bat feces Epidemiology Highest incidence is in North America, particularly in the [pathologyoutlines.com]

The epidemiology of histoplasmosis: A review. Semin Respir Infect 2001;16:109-18. 5. Singhi MK, Gupta L, Kacchawa D, Gupta D. Disseminated primary cutaneous histoplasmosis successfully treated with itraconazole. [e-ijd.org]

Guided Medline Search For Recent Reviews Epidemiology Clinical Manifestations Pathogenesis Therapy Prevention [antimicrobe.org]

Case report and review of disseminated histoplasmosis in South-East Asia: clinical and epidemiological implications. Trop Med Int Health. 1996;1:35–42. 15. Walsh TJ, Gonzalez C, Lyman CA, Chanock SJ, Pizzo PA. [aafp.org]

Pathophysiology

The internationally acclaimed "gold standard" offers unparalleled coverage of pathophysiology, diagnosis, and treatment of diseases affecting dogs and cats, as well as the latest information on the genome, clinical genomics, euthanasia, innocent heart [books.google.com]

Pathophysiology Granuloma formation is incompletely understood. The lesions are regarded as a host attempt to protect against poorly soluble exogenous or endogenous irritants. [hepatitiscentral.com]

Understanding the pathophysiology of feline hepatic lipidosis. J Comp Pathol 2015; 152:70. http://www.sciencedirect.com/science/journal/00219975 Plumb DC. Plumb´s Veterinary Drug Handbook. 7ª ed. [revistas.ces.edu.co]

Prospective study of histoplasmosis in patients infected with human immunodeficiency virus: incidence, risk factors, and pathophysiology. Clin Infect Dis. 1997 Jun;24(6):1195-203. Wheat LJ, Chetchotisakd P, Williams B, Connolly P, Shutt K, Hajjeh R. [med.ucla.edu]

[…] profound, can calcify Extrapulmonary findings: Liver and spleen calcifications, adrenals, oral ulcers, bone marrow Differentials: Sarcoidosis and tuberculosis Usual treatment: Itraconazole; amphotericin for severe or diffuse disease Prognosis: Excellent Pathophysiology [emedicine.medscape.com]

Prevention

Centers for Disease Control and Prevention (June 12, 2015 updated.) Candidiasis. Available online at http://www.cdc.gov/fungal/diseases/candidiasis/index.html. Accessed August 27, 2016. [labtestsonline.it]

[…] inoculating macroconidia of Histoplasma into the mouse Histopathological examination X-ray examination Treatment: Amphotericin B: Intravenous drug Itraconazole: oral drug ketoconazole Fluconazole Veroconazole Pasaconazole Supportive therapy and rest Prevention [onlinebiologynotes.com]

The maintenance phase is directed at preventing relapse. [hivinsite.ucsf.edu]

Patients with progressive hepatic sarcoidosis may benefit from corticosteroid therapy, though it remains unclear whether this prevents hepatic fibrosis; corticosteroids are not indicated for most patients with sarcoidosis and should be given only if TB [hepatitiscentral.com]

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