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]
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]
- 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]
- Malaise
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]
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]
[…] include fever, headache, nonproductive cough, chills, pleuritic chest pain, weight loss, malaise, myalgias, and sweats. [aafp.org]
Fever, malaise, and other systemic symptoms are the usual presenting manifestations of an infective etiology; prolonged FUO is especially common in TB and fungal infections. The history is critical in establishing a drug etiology. [hepatitiscentral.com]
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]
Respiratoric
- Pleural Effusion
Pleural-effusion right middle lobe Atelectasis Location left inferior lobe right lower lobe right lower lobe Histology All of the biopsy specimens of the ascending colon, transverse colon, sigmoid colon, rectum, and descending colon showed increased [wjgnet.com]
A chest x-ray demonstrated a large amount of free intraperitoneal air and a suspected small left pleural effusion. [uscapknowledgehub.org]
Clinical manifestations depend on the immune status of the infected person and may present as acute pulmonary histoplasmosis, chronic cavitary pulmonary histoplasmosis, granulomatous mediastinitis, mediastinal fibrosis, pericarditis, pleural effusion, [cureus.com]
Common ancillary findings include abdominal lymphadenopathy and pleural effusions. Although the CT appearance is not pathopneumonic, this does help to support the diagnosis and evaluate the extent of disease. [ctisus.com]
Acute pericarditis can occur in as many as 5% of patients who are symptomatic. [2] The pericardial fluid is generally exudative. [12] Pleural effusions develop in 40-60% of patients with pericarditis. [emedicine.medscape.com]
Liver, Gall & Pancreas
- Hepatomegaly
Abdominal ultrasound revealed heterogeneous hepatomegaly with necrotic lymphadenopathy around the caeliac trunk and splenic hilum. We considered the following diagnoses: lymphoma, connective tissue disease, tuberculosis and sarcoidosis. [casereports.bmj.com]
Lymphadenopathy, hepatomegaly, ocular disease (conjunctivitis, granulomatous chorioretinitis, retinal detachment, optic neuritis), lameness, and cutaneous nodules or ulcers may also be seen. [msdvetmanual.com]
ALP isoenzyme test (Medical Encyclopedia) Ascites (Medical Encyclopedia) Diet - liver disease (Medical Encyclopedia) Hepatic encephalopathy (Medical Encyclopedia) Hepatomegaly (Medical Encyclopedia) Liver disease (Medical Encyclopedia) Liver scan (Medical [icdlist.com]
Amyloidosis of the liver and spleen usually presents with hepatomegaly or splenomegaly. [ctisus.com]
Contrast CT of abdomen showed hepatomegaly and multiple enlarged retroperitoneal lymph nodes some of which were necrotic [Figure 2] a and [Figure 2] b. [lungindia.com]
Cardiovascular
- Heart Murmur
murmurs, hyperbaric medicine, home prepared and raw diets, obesity, botulism, artificial pacing of the heart, cancer vaccines, and more. [books.google.com]
Musculoskeletal
- Myalgia
A few such patients have a syndrome of recurrent fevers, myalgias, fatigue, and other systemic symptoms, often occurring intermittently for years. [hepatitiscentral.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. [msdmanuals.com]
[…] host Definite host Reproduction Asexual multiplication (Schizogony) Sexual reproduction (Gametogony followed by sporogony) Incidence 21% detected by histopathologic study of tongue tissue 23.2% detected by stool examination Clinical features Myositis, myalgia [omicsonline.org]
[…] histoplasmosis manifests as a diverse clinical spectrum ranging from a brief period of malaise to a severe, protracted illness ( Table 1 ). 4, 5 Common symptoms include fever, headache, nonproductive cough, chills, pleuritic chest pain, weight loss, malaise, myalgias [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]
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]
X-Ray
- Atelectasis
Hepatosplenomegaly Hepatic cyst Hepatosplenomegaly Splenic infarction Lymphadenopathy Ascending colon Ascites Location Ileocecal Intraperitoneal Retroperitoneal Chest Lesions Small nodular Nodular shadows 1 Pleural-effusion Pleural-effusion right middle lobe Atelectasis [wjgnet.com]
A CT of the abdomen and pelvis, with oral and intravenous contrast, demonstrated free intraperitoneal air over the upper abdomen with periportal, retroperitoneal, and mesenteric lymphadenopathy as well as pleural effusion with bibasilar atelectasis, left [uscapknowledgehub.org]
Microbiology
- Paracoccidioides Brasiliensis
A test for H. capsulatum antigen is sensitive and specific, particularly when simultaneous serum and urine specimens are tested; however, cross-reactivity with other fungi ( Coccidioides immitis, Blastomyces dermatitidis, Paracoccidioides brasiliensis [msdmanuals.com]
- Trypanosoma Cruzi
Other microorganisms that could be confused with H. capsulatum include the following: Candida species, particularly C. glabrata, Cryptococcus neoformans, Blastomyces dernatitidis, Pneumocystis jirovecii, Leishmania spp., and Trypanosoma cruzi. [uscapknowledgehub.org]
Other Pathologies
- Hepatic Necrosis
Toxic liver disease with chronic persistent hepatitis Toxic liver disease with fibrosis and cirrhosis of liver Toxic liver disease with hepatic necrosis Vascular disorder of liver ICD-9-CM Volume 2 Index entries containing back-references to 573.8 : [icd9data.com]
Biopsy
- Liver Biopsy
[…] and hepatologists interested in reviewing liver biopsies with pathologists [books.google.com]
[…] and granulomata histoplasmosis Links: secondary liver cancer colorectal carcinoma renal adenocarcinoma osteosarcoma chondrosarcoma hydatid disease liver biopsy histoplasmosis [gpnotebook.co.uk]
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]
Hepatic granulomas are found in about 3 to 10% of liver biopsies. They may be insignificant incidental findings, but more often they reflect clinically relevant disease –usually a systemic disorder rather than primary liver disease. [hepatitiscentral.com]
Subcutaneous nodule histology was compatible with erythema induratum of Bazin, and liver biopsy evidenced granulomatous hepatitis. [casereports.bmj.com]
Pleura
- Pleural Effusion
Pleural-effusion right middle lobe Atelectasis Location left inferior lobe right lower lobe right lower lobe Histology All of the biopsy specimens of the ascending colon, transverse colon, sigmoid colon, rectum, and descending colon showed increased [wjgnet.com]
A chest x-ray demonstrated a large amount of free intraperitoneal air and a suspected small left pleural effusion. [uscapknowledgehub.org]
Clinical manifestations depend on the immune status of the infected person and may present as acute pulmonary histoplasmosis, chronic cavitary pulmonary histoplasmosis, granulomatous mediastinitis, mediastinal fibrosis, pericarditis, pleural effusion, [cureus.com]
Common ancillary findings include abdominal lymphadenopathy and pleural effusions. Although the CT appearance is not pathopneumonic, this does help to support the diagnosis and evaluate the extent of disease. [ctisus.com]
Acute pericarditis can occur in as many as 5% of patients who are symptomatic. [2] The pericardial fluid is generally exudative. [12] Pleural effusions develop in 40-60% of patients with pericarditis. [emedicine.medscape.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]