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Histoplasmosis

Histoplasmoses

Histoplasmosis is a mycosis that is most commonly found in the in the midwestern regions of the United States.


Presentation

It is rare for symptoms to show up when histoplasmosis is present [7]. In the rare symptomatic cases, symptoms occur usually a few weeks after exposure. The acute phase of histoplasmosis is characterized by non-specific signs and symptoms including fever, cough, myalgia, chest pain, and malaise.

The chronic form of the disorder is more common in older individuals with an underlying pulmonary disease and might present with cough, weight loss, fever, and malaise.

Disseminated histoplasmosis in immunocompromised hosts can trigger organ failure and become life threatening if left untreated. This severe infection can lead to hepatosplenomegaly, lymphadenopathy, mucocutaneous lesions and central nervous system involvement.

Ocular histoplasmosis affects the eyes and can lead to damage in the retina.

Splenomegaly
  • Results showed that the patients with PDH were more likely to have Karnofsky score 30 (prevalence ratio [PR] 1.98, 95% confidence interval [CI] 0.97-4.06), liver compromised with hepatomegaly and/or splenomegaly (PR 1.77, CI 1.03-3.06) and elevation in[ncbi.nlm.nih.gov]
  • Common clinical manifestations were fever (84%), weight loss (88%), anemia (63%), jaundice (16%), hepatomegaly (38%), splenomegaly (18%), lymphadenopathy (41%), and molluscum-like skin lesions (30%).[ncbi.nlm.nih.gov]
  • Since then, single cases of histoplasmosis have been reported by Riley and Watson, 3 Phelps and Mallory, 4 Crumrine and Kessell, 5 and Dodd and Tompkins. 6 The disease is manifested clinically by moderate fever, emaciation, splenomegaly, hepatomegaly,[annals.org]
  • After an intensive microscopical study of smears from the spleen, liver and rib marrow of all patients with splenomegaly examined at autopsy, he found 3 patients who had died of a disease . . .[nejm.org]
Generalized Lymphadenopathy
  • He developed numerous erythema nodosum leprosum-like mucocutanous lesions accompanied by fever, generalized lymphadenopathy, and weight loss.[ncbi.nlm.nih.gov]
Fever
  • Fungal infection - histoplasmosis; Ohio River Valley fever; Fibrosing mediastinitis Deepe GS. Histoplasma capsulatum (histoplasmosis). In: Bennett JE, Dolin R, Blaser MJ, eds.[nlm.nih.gov]
  • He developed numerous erythema nodosum leprosum-like mucocutanous lesions accompanied by fever, generalized lymphadenopathy, and weight loss.[ncbi.nlm.nih.gov]
  • The acute phase of histoplasmosis is characterized by non-specific signs and symptoms including fever, cough, myalgia, chest pain, and malaise.[symptoma.com]
  • A middle aged male with no known comorbidities presented with history of colicky abdominal pain, low grade fever and weight loss. Laboratory parameters were normal except low albumin.[ncbi.nlm.nih.gov]
  • The manifestations of disseminated form of histoplasmosis are fever, weakness, weight loss, hepatosplenomegaly, and mucocutaneous lesions. The mucosal involvement could be oropharyngeal or laryngeal involvement.[ncbi.nlm.nih.gov]
Weight Loss
  • The patient presented with hoarseness and weight loss. Pathology findings and molecular tests confirmed the diagnosis, and the patient responded to antifungal therapy.[ncbi.nlm.nih.gov]
  • A middle aged male with no known comorbidities presented with history of colicky abdominal pain, low grade fever and weight loss. Laboratory parameters were normal except low albumin.[ncbi.nlm.nih.gov]
  • The manifestations of disseminated form of histoplasmosis are fever, weakness, weight loss, hepatosplenomegaly, and mucocutaneous lesions. The mucosal involvement could be oropharyngeal or laryngeal involvement.[ncbi.nlm.nih.gov]
  • The cases were male patients, ranging from 33 to 61 years old, and primarily presented with non-specific symptoms such as irregular fever, weight loss, abdominal pain and distention. Hepatosplenomegaly and lymphadenopathy were the most common signs.[ncbi.nlm.nih.gov]
  • The patient presented with iron deficiency anaemia, diarrhoea, abdominal pain and progressive weight loss.[ncbi.nlm.nih.gov]
Fatigue
  • All three patients developed a persistent high fever and general fatigue. Laboratory tests showed increased C-reactive protein levels and mild liver dysfunction. All patients also showed increased soluble interleukin-2 receptor (sIL-2R) levels.[ncbi.nlm.nih.gov]
  • Some infections may cause acute pulmonary histoplasmosis, characterized by high fever, headache, non-productive cough, chills, weakness, pleuritic chest pain and fatigue.[who.int]
  • Although most people who breathe in the spores don’t get sick, those who do may have a fever, cough, and fatigue.[cdc.gov]
  • We ask about general symptoms (anxious mood, depressed mood, fatigue, pain, and stress) regardless of condition. Last updated: May 13, 2019[patientslikeme.com]
Malaise
  • The acute phase of histoplasmosis is characterized by non-specific signs and symptoms including fever, cough, myalgia, chest pain, and malaise.[symptoma.com]
  • More serious cases, with symptoms that include high fever, trouble breathing, loss of appetite, and malaise, are treated with anti-fungal medications.[rentokil-hygiene.co.uk]
  • 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]
  • 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.[merck.com]
  • Chronic cough, chest pain, night sweat, malaise, loss of weight etc are common in both patients. Cavity in upper lobe, is also seen in both the cases.[histopathology-india.net]
Anemia
  • Common clinical manifestations were fever (84%), weight loss (88%), anemia (63%), jaundice (16%), hepatomegaly (38%), splenomegaly (18%), lymphadenopathy (41%), and molluscum-like skin lesions (30%).[ncbi.nlm.nih.gov]
  • […] reported by Riley and Watson, 3 Phelps and Mallory, 4 Crumrine and Kessell, 5 and Dodd and Tompkins. 6 The disease is manifested clinically by moderate fever, emaciation, splenomegaly, hepatomegaly, enlargement of lymph nodes, leukopenia and slight anemia[annals.org]
  • A person may then develop the following symptoms: Anemia Meningitis Ulcers in the mouth Infection of heart valves Pneumonia Enlarged liver and spleen Swollen lymph nodes Treatment Mild cases of histoplasmosis may not need treatment.[rentokil-hygiene.co.uk]
  • […] capsulatum ), and is marked by benign involvement of lymph nodes of the trachea and bronchi usually without symptoms or by severe progressive generalized involvement of the lymph nodes and macrophage-rich tissues (as of the liver and spleen) with fever, anemia[merriam-webster.com]
Cough
  • Symptoms include: Chest pain and shortness of breath Cough, possibly coughing up blood Fever and sweating In a small number of people, especially in those with a weakened immune system, histoplasmosis spreads throughout the body.[nlm.nih.gov]
  • Most people do not have symptoms, but some feel sick and have a fever and cough, sometimes with difficulty breathing. Sometimes the infection spreads, causing the liver, spleen, and lymph nodes to enlarge and damaging other organs.[merck.com]
  • The acute phase of histoplasmosis is characterized by non-specific signs and symptoms including fever, cough, myalgia, chest pain, and malaise.[symptoma.com]
  • The patients exhibited pulmonary infiltrates (83%), fever (76%), cough, constitutional symptoms (38%), headache (35%), and lymph node hypertrophy (33%).[ncbi.nlm.nih.gov]
  • A male patient with newly diagnosed glioblastoma multiform presented with non-productive cough and chest pain. Before presentation, the patient received the standard therapy including surgical resection, radiation and TMZ.[ncbi.nlm.nih.gov]
Dry Cough
  • A 21-year-old previously healthy woman presented with a three-week history of shortness of breath and dry cough. She had recently returned from a humanitarian trip planting crops in El Salvador.[cmaj.ca]
  • Symptoms include, fever, chills, muscle aches, chest pains, and a dry cough. Common symptoms reported by people with histoplasmosis Reports may be affected by other conditions and/or medication side effects.[patientslikeme.com]
  • When a person develops symptoms, it usually involves the lungs and is characterized by weakness, chills, fever, muscle aches, chest pains, and a dry cough. Chronic lung infections resemble tuberculosis and may progress over months or years.[dhs.wisconsin.gov]
  • Symptoms include feeling ill, fever, chest pains, and a dry cough. In severe cases, histoplasmosis spreads to other organs. This is called disseminated disease.[medlineplus.gov]
  • Symptoms include feeling ill, fever, chest pains, and a dry cough. In severe cases, histoplasmosis spreads to other organs; this is called disseminated disease.[icd9data.com]
Pleural Effusion
  • In rare instances, acute pericarditis and pleural effusion can develop. Chronic and disseminated forms have a poor prognosis and high mortality rate, if not treated timely. Histoplasmosis is caused by the histoplasma capsulatum fungus.[symptoma.com]
  • Pleural thickening adjacent to apical cavitary lesions is common, but pleural effusions are uncommon ( 49 ).[doi.org]
  • 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.com]
Vomiting
  • 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]
  • His present illness dates from Sept. 15, 1905, when he complained of fever and vomiting. Condition on Admission to Hospital. —On entering Ancon Hospital Dec. 5, 1905, he was mildly delirious and incoherent. Lungs were clear; abdomen[doi.org]
  • Symptoms mainly showed as abdominal pain, diarrhea, anorexia, nausea, bilious vomiting, constipation, tenesmus and abdominal tenderness [ 6 ].[omicsonline.org]
  • Case Report A 36-year-old woman with a 15-year history of rheumatoid arthritis presented on July 5, 2007, with fever, chills, fatigue, nausea, vomiting, and abdominal pain.[doi.org]
  • When – and why – antibiotics sometimes fail Back in the fall of 2011, an eight-year-old boy and his five-year-old sister in northeastern Arkansas developed vague abdominal discomfort, a dry cough, and vomiting.[forbes.com]
Nausea
  • 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 mainly showed as abdominal pain, diarrhea, anorexia, nausea, bilious vomiting, constipation, tenesmus and abdominal tenderness [ 6 ].[omicsonline.org]
  • Case Report A 36-year-old woman with a 15-year history of rheumatoid arthritis presented on July 5, 2007, with fever, chills, fatigue, nausea, vomiting, and abdominal pain.[doi.org]
  • The patient exhibits fever, malaise, orthostatic hypotension, nausea, and vomiting ( 110, 119 ). Hyperkalemia, hyponatremia, and eosinophilia are usually present.[doi.org]
Loss of Appetite
  • More serious cases, with symptoms that include high fever, trouble breathing, loss of appetite, and malaise, are treated with anti-fungal medications.[rentokil-hygiene.co.uk]
  • The most common symptoms of acute histoplasmosis are: Fever and chills, flu-like illness Headaches Muscle pain Loss of appetite Shortness of breath Dry cough Chest pain Fatigue Most symptoms resolve in few weeks.[lung.org]
  • The most common symptoms of acute histoplasmosis are: Fever and chills, flu-like illness Headaches Muscle pain Loss of appetite Shortness of breath Dry cough Chest pain Most symptoms resolve in a few weeks.[foundation.chestnet.org]
Chest Pain
  • Symptoms include: Chest pain and shortness of breath Cough, possibly coughing up blood Fever and sweating In a small number of people, especially in those with a weakened immune system, histoplasmosis spreads throughout the body.[nlm.nih.gov]
  • A male patient with newly diagnosed glioblastoma multiform presented with non-productive cough and chest pain. Before presentation, the patient received the standard therapy including surgical resection, radiation and TMZ.[ncbi.nlm.nih.gov]
  • The acute phase of histoplasmosis is characterized by non-specific signs and symptoms including fever, cough, myalgia, chest pain, and malaise.[symptoma.com]
Hepatomegaly
  • Results showed that the patients with PDH were more likely to have Karnofsky score 30 (prevalence ratio [PR] 1.98, 95% confidence interval [CI] 0.97-4.06), liver compromised with hepatomegaly and/or splenomegaly (PR 1.77, CI 1.03-3.06) and elevation in[ncbi.nlm.nih.gov]
  • Common clinical manifestations were fever (84%), weight loss (88%), anemia (63%), jaundice (16%), hepatomegaly (38%), splenomegaly (18%), lymphadenopathy (41%), and molluscum-like skin lesions (30%).[ncbi.nlm.nih.gov]
  • Since then, single cases of histoplasmosis have been reported by Riley and Watson, 3 Phelps and Mallory, 4 Crumrine and Kessell, 5 and Dodd and Tompkins. 6 The disease is manifested clinically by moderate fever, emaciation, splenomegaly, hepatomegaly,[annals.org]
  • The combined results of computed tomography, hepatobiliary scintigraphy with iminodiacetic acid, and ultrasonography showed mild, diffuse thickening of the gallbladder wall, mild hepatomegaly and splenomegaly, and pericholecystic fluid.[doi.org]
Musculoskeletal Pain
  • Previously, his symptoms had been diagnosed as musculoskeletal pain and later as pneumonia.[ncbi.nlm.nih.gov]
Night Sweats
  • The most common symptoms of chronic histoplasmosis are: Cough that is productive of thick yellow sputum Shortness of breath Feeling run-down or tired Low-grade fever Night sweats Weight loss Patients with emphysema may develop a slowly progressive form[lung.org]
  • 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.[merck.com]
  • Chronic cough, chest pain, night sweat, malaise, loss of weight etc are common in both patients. Cavity in upper lobe, is also seen in both the cases.[histopathology-india.net]
Subcutaneous Nodule
  • There were only two painful subcutaneous nodules, from which we arrived at the correct diagnosis of histoplasmosis.[ncbi.nlm.nih.gov]
Headache
  • The patients exhibited pulmonary infiltrates (83%), fever (76%), cough, constitutional symptoms (38%), headache (35%), and lymph node hypertrophy (33%).[ncbi.nlm.nih.gov]
  • The most common symptoms of acute histoplasmosis are: Fever and chills, flu-like illness Headaches Muscle pain Loss of appetite Shortness of breath Dry cough Chest pain Fatigue Most symptoms resolve in few weeks.[lung.org]
  • Some infections may cause acute pulmonary histoplasmosis, characterized by high fever, headache, non-productive cough, chills, weakness, pleuritic chest pain and fatigue.[who.int]

Workup

Blood and sputum samples for cultures are necessary in order to diagnose histoplasmosis [8]. Urine analysis with polymerase chain reaction (PCR) or enzyme-linked immunosorbent assay (ELISA) can also be beneficial, particulary in immunocompromised hosts, to detect specific antigens. A serum antigen test may also be used, but this test can show false negative results four to six weeks after exposure.

Cavitary Lesion
  • Computerized tomography of the chest showed a very large cavitary lesion in the upper segment of the right lower lobe and multiple nodular lesions with some starting to cavitate.[ncbi.nlm.nih.gov]
  • Interstitial infiltration was the most common radiographic finding (42%), followed by perihilar adenopathy (19%) and cavitary lesion (16%).[ncbi.nlm.nih.gov]
  • Chest x-rays should be done and may show the following: In acute infection: Normal or a diffuse nodular or miliary pattern In chronic pulmonary histoplasmosis: Cavitary lesions in most patients In progressive disease: Hilar adenopathy with diffuse nodular[merckmanuals.com]
  • Pleural thickening adjacent to apical cavitary lesions is common, but pleural effusions are uncommon ( 49 ).[doi.org]
Pulmonary Calcification
  • The seminal studies by Christie and Peterson and Palmer established the relationship of histoplasmin skin test positivity to pulmonary calcifications in tuberculin-negative persons ( 12, 95 ).[doi.org]
Colitis
  • On investigation, a mild granulomatous colitis primarily affecting the right colon was identified, that initially improved with mesalazine. Her symptoms worsened after 18 mo with progressive ulceration of her distal small bowel and right colon.[ncbi.nlm.nih.gov]
  • TNF is also involved in symptoms in inflammatory disorders like ulcerative colitis, Crohn's disease and rheumatoid arthritis. Usually these patients already are receiving corticosteroids and methotrexate to manage the disorder.[scientificamerican.com]
Granulomatous Tissue
  • Biopsy will reveal granulomatous tissue infiltrated with giant cells, lymphocytes, and numerous macrophages. [5] Circulating H. capsulatum antigen can be detected in the urine or serum of patients with disseminated disease.[laryngologyandvoice.org]
Pleural Effusion
  • In rare instances, acute pericarditis and pleural effusion can develop. Chronic and disseminated forms have a poor prognosis and high mortality rate, if not treated timely. Histoplasmosis is caused by the histoplasma capsulatum fungus.[symptoma.com]
  • Pleural thickening adjacent to apical cavitary lesions is common, but pleural effusions are uncommon ( 49 ).[doi.org]
  • 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.com]

Treatment

Usually, this condition will resolve itself without any treatment as long as the affected individual is immunocompetent [9]. In some mild cases, symptomatic measures are indicated. In severe, chronic, or disseminated cases, treatment with antifungal medications like amphotericin B which is usually followed by oral itraconazole, is necessary.

Prognosis

Acute pulmonary histoplasmosis is considered to be asymptomatic 90 percent of cases [6]. The small percentage of affected individuals who do develop symptoms completely recover usually.

In rare instances, acute pericarditis and pleural effusion can develop. Chronic and disseminated forms have a poor prognosis and high mortality rate, if not treated timely.

Etiology

Histoplasmosis is caused by the histoplasma capsulatum fungus [2]. The infectious spores are light and easily become airborne when disturbed. Histoplasma capsulatum is a thermally dimorphic fungus that is present in a mycelial form in the environment and grows into a yeast at body temperature. 

Epidemiology

The fungus associated with histoplasmosis is found across the globe. There are certain places, like the Ohio River Valley and the lower Mississippi River area in the US, where the histoplasma capsulatum fungus is considered to be endemic [3]. Since the fungus is found in so many places, the occurrence of histoplasmosis is common especially in the US where 250,000 cases are reported every year. It is also prevalent in southern and eastern Africa, South America, Europe, and Asia. The disorder may occur at any age and there is no racial predilection.

There is a correlation with acidity and humidity levels of the soil as well as the activity level of local birds and bats. The fungus grows in soil that has been contaminated with bat or bird droppings and the microconida become airborne when the soil is disturbed.

Sex distribution
Age distribution

Pathophysiology

The histoplasma capsulatum fungus grow in the mycelial form while in the saprobic state [4]. When the spores produced by this mycelial form along with mycelial fragments become airborne, they may be inhaled and deposited in alveoli. Under these favourable conditions, the spores can intracellularly be converted to the yeast form. 

The yeast reproduces within the first 15 to 18 hours after the phagocytosis by the macrophages occurs. The macrophages disseminate to various organs via lymphatic and blood circulation. After one to two weeks after the initial exposure, cellular immunity develops. The inflammatory response of the body may trigger the formation of calcified fibrinous granulomas within weeks to month after the initial infection.

Affected individuals with compromised immune systems may develop a progressive disseminated form of infection that can be life-threatening [5].

Prevention

Since the fungus histoplasma capsulatum is found anywhere, it isn’t practical to decontaminate every area that is considered to be affected. For those who may be working in affected areas, like construction workers, protective masks should be worn [10].

Summary

Histoplasmosis is an infectious disease that predominantly affects the lungs but can involve other organ systems if it progresses to disseminated histoplasmosis. The disorder is caused by the histoplasma capsulatum fungus and can be fatal if left untreated. It is also known as Ohio Valley disease, Cave disease, Darling’s disease, and reticuloendotheliosis [1].

Histoplasma capsulatum that causes histoplasmosis can be found in soil that has been contaminated with bird or bat droppings. When this soil is disrupted by excavation or some type of construction, the fungus is aerated and the infectious properties are released. When the now infected air is breathed in, the fungus can settle in the lungs and cause histoplasmosis. The condtition is considered to be more common in people that have compromised immune systems.

Patient Information

Histoplasmosis is an infection that is caused by the fungus histoplasma capsulatum that is found in both bat and bird droppings. This fungus is present in the soil that the droppings contaminate. The spores become airborne when agitated and can settle in the lungs once inhaled.

There are usually no signs or symptoms associated with the condition and people are mostly unaware that they have the infection. Children and people with compromised immune systems, are prone to develop more severe forms and may show various symptoms including fever, cough, muscle pain, chest pain, and malaise

There are treatments that can be administered including antifungal medications, but in most cases, there is no need for medical treatment as the ailment usually clears up on its own.

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Last updated: 2019-07-11 22:02