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Pulmonary Histoplasmosis


Presentation

  • Chronic cavitary pulmonary histoplasmosis is one of the rarest clinical presentations of this disease. The differential diagnosis with tuberculosis should be made in patients presenting with cavitated lesions in upper lung segments.[ncbi.nlm.nih.gov]
Fever
  • Soon after, he developed fever with pulmonary nodules. Fine-needle aspiration from lung nodules showed intracellular yeast forms of histoplasma. The patient responded well to amphotericin B with subsidence of fever.[ncbi.nlm.nih.gov]
Weight Loss
  • The patient visited our hospital with dyspnea, blood-tinged sputum, and weight loss, which had appeared 2 months earlier. The patient underwent video-assisted thoracic surgery (VATS) lung biopsy.[ncbi.nlm.nih.gov]
  • When to Call Your Health Care Provider Call your health care provider right away if you have any of the following: Fever Chest pain Coughing up blood Shortness of breath Extreme tiredness Loss of appetite and weight loss Symptoms that don’t get better[sterlingcare.com]
  • When to call your healthcare provider Call your healthcare provider right away if you have any of the following: Fever Chest pain Coughing up blood Shortness of breath Extreme tiredness Loss of appetite and weight loss Symptoms that don’t get better with[fairview.org]
  • When to call your healthcare provider Call your healthcare provider right away if you have any of the following: Fever Chest pain Coughing up blood Shortness of breath Extreme tiredness Loss of appetite and weight loss Symptoms that don't get better with[mountnittany.org]
Malaise
  • Malaise, fatigability, low-grade fever, aching chest pain and mild cough lasting a few days to a few weeks are usual. Symptoms are ameliorated by rest. Rest and diminished activity are recommended as treatment.[ncbi.nlm.nih.gov]
  • […] interrogated in the history should include travel to endemic areas as well as exposures significant populations of bats and birds. acute pulmonary histoplasmosis 90% of cases can have no symptoms symptoms manifest for up to two weeks after exposure fever, malaise[radiopaedia.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.[merckmanuals.com]
  • […] pain, cough and other respiratory symptoms Skin lesions and joint pain occur in 5-6% of patients, mainly female Chronic pulmonary histoplasmosis Occurs mostly in patients with underlying lung disease Symptoms include coughing up blood, weight loss, malaise[dermnetnz.org]
  • […] include fever, headache, nonproductive cough, chills, pleuritic chest pain, weight loss, malaise, myalgias, and sweats.[aafp.org]
Falling
  • A male patient developed acute pulmonary histoplasmosis 2 weeks after bathing in the water falls of Wli, Ghana.[ncbi.nlm.nih.gov]
  • She also reported falling school grades and visual disturbances. Neurology referral was made in view of her new symptoms and magnetic resonance imaging (MRI) scan was normal.[mycology.imedpub.com]
  • It commonly occurs by inhaling the spores of a fungus called Histoplasma capsulatum This fungus spreads through bird and bat droppings that fall on the soil.[dovemed.com]
  • Prophylaxis should be restarted if the CD4 counts fall to less than or equal to 150 cells/ul.[clinicaladvisor.com]
Pseudotumor
  • To our knowledge, this is the first case of a spindle cell "pseudotumor" of the lung resulting from histoplasmosis.[ncbi.nlm.nih.gov]
Splenomegaly
  • […] 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.[merckvetmanual.com]
  • […] pulmonary fibrocavitary disease resembling tuberculosis; in immunosuppressed patients, and rarely, in otherwise healthy persons, histoplasmosis may cause disseminated disease of the reticuloendothelial system, which is manifested by fever, emaciation, splenomegaly[medical-dictionary.thefreedictionary.com]
  • […] consistency of the lungs Disseminated Form: Regional or generalized lymphadenopathy: Affected lymph nodes are firm and uniform in appearance, resembling lymphoma Intestines: Nodular thickening of mucosal surface , resembling Johne’s disease of cattle Splenomegaly[askjpc.org]
  • A wide spread of features may be found - fever, lymphadenopathy, hepatomegaly, splenomegaly, jaundice, leukopenia, chronic meningitis, endocarditis, granulomatous hepatitis, Addison’s disease and GIT ulceration.[ayubmed.edu.pk]
Cough
  • They gave a history of fever, fatigue, myalgia, dry cough, and chest pain during the stay or just after returning from Ecuador. In two patients, symptoms persisted in mild nature.[ncbi.nlm.nih.gov]
  • If symptoms do occur, they may include: fever, chills, dry cough, and chest pain. Some people also have joint pain.[sterlingcare.com]
Pleural Effusion
  • Infection with H capsulatum was confirmed by culture of pleural effusion fluid, DNA probe analysis of the pleural fluid culture isolate, urinary Histoplasma antigen detection, and Grocott methenamine silver stains of tissue sections.[ncbi.nlm.nih.gov]
  • Ultrasound chest confirmed it to be a loculated pleural effusion. A pleural biopsy was arranged but it was not informative at all and the loculated pleural effusion could not be drained with the Abram’s needle.[ayubmed.edu.pk]
  • effusions are possible but uncommon healing process with formation of histoplasmomas, which are well-defined nodules with central calcifications Promoted articles (advertising)[radiopaedia.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]
  • Few may get acute pericarditis and pleural effusions. As the severity of the disease increases, the prognosis worsens from fair to poor.[emedicinehealth.com]
Productive Cough
  • As in our patient, the symptoms of malaise, productive cough, fever, and night sweats in pulmonary histoplasmosis are similar to those of TB but are usually less severe [ 4 ].[jmedicalcasereports.biomedcentral.com]
  • The presentation is similar to chronic pulmonary aspergillosis with productive cough, increasing shortness of breath, weight loss, night sweats and sometimes fever.[life-worldwide.org]
  • The signs and symptoms associated with Acute Pulmonary Histoplasmosis (in those having weak immunity) may include: Chest tightness Breathing difficulties Productive cough Fever Muscle pain, generalized body aches Skin rashes that usually occur on the[dovemed.com]
  • Some infections may cause acute pulmonary histoplasmosis, characterized by high fever, headache, non-productive cough, chills, weakness, pleuritic chest pain and fatigue.[who.int]
  • Another reported case of pulmonary histoplasmosis involves a 15 year old male patient with pulmonary tuberculosis who presented with chronic productive cough [ 28 ].[mycology.imedpub.com]
Hemoptysis
  • […] bats and birds. acute pulmonary histoplasmosis 90% of cases can have no symptoms symptoms manifest for up to two weeks after exposure fever, malaise, headache, myalgia, abdominal pain dyspnea can manifest if there is diffuse involvement a cough and hemoptysis[radiopaedia.org]
  • 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]
  • ., arthritis) are possible sequelae following acute infections of pulmonary histoplasmosis ( Table 1 ). 4, 5 Actively inflamed mediastinal lymph nodes cause chest pain, cough, hemoptysis, and dyspnea because of airway or vascular compression, and the[aafp.org]
Chronic Cough
  • Once established, an infected cavity tends to persist and to be attended by symptoms of chronic bronchitis with chronic cough and sputum, fatigability, anorexia, and weight loss.[ncbi.nlm.nih.gov]
  • 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.[merckvetmanual.com]
  • A high ESR (62mm / 1 st hour), with three consecutive negative sputum samples for Acid Fast Bacilli (AFB) and a clinical history of night sweats, weight loss and chronic cough with deteriorating health had convinced us to commence anti-tuberculous therapy[ayubmed.edu.pk]
Chest Pain
  • They gave a history of fever, fatigue, myalgia, dry cough, and chest pain during the stay or just after returning from Ecuador. In two patients, symptoms persisted in mild nature.[ncbi.nlm.nih.gov]
  • If symptoms do occur, they may include: fever, chills, dry cough, and chest pain. Some people also have joint pain.[sterlingcare.com]
  • Symptoms include feeling ill, fever, chest pains, and a dry cough. In severe cases, histoplasmosis spreads to other organs. This is called disseminated disease.[icdlist.com]
Cyanosis
  • Approximately 14 days after exploring a limestone cave in northcentral Florida in February 1973, an 18-year-old female developed a respiratory illness with pronounced shortness of breath and cyanosis.[ncbi.nlm.nih.gov]
Excitement
  • Exploring caves is, without doubt, a very exciting adventure; however, it carries some dangers. Three of four travellers were admitted to hospital with lung changes after returning from Ecuador, successively.[ncbi.nlm.nih.gov]

Workup

  • The workup for suspected histoplasmosis should include test for antibodies and antigens.[mycology.imedpub.com]
Bilateral Pulmonary Opacities
  • He was hypoxic with bilateral pulmonary opacities on chest radiograph. CT of the chest showed a geographical pattern of ground-glass attenuation. He started receiving intravenous antibiotics in addition to oral Bactrim for suspected PJ.[ncbi.nlm.nih.gov]
Hypocapnia
  • There is also hypocapnia from alveolar hyperventilation commonly found in restrictive and stiff lung syndrome.[ncbi.nlm.nih.gov]
Pleural Effusion
  • Infection with H capsulatum was confirmed by culture of pleural effusion fluid, DNA probe analysis of the pleural fluid culture isolate, urinary Histoplasma antigen detection, and Grocott methenamine silver stains of tissue sections.[ncbi.nlm.nih.gov]
  • Ultrasound chest confirmed it to be a loculated pleural effusion. A pleural biopsy was arranged but it was not informative at all and the loculated pleural effusion could not be drained with the Abram’s needle.[ayubmed.edu.pk]
  • effusions are possible but uncommon healing process with formation of histoplasmomas, which are well-defined nodules with central calcifications Promoted articles (advertising)[radiopaedia.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]
  • Few may get acute pericarditis and pleural effusions. As the severity of the disease increases, the prognosis worsens from fair to poor.[emedicinehealth.com]

Treatment

  • However, relapses occurred within a period of 1 to 18 months after the interruption of the treatment. Mycological diagnosis and the difficulties observed in the treatment were discussed.[ncbi.nlm.nih.gov]

Prognosis

  • If this occurs, the prognosis is less favorable.[ufhealth.org]
  • However, those with poor immune systems need to be watched closely for disseminated infection or severe forms of the infection, which can be fatal, if not treated properly The prognosis of Acute Pulmonary Histoplasmosis is excellent with appropriate treatment[dovemed.com]
  • IDSA Clinical Practice Guidelines 2007 Outlook and prognosis Adrenal histoplasmosis can be cured with antifungal therapy. Adrenal function maybe suboptimal and needs checking.[life-worldwide.org]
  • What is the prognosis of histoplasmosis? People with mild symptoms of histoplasmosis usually resolve the disease on their own without treatment. In more severe cases, the prognosis is good for those who receive appropriate treatment.[medicinenet.com]

Etiology

  • Histoplasmosis, a dimorphic fungus, and sarcoidosis, a disease of unknown etiology, share many clinical features, including typical manifestations of granulomatous inflammation involving the lungs and mediastinal lymphatics in association with constitutional[ncbi.nlm.nih.gov]
  • […] and Discontinuation 339 Oxygen Therapy and Toxicity 345 ProtocolDriven Care in Respiratory Therapy 351 Epidemiology Natural History 357 Prophylaxis 364 Chronic Thromboembolic Pulmonary Hypertension 375 Unusual Forms of Embolism 384 Pathogenesis and Etiology[books.google.de]
  • (Etiology) Acute Pulmonary Histoplasmosis is caused by the fungus Histoplasma capsulatum, in a majority of the cases.[dovemed.com]
  • MORPHOLOGIC DIAGNOSIS: Lung: Pneumonia, granulomatous, diffuse, marked, with numerous intrahistiocytic and extracellular yeast, etiology consistent with Histoplasma capsulatum var. capsulatum, Thoroughbred, equine .[askjpc.org]
  • Histoplasmosis Characteristics • Member of the phylum Ascomycota • Worldwide distribution • Naturally found in fecal-contaminated soils • Birds and bats appear to be reservoirs • Etiologic agent of histoplasmosis 4.[slideshare.net]

Epidemiology

  • Final diagnosis was made on epidemiological histories, as well as typical radiological changes, and was supported by positive tests for antibodies to Histoplasma capsulatum.[ncbi.nlm.nih.gov]
Sex distribution
Age distribution

Pathophysiology

  • […] 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]
  • Prospective study of histoplasmosis in patients infected with human immunodeficiency virus: incidence, risk factors, and pathophysiology. Clin Infect Dis 1997; 24:1195-203. 10. Wheat J. Histoplasmosis in the acquired immunodeficiency syndrome.[hivinsite.ucsf.edu]

Prevention

  • Fungemia may be prevented or arrested by an intact immune system or by other factors not yet known.[ncbi.nlm.nih.gov]
  • Organized by types of fungi, this volume covers microbiologic, epidemiologic and demographic aspects of fungal infections as well as diagnostic, clinical, therapeutic, and preventive approaches. Special patient populations are also detailed.[books.google.de]

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