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The Fungi
Published in Julius P. Kreier, Infection, Resistance, and Immunity, 2022
Exposure and subclinical infections are common in endemic areas. Different studies have revealed that from fifty to ninety-five percent of the population in these areas show evidence of infection as revealed by a positive reaction to the delayed type hypersensitivity (DTH) skin test. Clinical disease occurs in only a small percentage of those infected, and respiratory disease is the most common manifestation of clinical histoplasmosis. In otherwise healthy individuals, this disease is self-limiting. Progressive, disseminated histoplasmosis can occur in individuals who have been exposed to a large inoculum or who are unable to mount a CM1 response. This explains why the disease poses a particular problem with AIDS patients.
Disseminated Histoplasmosis, Coccidioidomycosis, And Cryptococcosis
Published in Lourdes R. Laraya-Cuasay, Walter T. Hughes, Interstitial Lung Diseases in Children, 2019
The propensity for diffuseness of the pneumonitis is illustrated in several studies. Of 26 patients with progressive disseminated histoplasmosis at the National Institutes of Health, 13 had radiographic abnormalities. Of the 13 patients, 11 had interstitial pneumonitis, 2 had pleural effusion, and 2 had enlarged hilar lymph nodes.2 Of 8 immunosuppressed patients with disseminated histoplasmosis in Minneapolis, 4 had diffuse interstitial pulmonary infiltrates, one had nodular infiltrates, one had metastatic nodules, and two had normal radiographs.3
Cutaneous Manifestations of Deep Fungal Infections in HIV Disease
Published in Clay J. Cockerell, Antoanella Calame, Cutaneous Manifestations of HIV Disease, 2012
Loebat Kamalpour, Antoanella Calame, Clay J. Cockerell
Disseminated histoplasmosis is a progressive granulomatous disease caused by the intracellular dimorphic fungus, Histoplasma capsulatum. Samuel Darling, a pathologist, first identified H. capsulatum in the visceral tissues and bone marrow of an adult male presumed to have died of miliary tuberculosis in Panama (1905).37 It was designated H. capsulatum based on its appearance in histiocytes, an archaic term for macrophages (‘histo’), its resemblance to protozoan parasites (‘plasma’), and the apparent presence of a surrounding capsule (‘capsulatum’).38 Progressive disseminated histoplasmosis has been included among the AIDS-defining illnesses since 1987.
Histoplasmosis presenting as colitis and blood dyscrasias in a patient with systemic lupus erythematosus
Published in Baylor University Medical Center Proceedings, 2022
Dua Noor Butt, Muhamad Sheharyar Warraich, Akshay Machanahalli Balakrishna, Mahmoud Ismayl, Sumbul Liaqat, Kanza Noor Butt, Joseph Thirumalareddy, Manasa Velagapudi
Histoplasmosis is the most common endemic mycosis in the United States.1,2 There is a wide spectrum of disease manifestations, ranging from asymptomatic infections to acute pulmonary infections to devastating progressive disseminated disease.3 The causative organism H. capsulatum is a dimorphic fungus. It grows as a mold in the environment at cooler temperatures and as a yeast at 37°C at body temperature. Most patients infected with this fungus experience asymptomatic hematogenous dissemination throughout the reticuloendothelial system via parasitized macrophages. Progressive disseminated histoplasmosis is common in patients with impaired cell-mediated immunity. AIDS, hematologic malignancy, solid organ transplantation, hematopoietic stem cell transplantation, corticosteroid use, tumor necrosis factor antagonist therapy, congenital T-cell deficiency, and infancy and old age have been reported as risk factors.4
Rash decisions can be life-saving: a case of disseminated histoplasmosis in an immunocompromised patient
Published in Journal of Community Hospital Internal Medicine Perspectives, 2019
Huda Naz Khan, Stephen L. Hines, Leigh Hunter
Treatment is indicated for everyone with a diagnosis of disseminated histoplasmosis. Recommended treatment for mild to moderate disease is a regimen of oral itraconazole. In moderate to severe disease, initial treatment is 1–2 weeks of intravenous liposomal amphotericin B followed by a course of oral itraconazole. To reduce the risk of relapse, the total duration of treatment is at least 1 year. Because Histoplasma antigen concentrations in urine and serum fall with effective therapy, patients should be monitored for therapeutic response with serum and/or urine antigen testing at 4 to 6-month intervals [3]. Our patient was scheduled for outpatient infectious diseases follow up to monitor therapeutic response. She was also referred for outpatient wound care. Overall mortality of progressive-disseminated histoplasmosis is 85–100% without treatment and reduced to less than 25% with treatment [3].
Variable urine Histoplasma antigen with volume status
Published in Journal of Community Hospital Internal Medicine Perspectives, 2019
Allyson Hughes, Joy Underwood, George E. Nelson, Richard W. Larue, Melissa L. Scalise
Histoplasmosis is a common fungal infection in the Ohio and Mississippi River Valley regions caused by inhalation of Histoplasma capsulatum with a wide range of clinical manifestations [2]. Immunosuppressed patients are at higher risk for the development of progressive disseminated histoplasmosis [2]. While culture remains the gold standard for diagnosis, its sensitivity is limited. Thus, antigen detection assays utilizing serum, urine, bronchoalveolar lavage, and cerebrospinal fluid have emerged as an effective tool for the diagnosis of active infection [3].