scholarly journals DISSEMINATED HISTOPLASMOSIS IN IMMUNOCOMPETENT INDIVIDUALS- NOT A SO RARE ENTITY

2015 ◽  
Vol 7 ◽  
pp. e2015028 ◽  
Author(s):  
Dibyendu De ◽  
Uttam Kumar Nath
Keyword(s):  
Hemophagocytic Syndrome ◽  
Histoplasma Capsulatum ◽  
Case Fatality ◽  
Imaging Study ◽  
Fungal Culture ◽  
Dimorphic Fungi ◽  
Excellent Outcome ◽  
Disseminated Histoplasmosis ◽  
Amphotericine B ◽  
Amphotéricine B

Introduction:Histoplasmosis is a rare fungal disease caused by dimorphic fungi Histoplasma capsulatum. The causative fungus is present in soil, infects through inhalation and manifests in three main types-acute primary, chronic cavitary and progressive disseminated Histoplasmosis. Disseminated Histoplasmosis (DH) is defined as a clinical condition where fungus is present in more than one location. Among the forms of histoplasmosis, DH is the rarest and generally found in immune-compromised individual.Here we are presenting our experiences of the series of cases of Disseminated Histoplasmosis in immune-competent individuals who have been diagnosed in our institute in last 5 years.Materials and methods:This is a single centre retrospective observational study, from May 2009 to April 2014. Only cases with Disseminated Histoplasmosis in otherwise healthy immune-competent individuals were included in the study. The Histoplasmosis is confirmed by either presence of Histoplasma in biopsy specimen from extra-pulmonary organ or by positive growth in fungal cultureResult:Total seven patients met the inclusion criteria. Five out of 7 patients were male. The mean age was 35 years. Five of the 7 patients presented with fever for long duration. Six patients complained of significant weight loss before diagnosis. On examination, one patient had skin nodules, five patients had hepato-splenomegaly, and two patients had lymphadenopathy.The laboratory investigation revealed anaemia in six out of 7 patients, and pancytopenia in 3 patients. Two patients had features of hemophagocytic syndrome in the bone marrow.All of the patient had undergone treatment with conventional amphotericine B  deoxy-cholate and azole antifungal. One patient with adrenal involvement died in hospital. The patient with skin nodule had recurrent relapses. The other patients had resolution of symptoms and clinically cured.Conclusion:Disseminated Histoplasmosis is not an uncommon etiology of fever of prolonged duration even in immuno-competent individual, and should be kept as a differential diagnosis. Targeted investigation with early bone marrow biopsy and fungal culture may help in diagnosis of DH. Imaging study to exclude adrenal involvement prevents case fatality in DH. Cytopenia may be due to secondary hemophagocytic syndrome, which improves with anti-fungal therapy. Treatment with either amphotericine B or itraconazole gives excellent outcome, though therapy may have to given for prolonged period in case of relapses. 

Pancytopenia a Presentation of disseminated Histoplasmosis

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 4687-4687
Author(s):  
Sakeer Hussain
Keyword(s):  
Rheumatoid Arthritis ◽  
Bone Marrow ◽  
Histoplasma Capsulatum ◽  
Urine Analysis ◽  
Conflicts Of Interest ◽  
White Cell Count ◽  
Oral Prednisone ◽  
Mediastinal Lymphadenopathy ◽  
Fungal Culture ◽  
Disseminated Histoplasmosis

Abstract Abstract 4687 A 70 year old female with diabetes mellitus, rheumatoid arthritis with worsening fatigue, intermittent shaking chills and fever for 2 weeks. She had been on oral prednisone 5 mg daily and methotrexate 15 mg every week for her rheumatoid arthritis. Vital signs were stable and physical examination was significant for 3+ lower extremity edema and pallor. The CBC showed pancytopenia, white cell count of 2.5×109/L (4.3–10.8×109/L), hemoglobin was 9.2g/dl (11.0–15.0g/dl), and platelet counts were 93 × 109/L (130–400 × 109/L). SHe had mildly elevated total bilirubin 1.7mg/dl (0.0–1.2mg/dl), elevated alkaline phosphate 1212U/L (38–126 U/L) liver enzymes, SGPT 83U/L (0–40U/L), SGOT 126U/L (0–35U/L), and elevated blood sugar of 260mg/dl. Blood cultures remain negative for bacterial growth for multiple days. Her SPEP, ANA, HIV, CMV, and EBV serology were negative. CT scan of the chest, abdomen and pelvis were consistent with hilar, mediastinal lymphadenopathy and upper abdominal lymphadenopathy with splenomegaly. A bone marrow aspiration and biopsy was consistant with histoplasma capsulatum infection. Patient was treated with IV amphotericin B for 4 weeks. Histoplasma capsulatum was identified from fungal culture from the bone marrow aspirate. Retrospectively urine analysis for histoplasma antigen was positive by ELISA. Subsequently patient recieved itraconazole for 6 months. Cytopenia and symptoms improved and lymphadenopathy regressed. Most patoents who develop disseminated histoplasmosis are immunosuppressed It often mimic the presentation of malignancy like lymphoma or infection like tuberculosis and inflammatory process like sarcoidosis. Misdiagnosis can lead to inappropriate and harmful therapy with glucocorticoides and cytotoxic chemotherapy. Diagnosis requires high index of suspicion and familiarity with clinical presentation and appropriate diagnostic test. Disclosures: No relevant conflicts of interest to declare.

scholarly journals SAT-221 50-Year-Old Fungus Suddenly Flourishes in Adrenal Glands: A Case of Sudden-Onset Bilateral Adrenal Masses Due to Latent Disseminated Histoplasmosis

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Maritza Elide Carrillo ◽  
Amy Chang ◽  
Christopher L Walsh
Keyword(s):  
Adrenal Glands ◽  
Histoplasma Capsulatum ◽  
Rapid Development ◽  
Granulomatous Inflammation ◽  
Fungal Culture ◽  
Travel History ◽  
Disseminated Histoplasmosis ◽  
First Case ◽  
Free Cortisol ◽  
Adrenal Masses

Abstract Histoplasma capsulatum is endemic to Africa, Asia, Central and South America, and within the US, to the Ohio and Mississippi River Valley. Disseminated histoplasmosis is less commonly seen in immunocompetent individuals, who usually present with asymptomatic self-limited acute pneumonitis. Time to involvement of the adrenals is unknown. Adrenal insufficiency occurs in 45% of cases involving the adrenals, and is thought to be irreversible even in patients in remission. A 76-year-old man with no significant past medical history was incidentally found to have large bilateral adrenal masses during routine surveillance of a 7 mm pulmonary nodule on annual Chest CT, which showed normal adrenal glands the year prior. He was asymptomatic. A lifetime non-smoker native to California, whose only significant travel history was in his 20s to Ecuador and Puerto Rico, areas endemic to Histoplasma. Abdominal CT showed large bilateral adrenal masses with intermediate density and low washout values (right: 4.9 cm, HU 45, absolute washout 30%; left: 4.8 cm, HU 30, absolute washout 25%). On exam, vital signs were stable with normal orthostatics. Labs revealed normocytic anemia, normal chemistry panel, normal cortisol after 1-mg dexamethasone overnight test 2.6 mcg/dL (n<5 mcg/dL), plasma metanephrine <0.10 nmol/L (n <0.50 nmol/L), plasma normetanephrine 0.89 nmol/L (n <0.90 nmol/L), aldosterone 4.0 ng/dL (n <31 ng/dL), PRA 2.0 ng/ml/hr (n 0.5-4 ng/ml/hr) and random free cortisol 0.38 ug/dL (n 0.022-0.254ug/dL). HIV antigen and antibody, and Histoplasma urinary antigen were negative. Left adrenal mass biopsy revealed necrotizing granulomatous inflammation with fungal culture revealing budding yeast morphologically consistent with Histoplasmosis, with DNA probe confirming Histoplasma capsulatum. Treatment with itraconazole was initiated and the patient is tolerating the treatment well. To our knowledge, this is the first case demonstrating rapid development of large bilateral adrenal masses within a year due to latent disseminated histoplasmosis in an asymptomatic individual, which highlights the need for appropriate testing in patients with known exposure or travel history to endemic areas, regardless of time since exposure. 1.Singh M, Chandy DD, Bharani T, Marak RSK, Yadav S, Dabadghao P, et al. Clinical outcomes and cortical reserve in adrenal histoplasmosis- a retrospective follow-up study of 40 patients. Clin Endocrinol 2019 Jan 17

Cross-reactivity of a Histoplasma capsulatum antigen enzyme immunoassay in urine specimens from persons with emergomycosis in South Africa

2020 ◽  
Author(s):  
Tsidiso G Maphanga ◽  
Serisha D Naicker ◽  
Beatriz L Gómez ◽  
Mabatho Mhlanga ◽  
Ruth S Mpembe ◽  
...  
Keyword(s):  
Sensitivity And Specificity ◽  
Histoplasma Capsulatum ◽  
Fungal Infections ◽  
Invasive Fungal Disease ◽  
Cross Reactivity ◽  
Fungal Culture ◽  
Cross Reactions ◽  
Disseminated Histoplasmosis ◽  
Culture Filtrates ◽  
Urine Specimens

Abstract Histoplasma antigen detection in urine is a rapid diagnostic method for disseminated histoplasmosis, although cross-reactivity has been reported in specimens from patients with other thermally dimorphic fungal infections. We tested urine specimens, from persons with suspected invasive fungal infections, using a commercial monoclonal antibody Histoplasma enzyme immunoassay (EIA) at a South African national mycology reference laboratory from August 2014 through December 2018. Corresponding fungal culture and histopathology results were obtained from an electronic laboratory information system. In some cases, cultured fungal isolates were sent with the urine specimen for species-level identification by phenotypic and molecular methods. Cross-reactivity was confirmed using culture filtrates of several fungal pathogens. Of 212 referred cases, 41 (19%) were excluded since they had no recorded clinical history (n = 1), alternative diagnoses were confirmed (n = 2), or no fungal culture or histopathology results (n = 38). Eighty-seven of 212 (41%) had laboratory evidence of an invasive fungal disease, while 84 (40%) did not. Of the 87 cases, 37 (43%) were culture-confirmed mycoses: emergomycosis (n = 18), histoplasmosis (n = 8), sporotrichosis (n = 6), cryptococcosis (n = 2), talaromycosis (n = 1), and other fungi isolated (n = 2). The sensitivity and specificity of the EIA were calculated for two groups: culture-confirmed (n = 37) and histology-confirmed invasive fungal disease (n = 50). The sensitivity and specificity of the EIA for diagnosis of histoplasmosis compared to culture were 88% (7/8, 95%CI 47-100%) and 72% (21/29, 95%CI 53-87%), respectively, and for diagnosis of emergomycosis/histoplasmosis compared to histology was 83% (29/35, 95%CI 66-93%) and 93% (14/15, 95%CI 68-100%), respectively. Cross-reactions occurred in urine specimens of patients with Emergomyces africanus infection and in culture filtrates of E. africanus, T. marneffei and Blastomyces species. A commercial Histoplasma EIA had satisfactory accuracy for diagnosis of culture-confirmed histoplasmosis, but cross-reacted in urine specimens from patients with invasive disease caused by the closely-related pathogen, E. africanus and in culture filtrates of E. africanus and other related fungi. Lay summary Emergomyces africanus and Histoplasma capsulatum are fungi that cause a multi-system disease among HIV-seropositive persons with a low CD4 cell count. Handling live cultures of these fungi to confirm a diagnosis requires specialized laboratory equipment and infrastructure which is infrequently accessible in low-resource settings. The features of the two diseases (i.e., disseminated histoplasmosis and emergomycosis) may be indistinguishable when infected tissue is prepared, stained, and examined under a microscope. Enzyme immunoassays (EIA) have been developed as rapid diagnostic tools for the detection of a cell wall component of H. capsulatum in urine specimens, although cross-reactions have been reported in specimens from patients with other fungal infections. We evaluated the accuracy of a commercial Histoplasma EIA to diagnose histoplasmosis and to assess cross-reactions in urine specimens from persons with emergomycosis and in cultures of E. africanus and related fungi. We report a sensitivity and specificity of 88% (95%CI 47-100%) and 72% (95%CI 53-87%) for diagnosis of histoplasmosis compared to culture and 83% (95%CI 66-93%) and 93% (95%CI 68-100%) for diagnosis of either histoplasmosis/emergomycosis compared to a diagnosis made by microscopic examination of infected tissue. The assay cross-reacted in urine specimens from patients with emergomycosis and in culture filtrates of related fungi. Although the EIA cross-reacted with other related fungi, this test can decrease the time to diagnosis and facilitate early treatment of emergomycosis and histoplasmosis in South Africa.

scholarly journals Oropharyngeal histoplasmosis: report of eleven cases and review of the literature

2011 ◽  
Vol 44 (1) ◽  
pp. 26-29 ◽  
Author(s):  
Vicente Sperb Antonello ◽  
Vanice Ferrazza Zaltron ◽  
Marcela Vial ◽  
Flávio Mattos de Oliveira ◽  
Luiz Carlos Severo
Keyword(s):  
Medical Records ◽  
Histoplasma Capsulatum ◽  
Systemic Mycosis ◽  
Database Analysis ◽  
Laboratory Findings ◽  
Active Pulmonary Tuberculosis ◽  
Disseminated Histoplasmosis ◽  
Amphotericin B Deoxycholate ◽  
One Year ◽  
Hiv Seropositive

INTRODUCTION: Histoplasmosis is a systemic mycosis endemic in Brazil, especially in the State of Rio Grande do Sul, where Histoplasma capsulatum was isolated from the soil. H. capsulatum may compromise unusual areas, including the oropharynx, particularly in patients presenting disseminated histoplasmosis; which is associated with a state of immunosuppression, such as AIDS. METHODS: During database analysis of a total of 265 cases of histoplasmosis, the medical records of 11 patients with histological or microbiological diagnoses of oral histoplasmosis (OH) between 1987 and 2008 were retrospectively reviewed. RESULTS: This work reports 11 cases of OH, the majority presenting histopathological or microbiological evidence of disseminated histoplasmosis (DH). In the patients with DH, OH was the first manifestation of histoplasmosis. Five of the 11 patients discussed were HIV-seropositive with clinical and laboratory findings of AIDS. Four patients presented active pulmonary tuberculosis concomitant with histoplasmosis. Treatment was based on the use of itraconazole and amphotericin B deoxycholate. Eight patients responded successfully to therapy after one year, two did not come back for reevaluation and one died despite adequate therapy. CONCLUSIONS: Oral histoplasmosis is closely associated with immunosuppression status, especially in patients presenting AIDS; moreover, in many cases, OH is the first sign of disseminated histoplasmosis.

Mucormycose naso-orbito-cérébrale traitée par amphotéricine B puis kétoconazole

1984 ◽  
Vol 14 (11) ◽  
pp. 610-611 ◽  
Author(s):  
Th. May ◽  
J.L. Schmit ◽  
A. Gerard ◽  
J.M. Vignaud ◽  
P. Tisserand ◽  
...  
Keyword(s):  
Amphotericine B ◽  
Amphotéricine B

scholarly journals Bats, Fever and Adenopathy – What Is the Link?

2013 ◽  
Vol 24 (1) ◽  
pp. 35-37 ◽  
Author(s):  
Joshua J Manolakos ◽  
Mohan Cooray ◽  
Ameen Patel ◽  
Shariq Haider
Keyword(s):  
Costa Rica ◽  
Environmental Exposure ◽  
Salvage Therapy ◽  
Histoplasma Capsulatum ◽  
Treatment Options ◽  
Diagnostic Approach ◽  
Disseminated Histoplasmosis ◽  
Progressive Disseminated Histoplasmosis

A case of travel-related, subacute, progressive disseminated histoplasmosis in a nonimmunocompromised individual is described. The present case highlights the environmental exposure toHistoplasma capsulatumin Costa Rica, the diagnostic approach and treatment options, as well as new alternatives for salvage therapy for histoplasmosis infection.

scholarly journals Disseminated histoplasmosis in a renal transplant recipient – a fatal case report

2011 ◽  
Vol 12 (2) ◽  
pp. 163-165
Author(s):  
Tânia Mara L.B. Araújo ◽  
Geraldo B. Silva Junior ◽  
Orivaldo A. Barbosa ◽  
Rafael S.A. Lima ◽  
Elizabeth F. Daher
Keyword(s):  
Renal Transplant ◽  
Transplant Recipient ◽  
Renal Transplant Recipient ◽  
Histoplasma Capsulatum ◽  
Fatal Case ◽  
Tracheal Aspirate ◽  
Respiratory Pattern ◽  
Vasoactive Drugs ◽  
Dimorphic Fungus ◽  
Disseminated Histoplasmosis

Histoplasmosis is an infectious disease caused by the dimorphic fungus Histoplasma capsulatum.. The disseminated form is usually found in immunocompromised patients. A 53 year-old man, renal transplant recipient, was admitted with fever, dyspnea, productive cough, adynamia and weight loss. He was septic, but hemodynamically stable. The tracheal aspirate found intracellular fungi and the peripheral blood exam was compatible with histoplasmosis. The patient presented a progressive worsening of respiratory pattern and needed mechanical ventilation, vasoactive drugs and hemodialysis. A large spectrum antimicrobial therapy was started, including amphotericin B, but the patient died. Keyword: Disseminated histoplasmosis. Kidney transplantation. Immunosuppression DOI: http://dx.doi.org/10.3329/jom.v12i2.7125 JOM 2011; 12(2): 163-165

scholarly journals A Case Report on Bilateral Adrenal Histoplasmosis

2020 ◽  
Vol 23 (2) ◽  
pp. 210-212
Author(s):  
Md Sazzad Hossain ◽  
Mohammad Zahid Hasan ◽  
Mir Ehteshamul Haque ◽  
Mostakim Maoya
Keyword(s):  
Adrenal Mass ◽  
Adrenal Glands ◽  
Histoplasma Capsulatum ◽  
Needle Aspiration ◽  
Immunosuppressed Patient ◽  
Aspiration Cytology ◽  
Fine Needle ◽  
Disseminated Histoplasmosis ◽  
Adrenal Masses ◽  
Needle Aspiration Cytology

Disseminated histoplasmosis affecting the adrenal glands is a very rare infection and an uncommon cause of adrenal insufficiency. We present a case of bilateral adrenal histoplasmosis in a 77 years old immunosuppressed patient who presented with bilateral adrenal masses. The fine needle aspiration cytology of the adrenal mass was positive for Histoplasma capsulatum. Bangladesh Journal of Urology, Vol. 23, No. 2, July 2020 p.210-212

scholarly journals Hemophagocytic Lymphohistiocytosis Secondary to Disseminated Histoplasmosis in Rheumatologic Disease

2021 ◽  
Vol 2021 ◽  
pp. 1-6
Author(s):  
Yael Kusne ◽  
Michael Christiansen ◽  
Christopher Conley ◽  
Juan Gea-Banacloche ◽  
Ayan Sen
Keyword(s):  
Hemophagocytic Lymphohistiocytosis ◽  
Pediatric Patients ◽  
Histoplasma Capsulatum ◽  
Hematologic Malignancies ◽  
Rapid Diagnosis ◽  
Rheumatologic Disease ◽  
Disseminated Histoplasmosis ◽  
Serious Infections ◽  
Time To Diagnosis ◽  
Prompt Diagnosis

Background. Hemophagocytic lymphohistiocytosis (HLH) was originally described in pediatric patients presenting with fever, hepatosplenomegaly, and blood cell abnormalities. Later, HLH was recognized to occur in adults, often associated with hematologic malignancies or serious infections. Conclusion. Patients presenting with HLH are critically ill, and rapid diagnosis is key. In adults, the search for the trigger must begin promptly as time to diagnosis effects survival. The underlying trigger in our patients was Histoplasma capsulatum infection, which is rare in the southwestern United States. Prompt diagnosis led to recovery in one patient, while the other did not survive.

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