scholarly journals Disseminated Histoplasmosis Involving Soft Palate, Duodenum, Sigmoid Colon and Bone Marrow in a Patient With Isolated CD4+ T-Lymphocytopenia

Cureus ◽  
2021 ◽  
Author(s):  
Naga Swetha Samji ◽  
Rajanshu Verma ◽  
Sanobar Y Mohammed ◽  
Farhan Khan ◽  
Mohammad K Ismail
Keyword(s):  
Bone Marrow ◽  
Sigmoid Colon ◽  
Soft Palate ◽  
Disseminated Histoplasmosis

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.

Pharmacotherapy of Disseminated Histoplasmosis in Patients with AIDS

1993 ◽  
Vol 27 (12) ◽  
pp. 1510-1518 ◽  
Author(s):  
S. Diane Goodwin ◽  
Courtney V. Fletcher ◽  
Richard H. Drew
Keyword(s):  
Bone Marrow ◽  
Clinical Trials ◽  
Maintenance Therapy ◽  
Amphotericin B ◽  
Induction Therapy ◽  
Antifungal Agent ◽  
Clinical Presentation ◽  
Biomedical Literature ◽  
Aids Patients ◽  
Disseminated Histoplasmosis

OBJECTIVE: To review the pharmacotherapy of disseminated histoplasmosis (DH) in patients with AIDS. The article provides an overview of the pathophysiology, epidemiology, clinical presentation and diagnosis of this disease. Clinical trials reporting intervention with antifungal therapy are reviewed, with an emphasis on efficacy and toxicity of these agents. DATA SOURCES: A MEDLINE search from 1976 to the present was performed to identify pertinent biomedical literature, including reviews. STUDY SELECTION: All available reviews and clinical trials in AIDS patients were evaluated, as were all available case series and interventional clinical trials. DATA SYNTHESIS: DH in patients with HIV infection is an AIDS-defining opportunistic infection caused by Histoplasma capsulatum. It is most frequently observed in HIV-infected patients living in or traveling to endemic regions. The clinical presentation most often includes fever and weight loss, but may be complicated by comorbid illness such as other opportunistic infections. Diagnosis is best established by histologic examination of peripheral blood smear or bone marrow aspirate, or isolation of the organism in cultures of blood, bone marrow, and respiratory secretions. Serologic examinations may provide supportive diagnostic information. Detection of histoplasma polysaccharide antigen (HPA) in serum or urine may prove to be a promising approach for the rapid diagnosis and therapeutic monitoring of DH in AIDS patients. In contrast to immunocompetent hosts, high relapse rates are reported after therapy in AIDS patients. Therefore, initial (induction) therapy is routinely followed by long-term (maintenance) therapy to prevent relapse. Issues regarding the selection, dosage, and duration of therapy, as well as prophylaxis of patients at highest risk, still need to be addressed by controlled clinical trials. CONCLUSIONS: Amphotericin B is presently the drug of choice for induction therapy. Maintenance therapy with either amphotericin B or an oral azole antifungal agent active against H. capsulatum is necessary to prevent relapse. Itraconazole, a triazole antifungal agent, may provide effective alternative therapy for both induction and maintenance treatment of DH.

Trephine biopsy of the bone marrow in disseminated histoplasmosis

1979 ◽  
Vol 67 (4) ◽  
pp. 617-622 ◽  
Author(s):  
Scott F. Davies ◽  
Robert W. McKenna ◽  
George A. Sarosi
Keyword(s):  
Bone Marrow ◽  
Trephine Biopsy ◽  
Disseminated Histoplasmosis

scholarly journals Diagnostic accuracy of antigen detection in urine and molecular assays testing in different clinical samples for the diagnosis of progressive disseminated histoplasmosis in patients living with HIV/AIDS: A prospective multicenter study in Mexico

2021 ◽  
Vol 15 (3) ◽  
pp. e0009215
Author(s):  
Areli Martínez-Gamboa ◽  
María Dolores Niembro-Ortega ◽  
Pedro Torres-González ◽  
Janeth Santiago-Cruz ◽  
Nancy Guadalupe Velázquez-Zavala ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Diagnostic Accuracy ◽  
Nested Pcr ◽  
Urine Samples ◽  
People Living With Hiv ◽  
Bone Marrow Tissue ◽  
Disseminated Histoplasmosis ◽  
Progressive Disseminated Histoplasmosis ◽  
Sensitivity Specificity ◽  
Living With Hiv

Background The progressive disseminated histoplasmosis (PDH) has been associated with severe disease and high risk of death among people living with HIV (PLWHIV). Therefore, the purpose of this multicenter, prospective, double-blinded study done in ten Mexican hospitals was to determine the diagnostic accuracy of detecting Histoplasma capsulatum antigen in urine using the IMMY ALPHA Histoplasma EIA kit (IAHE), clarus Histoplasma GM Enzyme Immunoassay (cHGEI IMMY) and MiraVista Histoplasma Urine Antigen LFA (MVHUALFA); as well as the Hcp100 and 1281-1283220SCAR nested PCRs in blood, bone-marrow, tissue biopsies and urine. Methodology/Principal findings We included 415 PLWHIV older than 18 years of age with suspicion of PDH. Using as diagnostic standard recovery of H. capsulatum in blood, bone marrow or tissue cultures, or histopathological exam compatible, detected 108 patients (26%, [95%CI, 21.78–30.22]) with proven-PDH. We analyzed 391 urine samples by the IAHE, cHGEI IMMY and MVHUALFA; the sensitivity/specificity values obtained were 67.3% (95% CI, 57.4–76.2) / 96.2% (95% CI, 93.2–98.0) for IAHE, 91.3% (95% CI, 84.2–96.0) / 90.9% (95% CI, 87.0–94.0) for cHGEI IMMY and 90.4% (95% CI, 83.0–95.3) / 92.3% (95% CI, 88.6–95.1) for MVHUALFA. The Hcp100 nested PCR was performed on 393, 343, 75 and 297, blood, bone marrow, tissue and urine samples respectively; the sensitivity/specificity values obtained were 62.9% (95%CI, 53.3–72.5)/ 89.5% (95%CI, 86.0–93.0), 65.9% (95%CI, 56.0–75.8)/ 89.0% (95%CI, 85.2–92.9), 62.1% (95%CI, 44.4–79.7)/ 82.6% (95%CI, 71.7–93.6) and 34.9% (95%CI, 24.8–46.2)/ 67.3% (95%CI, 60.6–73.5) respectively; and 1281-1283220SCAR nested PCR was performed on 392, 344, 75 and 291, respectively; the sensitivity/specificity values obtained were 65.3% (95% CI, 55.9–74.7)/ 58.8% (95%CI, 53.2–64.5), 70.8% (95%CI, 61.3–80.2)/ 52.9% (95%CI, 46.8–59.1), 71.4% (95%CI, 54.7–88.2)/ 40.4% (95%CI, 26.4–54.5) and 18.1% (95%CI, 10.5–28.1)/ 90.4% (95%CI, 85.5–94.0), respectively. Conclusions/Significance The cHGEI IMMY and MVHUALFA tests showed excellent performance for the diagnosis of PDH in PLWHIV. The integration of these tests in clinical laboratories will certainly impact on early diagnosis and treatment.

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