African Histoplasmosis in the United States

Abstract

THE TERM African refers to a distinct form of histoplasmosis caused by the organism Histoplasma capsulatum var duboisii . All cases have originated in equatorial Africa—even the few recognized outside the continent. 1,2 We describe the occurrence of the disease in a US resident who had been in Africa six years earlier. Report of a Case A 34-year-old Maryland woman had a 3-mm recurrent, crusted, tender scalp papule that she had first noted six years earlier during pregnancy while living in Zaire. She suspected that trauma from a hairpin initiated the lesion. Scrapings of skin from the lesion yielded several white cottony colonies composed of hyphae and tuberculate macroaleuriospores. At 37 °C, the organism converted to a yeast, and a presumptive identification of Histoplasma sp was made. A biopsy specimen of the scalp lesion revealed foci of inflammatory cells within the dermis with giant cells and histiocytes predominating. Numerous thick-walled