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Abstract
Chronic pulmonary histoplasmosis (CPH) is an uncommon manifestation of Histoplasma infection with features similar to pulmonary tuberculosis (TB). In endemic areas, it may be misdiagnosed as smear-negative pulmonary TB. Historical case series mainly from patients with presumed TB described a high frequency of cavitation and poor prognosis, likely resulting from delayed presentation. More recent reports suggest that CPH can present with nodules, lymphadenopathy, or infiltrates, with cavities being a less common feature. Emphysema is the main risk factor for cavitary CPH. CPH is therefore an umbrella term, with chronic cavitary pulmonary histoplasmosis and Histoplasma nodules being the main long-term manifestations in nonimmunocompromised individuals. Diagnosis relies on a high index of suspicion, use of fungal culture of respiratory samples, antibody testing, and compatible radiological picture. Treatment with itraconazole for at least 12 months is recommended. Morbidity from CPH results from slow progression of cavities and gradual loss of lung function, especially if not recognized and treated. Studies on the epidemiology of CPH are needed in order to improve understanding of the disease.
Highlights
Histoplasma capsulatum var. capsulatum (Hcc) is a dimorphic fungus [1] transmitted via the airborne route, during activities like caving, construction work, and excavations [2]
More recent series have emphasized that nodules are a more common manifestation of chronic histoplasma infection, so in this review we use the term Chronic cavitary pulmonary histoplasmosis (CCPH) to refer to those with cavitary disease and the term chronic pulmonary histoplasmosis (CPH) for all forms of chronic lung infection caused by Histoplasma, including Histoplasma nodules
More recent case series consider CPH as an entity defined by the chronicity of symptoms rather than the development of cavitation [19]
Summary
Chronic pulmonary histoplasmosis (CPH) is an uncommon manifestation of Histoplasma infection with features similar to pulmonary tuberculosis (TB). In endemic areas, it may be misdiagnosed as smear-negative pulmonary TB. More recent series have emphasized that nodules are a more common manifestation of chronic histoplasma infection, so in this review we use the term CCPH to refer to those with cavitary disease and the term chronic pulmonary histoplasmosis (CPH) for all forms of chronic lung infection caused by Histoplasma, including Histoplasma nodules. Because of its clinical presentation, CCPH can cause considerable diagnostic confusion with TB Another chronic fungal infection, chronic pilmonary aspergillosis or CPA, has recently attracted attention as a differential diagnosis of TB in endemic areas [18]. The various features and forms of CPH are discussed in more detail below with a focus on the changing understanding of the disease over the years
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