Pulmonary histoplasmosis

Abstract

Thirty-five patients with proven histoplasmosis and 9 patients with presumptive histoplasmosis were treated between 1st January 1957 and 31st July 1962. Four patients had acute pulmonary histoplasmosis, 21 chronic pulmonary histoplasmosis, 2 generalized disseminated disease, 3 nodular lesions in the lungs, and 2 histoplasmosis of thoracic lymph nodes. The disease of 3 patients was not classified because their X-rays could not be obtained. Four patients also had active pulmonary tuberculosis. The fungus was isolated from the sputum in 23 patients, from resected tissue in 9, from a lymph node in 1, at autopsy in 1, and from soil with which the patient had had contact in one. Complement fixation serologic tests were negative in almost half the patients on admission. Many patients later showed a significant rise. The positive tests were seen most often in patients with an exudative element to their disease. The yeast phase antigen gave more positive tests than the mycelial phase antigen. Eight patients had completely negative complement fixation tests during their entire hospitalization. Skin tests with histoplasmin were positive in 91 percent of our patients tested. Treatment consisted of bedrest only, in 6 patients, surgical measures in 8, and amphotericin in 21. Nine patients showed radiologic clearing and 7 fungus-free sputum even before amphotericin was begun. During amphotericin therapy, radiologic clearing occurred in 15 patients and sputum conversion in all the patients who were still positive except for one who died of generalized disseminated histoplasmosis shortly after the start of therapy. Most patients showed some evidence of amphotericin toxicity but in only two was this sufficiently severe to require cessation of therapy. One additional patient refused to continue the medication because of the symptoms. Two patients died during treatment, one of generalized disseminated histoplasmosis and tuberculosis, and the other of myocardial infarction.