Case Of Histoplasmosis Research Articles

Histoplasmosis associated hemophagocytosis- a rare cause of pancytopenia in an immunocompetent patient

Pancytopenia as a result of hemophagocytosis in a middle-aged man presenting with high-grade fever of unknown etiology could be a rare consequence of Histoplasmosis infection. In the past, many cases of patients with human immunodeficiency virus infection contracting histoplasmosis-induced hemophagocytosis have been well documented, however, little data has been entered in the setting of HIV non-reactive status. Interestingly, we report a case of histoplasmosis in an immunocompetent male with the presence of yeast forms of H. capsulatum in the bone marrow smears. The patient was subsequently placed on Amphotericin B and corticosteroids but lost to the infectious disease. Cases like this, highlight the importance of taking into account the early decision for bone marrow sampling with careful attention to microscopic details as incidental pathologies may be elicited which could have significant effects on patient’s prognosis.

Histoplasmosis misdiagnosed as malignancies in immunocompetent and immunocompromised patients: A global perspective on clinical presentation, radiological and pathological findings

The clinical presentation of histoplasmosis is non-specific and has several mimics as documented in the literature. Regarding cancers, previous reviews emphasized mainly the clinical and radiological similarities between histoplasmosis and pulmonary malignancies. Besides lung cancers, histoplasmosis also masquerades as other malignancies. We identified one hundred and twenty-four cases of histoplasmosis clinically mistaken for malignancies. Of the 124,84 (67.7%) were included in the analyses of demographics, immune status, clinical features, diagnosis, and treatment outcomes. The remainder were excluded as the available data was mainly on diagnosis. Of the eighty-four, histoplasmosis was predominantly misdiagnosed as lung cancers (n = 16, 19.0%), gastrointestinal tumors (n = 15, 17.9%), and lymphomas/hematological malignancies (n = 15, 17.9%). Fifty-four (64.3%) were immunocompromised including 16 (29.6%) who were living with HIV, while the remainder were immunocompetent. We conclude that infective aetiologies like histoplasmosis should be considered or ruled out in patients clinically suspected of malignancy regardless of their immune status.

Cutaneous and Osseous Histoplasmosis caused by Histoplasma capsulatum var. duboisii in a Seemingly Immunocompetent Young Senegalese Woman

African histoplasmosis is a rare deep mycosis caused by Histoplasma capsulatum var duboisii. It can affect various organs such as the skin, lymph nodes, and bones. The diagnosis is often delayed due to its similarity to certain diseases such as tuberculosis, cryptococcosis, pyogenic abscesses, and even neoplasia. We report a case of cutaneous and osseous histoplasmosis caused by H. capsulatum var. duboisii in a seemingly immunocompetent 19-year-old senegalese woman who presented with chronic disseminated cutaneous abscesses, some of which had fistulised, and umbilicated papules on the face. The radiograph of the right forearm showed a metaphyso-diaphyseal osteolytic lesion of the ulna. Histology after biopsy of a facial papule confirmed the diagnosis of histoplasmosis caused by H. capsulatum var duboisii. The patient's condition improved with fluconazole treatment.

Disseminated histoplasmosis in an urban canine with access to the rural environment

Histoplasmosis is a systemic disease caused by the fungus Histoplasma capsulatum. The microorganism causes localized granulomatous disease, with the respiratory tract being most affected, and can spread through the lymphatic and blood stream. Severe infection in dogs is associated with immunosuppressive therapies. The reported case occurred in a canine, brought to care with a serious clinical condition, which did not respond to treatment and was euthanized. The necropsy examination showed white nodules, of firm consistency and distributed throughout the omentum, liver, splenic capsule, pancreas, stomach serosa, intestines, bladder, mesenteric and inguinal lymph nodes, diaphragm, parietal pleura, aorta and aortic lunate. Microscopically, all nodular lesions consisted of areas of necrosis, with intense histiolymphoplasmacytic infiltrate, epithelioid macrophages and Langhans-type giant cells with yeast-like structures, with morphology and arrangement consistent with Histoplasma spp., confirmed by special Periodic Acid-Schiff (PAS) stains and Grocott. Therefore, the present study aims to describe a case of multisystemic histoplasmosis in a canine, diagnosed through anatomopathology and histochemistry, and to alert to this potential infection in urban canines with access to rural areas and/or environments with the fungal agent.

Surveillance for Coccidioidomycosis, Histoplasmosis, and Blastomycosis During the COVID-19 Pandemic - United States, 2019-2021.

Coccidioidomycosis, histoplasmosis, and blastomycosis are lower respiratory tract fungal infections whose signs and symptoms can resemble those of other respiratory illnesses, including pneumonia caused by bacterial or viral etiologies; this overlap in clinical presentation might lead to missed or delayed diagnoses. The causative fungi live in the environment, often in soil or plant matter. To describe the epidemiologic characteristics of cases of coccidioidomycosis, histoplasmosis, and blastomycosis during the COVID-19 pandemic, CDC analyzed case surveillance data for 2019-2021. During this period, a total of 59,655 coccidioidomycosis cases, 3,595 histoplasmosis cases, and 719 blastomycosis cases were reported to CDC. In 2020, fewer cases of each disease occurred in spring compared with other seasons, and most cases occurred in fall; national seasonality is not typically observed, and cases were seasonally distributed more evenly in 2019 and 2021. Fewer cases coinciding with the start of the COVID-19 pandemic, along with an unusually high blastomycosis case fatality rate in 2021 (17% compared with more typical rates of 8%-10%), suggest that the pandemic might have affected patients' health care-seeking behavior, public health reporting practices, or clinical management of these diseases. Increased awareness and education are needed to encourage health care providers to consider fungal diseases and to identify pneumonia of fungal etiology. Standardized diagnostic guidance and informational resources for fungal testing could be incorporated into broader respiratory disease awareness and preparedness efforts to improve early diagnosis of coccidioidomycosis, histoplasmosis, and blastomycosis.

Disseminated Histoplasmosis presenting with panniculitis and macrophage activation syndrome in a patient undergoing immunosuppressive therapy for Mixed Connective Tissue Disease (MCTD).

Histoplasmosis, a fungal infection caused by Histoplasma capsulatum, is endemic in many parts of the world. However, this is not common in Japan. We herein present a unique case of military histoplasmosis in a 45-year-old female with mixed connective tissue disease (MCTD) who was receiving immunosuppressive therapy. The histological findings coupled with molecular confirmation led to final a diagnosis. This case emphasizes the diagnostic challenges associated with histoplasmosis in immunocompromised patients and underscores the importance of considering it in the differential diagnosis of any atypical presentation in rheumatic patients.

Incidentally Diagnosed Disseminated Histoplasmosis among Non HIV Patients: A Series of Three Cases with Review of Literature

Histoplasmosis is a rare airborne fungal infection that is soil-based and is mostly documented in Human Immunodeficiency Virus (HIV)-positive patients. It is common in people living near valley regions. Hereby, authors report three cases of Asian women from different regions of Southern Rajasthan who died due to delayed diagnosis of histoplasmosis within a few days of admission. They all had complaints of fatigue and fever for one month. One presented with decreased urine output and pancytopenia, while the others had complaints of prolonged fever with pancytopenia and fatigue. In all three cases, bone marrow examination was done, and they shared the same diagnosis - disseminated histoplasmosis. It was further confirmed by special stains and microbiological investigations. Authors also reviewed recent articles based on South Asian region histoplasmosis case reports and found three case presentations with the same clinical presentation and outcomes. Treatment was started, but patients deteriorated and died within 10 days of admission. Delay in the diagnosis of histoplasmosis leads to the death of patients. Therefore, histoplasmosis should be considered as a differential diagnosis for prolonged fever with pancytopenia and chronic infections.

Histoplasmose africaine chez un enfant en Guinee: a propos d’un cas

African histoplasmosis is a rare deep mycosis caused by two varieties of Histoplasma capsulatum (capsulatum and duboisii). We report a case of histoplasmosis in an immunocompetent child. 6-year-old female patient, hospitalized for poor general condition, fluctuating inflammatory swelling of the lower limb evolving for 4 months. The clinical examination revealed in an altered and febrile patient, papulo-nodular lesions of variable size, fluctuating in places, disseminated umbilical predominantly on the trunk, the root of the upper and lower limbs. There were also axillary and inguinal lymphadenopathy and osteo-articular involvement. X-ray of the right lower limb revealed osteomyelitis. Histopathology of the biopsied nodule confirmed African histoplasmosis. The rarity of African histoplasmosis in our country corroborates current data from the literature, however this could also be due to an underdiagnosis often influenced by self-medication.

Histoplasmosis: An epidemiological and clinical update in China, review and a case report

ABSTRACT Histoplasmosis is a systemic mycosis caused by the dimorphic fungus in the genus Histoplasma. Histoplasmosis is overlooked in China. This study aims to provide an epidemiological and clinical update on histoplasmosis in China by literature review. We reviewed cases of histoplasmosis reported in recent 11 years and described a case of histoplasmosis-triggered hemophagocytic lymphohistiocytosis (HLH) in an immunocompetent patient. A total of 225 cases of histoplasmosis diagnosed in China between 2012 and 2022 were involved in this study, compared with 300 cases reviewed from 1990 to 2011, an increasing number of cases of histoplasmosis have been diagnosed in the last 11 years. The majority of cases of histoplasmosis were autochthonous cases, mainly from provinces Sichuan (56/225, 24.9%), Hunan (50/225, 22.2%), Guangdong (31/225, 13.8%), and Yunnan (24/225, 10.7%). Higher incidence (52.5%, 53/99) of histoplasmosis occurred in immunocompetent patients which is similar to those from the previous 21 years, and the prevalence of the disease did not vary highly over time. Of note, the number of histoplasmosis cases is increasing, and the geographic distribution is shifting southwards over time. Improved awareness is critically important for informing clinical practice in China.

A Phylogeographic Description of Histoplasma capsulatum in the United States.

Histoplasmosis is one of the most under-diagnosed and under-reported endemic mycoses in the United States. Histoplasma capsulatum is the causative agent of this disease. To date, molecular epidemiologic studies detailing the phylogeographic structure of H. capsulatum in the United States have been limited. We conducted genomic sequencing using isolates from histoplasmosis cases reported in the United States. We identified North American Clade 2 (NAm2) as the most prevalent clade in the country. Despite high intra-clade diversity, isolates from Minnesota and Michigan cases were predominately clustered by state. Future work incorporating environmental sampling and veterinary surveillance may further elucidate the molecular epidemiology of H. capsulatum in the United States and how genomic sequencing can be applied to the surveillance and outbreak investigation of histoplasmosis.

Histoplasmosis in Sri Lanka – barely recognized, yet present

Histoplasmosis has been reported in Sri Lanka for decades; however, clinical recognition and diagnosis of the disease are rare. We conducted a comprehensive search of English-language medical literature from 1969 to February 2022. Our analysis found one population survey of histoplasmin skin sensitivity testing in 1969 (5.7% positive incidence) and ten cases of histoplasmosis across Sri Lanka. The highest number of cases were reported from the Central province, where the positive histoplasmin tests were observed previously. None of the patients were positive for HIV, and both diabetes and betel chewing seem linked with oral histoplasmosis. Out of the reported cases, 50% were diagnosed with disseminated histoplasmosis; asymptomatic, acute pulmonary, and chronic pulmonary histoplasmosis were not observed. The clinical presentation varied from oral lesions (the most common presentation), skin lesions, and fever of unknown origin to adrenal crisis. Fungal culture and histopathology were used for diagnosis, with no use of antigen and antibody testing. Amphotericin B and itraconazole were used as treatment options. The rising at-risk population mandates enhancing laboratory diagnostic facilities and increasing the awareness of medical professionals in Sri Lanka on histoplasmosis.

Histoplasmosis at a Reference Center for Infectious Diseases in Southeast Brazil: Comparison between HIV-Positive and HIV-Negative Individuals.

Objectives: Histoplasmosis is a systemic mycosis, present globally. We aimed to describe cases of histoplasmosis (Hc) and to establish a risk profile associated with Hc in HIV-infected patients (HIV+). Methods: This was a retrospective study of patients with a clinical laboratory diagnosis of Hc. Data were fed into REDCap, and statistical analysis was performed with R. Results: We included 99 records, 65 HIV+ and 34 HIV-. Average age was 39 years. Median time from onset to diagnosis was 8 weeks in HIV- and 22 weeks in HIV+. Disseminated histoplasmosis occurred in 79.4% of HIV+, vs. 36.4% of HIV- patients. Median CD4 count was 70. Co-infection with tuberculosis was present in 20% of HIV+ patients. Blood cultures were positive in 32.3% of HIV+ vs. 11.8% of HIV- (p = 0.025) patients; bone marrow culture was positive in 36.9% vs. 8.8% (p = 0.003). Most HIV+ patients (71.4%) were hospitalized. On univariate analysis, anemia, leukopenia, intensive care, use of vasopressors and mechanical ventilation were associated with death in HIV+ patients. Conclusions: Most of our patients with histoplasmosis were HIV+, presenting advanced AIDS. Diagnosis was late in HIV+ patients, and they frequently presented disseminated Hc, required hospitalization, and died. Early screening for Hc in HIV+ and drug-induced immunosuppressed patients is crucial.

Development of a case fatality prognostic score for HIV-associated histoplasmosis

ObjectivesThe burden of histoplasmosis is as great as that of tuberculosis in Latin America and the attributable mortality is even higher. A better assessment of severity could help reduce mortality. MethodsFrom the French Guiana HIV-histoplasmosis database, we attempted to identify factors associated with 30-day death after antifungal drug initiation and constructed a prognostic score. We evaluated its discrimination performance using several resampling methods. ResultsOf the 415 patients included, 56 (13.5%) died within 30 days of treatment. The fatality-associated factors were performance status ≥3, altered mental status, dyspnea, C-reactive protein ≥75 mg/l, hemoglobin <9 g/dl and/or a platelet <100000/ml, and an interstitial lung pattern on chest X-ray. We constructed a 12-point prognostic score. A threshold ≥5 classified patients as alive or dead at 30 days with a sensitivity of 84%, a specificity of 81%, a positive predicted value of 40%, and a negative predicted value of 97%. The area under the curve of the receiver operating characteristic curves from the different resamples were stable between 0.88 and 0.93. ConclusionThe histoplasmosis case fatality score, which is easy and inexpensive to perform, is a good tool for assessing severity and helping in the choice of induction therapy. An external validation remains necessary to generalize these results.

Histoplasmosis in nasopharynx clinically mistaken for nasopharyngeal malignancy

Abstract Histoplasmosis is a rare type of fungal infection which may manifest as a respiratory disease or as a disseminated infection. It is common in immunocompromised patients and, in recent times, seen in association with COVID-19. On histopathological examination, many intracellular and extracellular yeast forms are seen, which can be confirmed by fungal stains. Histoplasmosis involving the nasopharyngeal region is quite rare. Till date, only less than 100 cases of pharyngo-laryngeal histoplasmosis have been reported. Such cases are clinico-radiologically easily and frequently mistaken for malignancy. Here, we report a case that initially had COVID-19-like symptoms and later presented with a nasopharyngeal mass clinico-radiologically mistaken as a nasopharyngeal malignancy. The diagnosis was established on histopathological examination and the patient recovered completely with anti-fungal treatment. A high grade of suspicion and thorough histopathological examination, especially in immunocompromised patients, complimented by fungal special stains is quite rewarding as even a disseminated disease is curable.

Acute pulmonary histoplasmosis of immunocompetent subjects from Martinique, Guadeloupe and French Guiana: a case series

IntroductionHistoplasmosis is a fungal disease caused by Histoplasma capsulatum. Histoplasma capsulatum var capsulatum is found in Martinique.Cluster cases following working in deserted house, have been described in Martinique. Cases of acute pulmonary histoplasmosis have been described in immunosuppressed individuals, or in case of substantial exposure to reservoirs of Histoplasma capsulatum; however, cases of acute histoplasmosis are rare in immunocompetent individuals.Cases seriesWe report a series of 4 cases of sporadic acute pulmonary histoplasmosis in immunocompetent subjects. Investigation revealed definite exposure in one patient and 3 cases with potential exposure. The diagnosis was microbiological and histological in 3 patients and histological in one patient. All subjects had positive serology to histoplasmosis. Pulmonary involvement was in the form of nodules and micronodules in 3 cases and ground glass lesions in one case. Patients were treated with itraconazole for 3 months and all had a favourable outcome.ConclusionWe report a series of 4 cases of acute pulmonary histoplasmosis in immunocompetent individuals, occurring in a context where exposure was uncertain. This raises the problem of occult exposure in the Caribbean. Interventions to raise awareness and encourage caution are warranted targeting the population of the French West Indies and French Guiana.

A Rare Primary Mucocutaneous Presentation of Chronic Disseminated Histoplasmosis in an Immunocompetent Young Female: A Case Report

Classical Histoplasmosis also known as Darling’s disease is a systemic mycosis caused by dimorphic fungus, Histoplasma capsulatum var capsulatum and Histoplasma capsulatum var duboisii. It is an opportunistic fungal infection that usually affects immunocompromised patients. Though microbiology culture methods are the gold standard, scrape cytology and histopathology give a relatively rapid diagnosis. It may pose a diagnostic dilemma on histopathology and morphology needs to be carefully studied to rule out other differentials. We present a rare case of chronic disseminated histoplasmosis with primary mucocutaneous lesions in an immunocompetent young female patient. This study is ethically approved from the institute and due written consent for publication from the patient has been taken.

Diagnosis of rare cases of cutaneous histoplasmosis in dromedary camel in India

Diagnosis of rare cases of cutaneous histoplasmosis in dromedary camel in India

Current epidemiology of histoplasmosis in Nigeria: A systematic review and meta-analysis.

Histoplasmosis commonly occurs in the advanced HIV disease population and also in immunocompetent individuals. Previous reviews and recent studies highlight several cases of histoplasmosis reported in Nigeria. We aimed to describe the current epidemiology of histoplasmosis in Nigeria and the need for active surveillance in the at-risk populations. Literature searches for all publications on histoplasmosis in Nigeria were performed using online databases including Google scholar, PubMed and African Journal online. The following search terms: 'histoplasmosis' and 'Nigeria', AND/OR 'Histoplasma and Nigeria' were used. No limitations on the date or other search criteria were applied, to avoid the exclusion of articles on histoplasmosis in Nigeria. All publications on histoplasmosis outside Nigeria were excluded. Our review identified a total of 231 cases of histoplasmosis reported from Nigeria: 128 were from individual case reports and case series while 103 were cases from two observational studies. Of the 231 cases, 97 (42.0%) were from South West Nigeria, 66 (28.6%) were from South-South Nigeria, 24 (10.4%) were from North West, 22 (9.5%) from North Central Nigeria, 17 (7.4%) from South East Nigeria and 5 (2.2%) from the North East. Based on Nigeria's current population size of 216,953,585 the burden of histoplasmosis per 100,000 inhabitants was estimated to be 0.1%. The sheer number of cases detected in recent observational studies compared with individual case reports and series reported over a longer duration of 6 decades suggests gross under-reporting of histoplasmosis in Nigeria. Histoplasmosis is not an uncommon clinical entity in Nigeria. Histoplasmosis case finding should be improved by training and retraining healthcare professionals and providing much-needed diagnostic capacity and infrastructure across health facilities in Nigeria.

Histoplasmosis Disguised as Pyrexia of Unknown Origin in Kidney Transplant Recipients: Bone Marrow Biopsy was Key to Diagnosis

Immunocompromised host commonly develops a disseminated form of histoplasmosis and may have diverse manifestations. We present a case of histoplasmosis in a kidney transplant recipient who presented with pyrexia of unknown origin and pancytopenia. Bronchoalveolar lavage fluid analysis and serum antigen were negative for histoplasmosis. Bone marrow biopsy showed periodic acid–Schiff-positive intra and extracellular yeast-like organisms and later confirmed as Histoplasma capsulatum. The patient was successfully treated with intravenous liposomal amphotericin B, followed by oral itraconazole. Thus, bone marrow examination proved as key to diagnosis in our case.

914: SEPSIS IN THE STREAM: SEVERE LEGIONELLA AND HISTOPLASMA PNEUMONIA ACQUIRED FROM SPRING WATER

Introduction: Legionnaires’ disease (LD) and pulmonary histoplasmosis are important causes of community-acquired pneumonia (CAP). Both infections are acquired via inhalation from a myriad of reported contaminated environmental sources. Herein, we present a case of concurrent LD and pulmonary histoplasmosis ultimately linked to contaminated spring water used in a home continuous positive airway pressure (CPAP) device, highlighting the importance of source identification and proper patient education on device maintenance. Description: A 67-year-old male with obstructive sleep apnea (OSA) was admitted to our ICU for acute respiratory distress syndrome (ARDS) requiring endotracheal intubation after one week of dyspnea associated with fevers, vomiting, and diarrhea. Vital signs on arrival were significant for fever of 102.8°F, vasopressor-dependent hypotension, and refractory hypoxemia despite maximal ventilator support. Thoracic CT revealed bilateral multifocal consolidations and urine legionella antigen test was positive, confirming the diagnosis of LD. He was also diagnosed with possible pulmonary histoplasmosis after serum histoplasma antigen resulted positive. Treatment included salvage ARDS supportive measures and broad-spectrum antimicrobials, including levofloxacin and amphotericin B. His ICU course was complicated by a prolonged ventilator wean requiring tracheostomy. Upon further questioning, the patient’s family revealed he used a nearby spring as his primary water source, including in his home CPAP device. He ultimately transitioned to a step-down unit with plans for outpatient pulmonary follow-up on discharge. Discussion: Legionella pneumonia and pulmonary histoplasmosis both represent significant and potentially fatal causes of CAP. Environmental reservoirs remain the primary source of infection and may persist since investigations are often reserved for large outbreaks. Our case highlights a source of both legionella and histoplasmosis not previously reported. It demonstrates the value of taking a thorough history while recognizing non-traditional sources of both infections. It also highlights the importance of emphasizing proper device maintenance. Increased awareness of risk factors for these infections enables earlier diagnosis and treatment and ideally improves outcomes.