Chronic Pulmonary Histoplasmosis Research Articles

The Association of Chronic Pulmonary Aspergillosis and Chronic Pulmonary Histoplasmosis with MDR-TB Patients in Indonesia

The Association of Chronic Pulmonary Aspergillosis and Chronic Pulmonary Histoplasmosis with MDR-TB Patients in Indonesia

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.

Recurrent Pneumothorax and a Solitary Pulmonary Nodule: A Case Report of a Rare Sequelae of Histoplasmosis

Histoplasmosis is a fungal infection caused by a histoplasma species known to be endemic to the Ohio River valley region. Commonly encountered as a solitary pulmonary nodule, histoplasmosis has both acute and chronic forms. We present a case of a 36-year-old woman with multiple episodes of pneumothorax who was ultimately diagnosed with pulmonary histoplasmosis, demonstrating a complication of chronic pulmonary histoplasmosis, which has not been reported in the medical literature.

P286 Histoplasmosis in Sri Lanka

Poster session 2, September 22, 2022, 12:30 PM - 1:30 PMBackgroundHistoplasmosis is a systemic mycosis caused by Histoplasma capsulatum, a dimorphic fungus. More severe disease has been observed in immunocompromised individuals. Most cases occur in certain endemic regions of the world however it seems to have a much wider global distribution. Histoplasmosis is infrequently recognized in Sri Lanka and the dispersion of information on cases is fragmented.MethodThe comprehensive search of medical literature in the English language through databases from any time to February 2022. Either, culture-proven or histopathologically proven cases were selected as diagnostically confirmed histoplasmosis. Duplicate reports were excluded. All available data on demography, clinical presentation, diagnostic method, management, and clinical outcome were appraised for the reported cases.ResultOne survey of histoplasmin skin sensitivity testing and ten cases of histoplasmosis across Sri Lanka were observed during the above period. A total of 5.7% of histoplasmin positivity had been observed in the survey of histoplasmin sensitivity among 1366 Sri Lankan volunteers of the Western and the Central Provinces in 1969. Most of the patients were reported from the Central province which had the positive histoplasmin test previously. In addition, cases were observed in Southern Province, the Sabragamuwa Province, and the Eastern Province. The majority of affected individuals were adult males (90%) and pediatric patients were not observed. The clinical presentation stretched from oral lesions (the most common presentation), skin lesions, and fever of unknown origin, to adrenal crisis. Disseminated histoplasmosis was diagnosed in 50% of the patients however asymptomatic, acute pulmonary, and chronic pulmonary histoplasmosis was not observed. Both diabetes and betel chewing are likely to be linked with oral histoplasmosis and none of the patients were positive for HIV. Both histopathology and fungal culture methods were used for the diagnosis while the use of antigen and antibody testing were not popular. Both itraconazole and amphotericin B were used for the treatment of the patients with variable outcomes.ConclusionHistoplasmosis exists in Sri Lanka. The number of cases could be expected to be much higher than reported along with the increase in at-risk populations. These mandates enhance laboratory diagnostic facilities and increase the awareness of medical professionals in Sri Lanka.

Mediastinal Mass with Unusual Etiology.

Mediastinal Mass with Unusual Etiology.

Presentations of Chronic Cavitary Pulmonary Histoplasmosis Mimic Infected Cystic Bronchiectasis in an Immunocompetent Host: A Case Report

BackgroundChronic cavitary pulmonary disease and laryngeal involvement are unusual manifestations of Histoplasmosis capsulatum infection, particularly in patients who are not immunocompromised. The presence of fibro-cavitary lesions has been reported as a radiologic presentation of chronic histoplasmosis in patients with pre-existing lung disease. However, there have been few reports of extensive basal predominant cavitary lesions that mimic cystic-bronchiectasis.Case presentationA 65-year-old previously healthy Thai male presented with productive cough, hoarseness, low-grade fever, and weight loss for 6 months. There was no history of significant exposure to Histoplasmosis capsulatum . Tests for HIV and anti-IFN- [[EQUATION]] antibody were negative. Chest CT revealed multifocal thick wall cavities, which were distributed in a peri-bronchial pattern, and some areas of consolidation in both basal lungs. Laryngoscopy revealed an ulcerative lesion of the false vocal cords. Histopathological study of false vocal cords and lung tissue showed granulomatous inflammation with mixed inflammatory cell infiltration and aggregation of histiocytes containing round intracytoplasmic organisms. GMS-staining was positive, but negative mucicarmine-staining was negative. A real-time PCR assay of the lung tissue was positive for Histoplasmosis capsulatum. The final diagnosis was chronic cavitary pulmonary histoplasmosis with laryngeal involvement.ConclusionChronic cavitary pulmonary histoplasmosis is rare, as is laryngeal involvement. However, there have been such cases in endemic areas, even in immunocompetent patients. Chronic histoplasmosis should be considered in patients who present with the extensive basal predominant cavitary-pulmonary lesions that mimic cystic bronchiectasis.

Chronic Pulmonary Histoplasmosis-A Scoping Literature Review.

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.

Pulmonary Mycoses in Indonesia: Current Situations and Future Challenges

Cases of pulmonary mycosis or pulmonary fungal diseases continues to increase in frequency along with the expanding population with impaired immune systems, including patients with pre-existing pulmonary diseases. Changing profile of underlying diseases might cause altering diseases profile as well. In previous decades, Pneumocystis pneumonia was the most common pulmonary mycosis in HIV-infected patients. As the increasing number of TB cases, pulmonary malignancy, chronic obstructive pulmonary disease (COPD) and certain chronic diseases, other pulmonary mycoses also increase such as chronic pulmonary aspergillosis, cryptococcosis, histoplasmosis, and other filamentous fungal infection. Furthermore, the airborne fungal particles of Aspergillus and other fungi could seriously worsen asthma or allergic respiratory diseases. In low- and middle-income countries, including Indonesia, lack of diagnostic facilities may lead to inadequate treatment. It will contribute to poor clinical outcomes with high mortality rates. The awareness among clinicians and other health workers of this epidemiology changes is the important step in early diagnosis and better managemenet of pulmonary mycosis in the future. (J Respir Indo. 2019; 39(3): 210-4)

Chronic pulmonary histoplasmosis in Portugal: a case report

Pulmonary histoplasmosis is a rare disease in Europe caused by Histoplasma capsulatum, a dimorphic fungus present in the soil contaminated with excrements of birds and bats. There are two varieties, variety capsulatum endemic of American continent and variety duboisii endemic of African continent. All cases in Europe were imported. In this article, we present a case of chronic pulmonary histoplasmosis, a rare presentation of histoplasmosis in an immunocompetent man several years after he has lived in a endemic region of Africa. He complained of fatigue and dyspnea in the last two years. In computed tomography of the chest, it was verified multiple and bilateral focus of densification with peribronchovascular distribution. Transthoracic lung biopsy was then requested, whose pathological anatomy revealed epithelioid granulomas infected by yeast from Histoplasma capsulatum.

Fibrosing Mediastinitis: A Review of Epidemiology, Diagnosis and Management

Fibrosing Mediastinitis (FM) is a rare but increasingly recognized complication that has been mainly associated with chronic pulmonary histoplasmosis, granulomatous diseases, infections and autoimmune processes. Symptoms vary depending on compromised structures, mainly structures within the mediastinum. This review will focus on the etiology, clinical presentation and management of fibrosing mediastinitis based on multiple case series published to date.

Histoplasmosis pulmonar crónica en un adulto inmunocompetente

La histoplasmosis es la micosis endémica más frecuente a nivel mundial. Su aumento es proporcional con la creciente necesidad de terapias inmunosupresoras para el tratamiento de distintas enfermedades. Causada por el microorganismo Histoplasma capsulatum, la forma clínica más frecuente es la pulmonar, la cual se clasifica, según el tiempo de presentación, en aguda, subaguda y crónica. La histoplasmosis crónica representa el 8% de los casos; esta se caracteriza por la formación progresiva de cavitaciones y extensa destrucción del parénquima pulmonar. Comúnmente se describe en pacientes con enfermedad pulmonar crónica y antecedente de tabaquismo. En Colombia hasta el 10% de los casos no se asocia con factores de riesgo. Dada su importancia, y la escasa información reportada en la literatura, presentamos el caso de un hombre de 50 años atendido en el Hospital Universitario San Ignacio; a quien se diagnosticó histoplasmosis pulmonar crónica con estudios de inmunodeficiencia normales, identificándose como único factor de riesgo su ocupación como demoledor de construcciones.

Gastrointestinal Histoplasmosis: A Case Series.

Histoplasmosis is an invasive mycosis caused by inhalation of the spores of dimorphic fungi Histoplasma capsulatum. The disease manifests in the lung as acute or chronic pulmonary histoplasmosis and in severe cases gets disseminated in multiple organs like skin, adrenal gland, central nervous system, lymph node, liver, spleen, bone marrow, and gastrointestinal tract. It occurs most commonly in immunodeficient patients like HIV-positive patients and transplant recipients, while immunocompetent hosts are affected rarely. In cases of gastrointestinal histoplasmosis, the samples are collected for culture and biopsy should be sent for histopathological examination for definitive diagnosis. We conducted a retrospective study of colonic biopsies performed in the department of gastroenterology in a tertiary care hospital of north India from January 2014 to December 2015. Five cases of colonic histoplasmosis were diagnosed on histopathology out of which 4 patients were from north India while 1 patient was from Myanmar. The patients presented with various complaints, including loose stools, diarrhea, altered bowel habits, and gastrointestinal bleeding. The prognosis is very good after early and aggressive treatment while the disease is fatal if it remains untreated. In our study, 2 patients died within few days of diagnosis due to delay in the diagnosis, dissemination, and associated complications. Other patients were started on amphotericin B deoxycholate and are under follow-up. An early diagnosis of gastrointestinal histoplasmosis is important as appropriate treatment leads to long-term survival while untreated cases are almost fatal.

Chronic Pulmonary Histoplasmosis and its Clinical Significance: an Under-reported Systemic Fungal Disease

[This corrects the article DOI: 10.7759/cureus.751.].

Medical image of the week: chronic pulmonary histoplasmosis

Medical image of the week: chronic pulmonary histoplasmosis

Clinical Presentation and Management of Histoplasmosis in Older Adults

To describe the influence of age on clinical features of histoplasmosis. Retrospective single-center cohort study. Large tertiary care center. All individuals who met criteria for probable or proven histoplasmosis between 1998 and 2008. Participants were divided into the following categories of histoplasmosis: acute pulmonary, chronic pulmonary, asymptomatic, disseminated, and other. Correcting for immune status, the influence of age at diagnosis on presentation, diagnosis, imaging, treatment, and all-cause mortality was evaluated. In 347 participants with histoplasmosis, a number of characteristics were associated with age when evaluating participants according to diagnostic category. An age-associated increase in asymptomatic histoplasmosis was observed (P<.001). In symptomatic pulmonary histoplasmosis, older adults were less likely to present with chest pain (P<.001) and less likely to have hilar lymphadenopathy on imaging (P=.04). Lower rates of seropositivity with older age were seen in asymptomatic (P=.04) but not other forms of histoplasmosis. Cavitary disease was associated with older age in chronic pulmonary histoplasmosis (P=.05). Treatment did not change with age. All-cause mortality at 6months was 4% and was associated with older age (P=.02). Although most studied characteristics of histoplasmosis were similar, notable age-related differences were present. Chronic cavitary disease and asymptomatic histoplasmosis were more common with older age. In acute histoplasmosis, the lack of chest pain and hilar lymphadenopathy may hinder diagnosis in older adults.

Pulmonary Histoplasmosis

Pulmonary histoplasmosis is an important cause of morbidity in the United States. Several outbreaks of acute pulmonary histoplasmosis have been linked to potentially preventable environmental exposures. Progressive disseminated histoplasmosis, which is seen frequently in the growing population of immunocompromised hosts, often presents with prominent pulmonary manifestations and is more commonly encountered in hospitalized patients than acute, subacute, or chronic pulmonary histoplasmosis. A battery of diagnostic studies including serology, antigen, cytology/histopathology, and culture should be obtained in suspected cases of histoplasmosis. The yield of antigenuria detection is highest when the multiple body fluids are tested; the level of antigenuria correlates with severity of disease. Amphotericin B is the treatment of choice for severe pulmonary or disseminated histoplasmosis, and itraconazole is effective for mild to moderately severe infection. Posaconazole exhibits promise as a salvage agent. Antifungal prophylaxis is not routinely recommended for at-risk populations. Measures to minimize environmental contamination may reduce the risk of epidemic-type acute pulmonary histoplasmosis related to high-risk exposures.

A Multicenter Evaluation of Tests for Diagnosis of Histoplasmosis

The sensitivity of the MVista Histoplasma antigen enzyme immunoassay (MiraVista Diagnostics) has been evaluated in disseminated histoplasmosis in patients with AIDS and in the "epidemic" form of acute pneumonia. Moreover, there has been no evaluation of the sensitivity of antigenemia detection in disseminated histoplasmosis after the implementation of methods to dissociate immune complexes and denature released antibodies. The goal of this study was to determine the sensitivity of the current antigen assay in different categories of histoplasmosis. Urine and serum specimens obtained from 218 patients with histoplasmosis and 229 control subjects, including 30 with blastomycosis, were tested. Antigenuria was detected in 91.8% of 158 patients with disseminated histoplasmosis, 83.3% of 6 patients with acute histoplasmosis, 30.4% of 46 patients with subacute histoplasmosis, and 87.5% of 8 patients with chronic pulmonary histoplasmosis; antigenemia was present in 100% of 31 tested cases of disseminated histoplasmosis. Among patients with disseminated cases, antigenuria was detected more often and at higher concentrations in immunocompromised patients and those with severe disease. Specificity was 99.0% for patients with nonfungal infections (n = 130) and in healthy subjects (n = 69), but cross-reactivity occurred in 90% of patients with blastomycosis. The sensitivity of antigen detection in disseminated histoplasmosis is higher in immunocompromised patients than in immunocompetent patients and in patients with more severe illness. The sensitivity for detection of antigenemia is similar to that for antigenuria in disseminated infection.

Histoplasmose pulmonar cavitária crônica

Histoplasmosis is a systemic mycosis caused by the thermally dimorphic fungus Histoplasma capsulatum, which can be isolated from soil contaminated with droppings from birds or bats. Chronic cavitary pulmonary histoplasmosis is one of the rarest clinical presentations of this disease. The differential diagnosis with tuberculosis should be made in patients presenting with cavitated lesions in upper lung segments. We report the case of a female patient with chronic cavitary pulmonary histoplasmosis who had presented with progressive dyspnea and worsening of the radiological pattern over a four-year period.

Capítulo 4: histoplasmose

Histoplasmosis is systemic mycosis caused by a small fungus, Histoplasma capsulatum var. capsulatum, whose natural habitat is soil contaminated by bat or bird excrement. The incidence of histoplasmosis is worldwide. In Brazil, the disease is found in all regions; however, the state of Rio de Janeiro is responsible for most of the microepidemics described. Human infection occurs when airborne spores of H. capsulatum are inhaled. The most common clinical presentation is asymptomatic. The symptoms of acute or epidemic histoplasmosis are high fever, cough, asthenia and retrosternal pain, as well as enlargement of the cervical lymph nodes, liver and spleen. The most common radiological findings are diffuse reticulonodular infiltrates in both lungs, as well as hilar and mediastinal lymph node enlargement. In chronic pulmonary histoplasmosis, the clinical and radiological manifestations are identical to those of reinfection with pulmonary tuberculosis. Histoplasmosis is diagnosed by means of the identification or culture growth of the fungus in sputum or fiberoptic bronchoscopy specimens. Histopathological examination reveals the fungus itself within or surrounding macrophages, as well as granulomatous lesions with or without caseous necrosis. Double agar gel immunodiffusion is the most easily used and readily available serologic test for making the immunological diagnosis. Acute histoplasmosis with prolonged symptoms requires treatment, as do the disseminated or chronic pulmonary forms of the disease. The drug of choice is itraconazole.

Histoplasmosis en un varón inmunocompetente manifestada 45 años después de la infección

We report a case of a lung reactivation of a latent histoplasmosis in a 68 year-old patient without immunologic dysfunction living in Barcelona (Spain). The Histoplasma capsulatum var. capsulatum infection was probably acquired in a previous stay in Equatorial Guinea 48 years before. Diagnosis of mild chronic pulmonary histoplasmosis was performed by histopathology of lung biopsy plus antibodies detection against H. capsulatum. Treatment with oral itraconazol during three months leaded to a complete clinical cure, and antibodies disappeared after four years of follow up.