Histoplasmin Skin Test Research Articles

Some Clinical and Radiographic Features of Gastrointestinal Histoplasmosis

Since the original description of the Histoplasma capsulatum by Darling in 1906 (4), involvement of the gastrointestinal tract in disseminated histoplasmosis has been observed frequently in autopsy material (13). Symptoms referable to the digestive system have been found in as many as 20 per cent of patients with histoplasmosis (14), but cases in which the gastrointestinal symptoms dominate the clinical picture are rare. The purpose of this article is to describe the clinical and radiographic findings in 5 cases of gastrointestinal histoplasmosis, 4 of which required surgery because of pre-operative clinical and roentgenographic changes. These patients were treated at Barnes Hospital and the Veterans Administration Hospital, St. Louis, Mo., from 1953 to 1965. The age of the patients varied from thirty-four to seventy-two years with an average of fifty-seven and eight-tenths years. Four were men, and one a woman. The surgical implications in 4 of the cases are reported elsewhere (19). The anatomical location of the lesions is shown in Table I. Clinical Features The 5 patients were all chronically ill, the duration of illness varying from four months to five years. Increasing fatig-ability, weight loss, anorexia, and cramping abdominal pain were usually present. Other specific gastrointestinal symptoms were dysphagia in the patient with the gastric lesion, constipation in two cases, and watery diarrhea in one with colonic involvement. Three of the patients presented with acute abdominal problems: uncontrollable gastrointestinal hemorrhage, perforations and peritonitis, and intestinal obstruction. Fever was present in only 2 instances. Palpable lymph nodes of varying size were described in 4 patients in the cervical, axillary, and∕or inguinal regions. In one patient, an associated malignant lymphoma was found. Hepatic and∕or splenic enlargement was an inconstant finding, observed in 3 patients. A severe hemorrhagic tendency, seen in one case, has occasionally been described with disseminated histoplasmosis (18). Laboratory Examinations: Invariably there was some degree of anemia, usually of the microcytic hypochromic type. The hemoglobin fell as low as 6 g. per 100 ml in 2 instances. Marked leukopenia was noted in 2. This finding has been reported in 50–60 per cent of patients with disseminated histoplasmosis (18). Guaiac reaction in stools was positive in only 2 cases, negative in 2, and unknown in 1. The histoplasmin skin test was negative in all 5 patients, but a complement fixation test was positive in the two instances in which it was carried out. A sputum smear and culture failed to demonstrate the organism in 4 patients in whom it was performed. Bone-marrow aspiration demonstrated the organism in 2 cases.

Histoplasmosis of the small bowel with “giant” intestinal villi and secondary protein-losing enteropathy

A rare case of histoplasmosis is reported in which the disease apparently was confined to the small bowel. Hypoproteinaemic oedema associated with marked diminution in both the albumin and globulin components of the serum proteins was the major clinical feature and the diagnosis was established by means of peroral jejunal biopsy. The biopsy findings are described, special attention being drawn to the appearance of “giant” mucosal villi on examination with the naked eye, to the accumulation of histoplasmaladen macrophages and interstitial oedema in the lamina propria, and to the grossly flattened and abnormal surface epithelial layer. The morphologic changes in the intestinal mucosa on serial intestinal biopsy specimens taken during and after a satisfactory course of treatment with amphotericin B are described. The clinical, roentgenologic and biochemical findings before and after treatment are also presented. A protein-losing enteropathy was demonstrated by means of I 131-albumin studies. The intestinal leakage of proteins appeared to be the only measurable defect of intestinal function. The mode of infection, the cause of the protein leakage and the effect of the hypogammaglobulinaemia in suppressing the histoplasmin skin test are considered, and the rarity of chronic histoplasmosis in South Africa briefly noted.

HISTOPLASMA CAPSULATUM AND ATYPICAL MYCOBACTERIUM. CASE REPORT OF COMBINED INFECTION.

THE COEXISTENCE of active infections withHistoplasma capsulatumand atypicalMycobacteriumhas not been previously reported in a child, although the simultaneous association of histoplasmosis with other fungus infections1-4as well as withMycobacterium tuberculosis,6,7is not a rarity. In areas, such as Louisville, where histoplasmosis is endemic there is a widespread incidence of both infections in adults as demonstrated by the tuberculin and histoplasmin skin tests.6 In the patient reported here bothH capsulatumand a Runyon group II scotochromogen were isolated in culture from tissue. Serological and skin test evidence of infection is included in the case study. Report of a Case A 2-year-old white girl became ill on Dec 1, 1962 with an upper respiratory tract infection. Associated with this infection was an abrupt enlargement of the right anterior cervical lymph nodes. The nodes were painless and nontender. The cough, rhinitis, and fever abated after

A STUDY OF HISTOPLASMIN SKIN TESTS AMONG SCHOOL CHILDREN IN CALI AND CANDELARIA (VALLE DEL CAUCA), COLOMBIA.

A STUDY OF HISTOPLASMIN SKIN TESTS AMONG SCHOOL CHILDREN IN CALI AND CANDELARIA (VALLE DEL CAUCA), COLOMBIA.

Histoplasmosis in Malaya

Summary A survey of 227 patients from 5–60 years of age revealed the presence of positive histoplasmin skin tests in 10·5 per cent. and positive complement-fixation tests in 19·8 per cent. Sputum from 13 of the 37 patients who had a positive complement-fixation test were cultured for H. capsulatum but with negative results. Exposure to infection by the fungus is equally distributed among the different race and age groups. A careful and constant watch should be kept for histoplasmosis in all chest hospitals as a certain number of cases may be present. It tends to elude diagnosis unless specially sought as it resembles the clinical picture of tuberculosis or other granulomatous disease. It presents a field for further investigation and research in Malaya.

SURGICAL ASPECTS OF HISTOPLASMOSIS.

There have been relatively few reported studies of the surgical removal of local lesions of histoplasmosis as described by Gryboski¹and associates in the October issue of the<i>Archives of Surgery</i>. This report concerns 51 cases of proved pulmonary and mediastinal histoplasmosis studied over a five-year period. Forty of the cases were diagnosed only by means of the Gomori methenamine silver stain. The series included 34 males and 17 females, ranging in age from 21/2 to 72 years. Twenty-two were asymptomatic at the time of surgical exploration and had no previous history of respiratory infection. In the other cases, cough was the most common symptom; chest pain, hemoptysis, and dyspnea were also noted. In 30 cases the histoplasmin skin test was positive, and in 16 cases the intermediate purified protein derivative was positive. Cavities, nonresolving infiltrative lesions, middle-lobe syndrome, and mediastinal lymphadenopathy exemplified the protean pattern of this disease.

Intrathoracic Sarcoidosis: A Review of 69 Cases

In a series of 69 cases of intrathoracic sarcoidosis diagnosed between 1955 and 1961, the diagnosis was generally made on the basis of a consistent clinical picture, roentgenographic findings of hilar lymph node enlargement and/or pulmonary involvement and the finding of noncaseating epithelioid tubercles in biopsied tissue. The most common symptoms were cough, fatigue, dyspnea, weight loss, and fever or sweats. One-fifth had no symptom at the time of diagnosis. Elevation of serum globulin, particularly the gamma fraction was the most consistent laboratory abnormality. Eight subjects had a close relative who had had tuberculosis. In 17 per cent of 64 cases, the tuberculin test was positive. In only three of 47 was the histoplasmin skin test positive. Ninety-one biopsies were made in 68 subjects. Scalene node biopsy revealed epithelioid tubercles in 40 of 44 cases in which it was done. A variety of pulmonary involvement was seen, including local and widespread disease, ranging from fine to coarse shadows. Evidence of no change or progression of disease was noted in 21 of 32 with a two-year or more follow-up. Five of the 69 subjects had erythema nodosum. Pulmonary function abnormalities included both restrictive and obstructive phenomena and blood gas abnormalities. Extrathoracic sarcoidosis (exclusive of liver or lymph nodes) was demonstrated in nearly one-fourth of the subjects, more often in Negroes. Five persons are known to have died, four from cardiopulmonary causes.

PROBABLE HISTOPLASMA PERICARDITIS WITH EFFUSION. REPORT OF A CASE WITH RECURRENCE.

As Histoplasma capsulatum is capable of systemic dissemination, disease due to this agent may have protean manifestations including cardiovascular involvement. Such involvement has been reported as follows: pericardial calcification, 1-3 fibrocalcific pericarditis with constriction, 4 superior vena caval obstruction, 5 endocarditis, 6 electrocardiographic evidence of pericarditis with positive histoplasmin skin test, 7 and at least six cases of acute pericarditis with effusion. 5,8-12 The present report adds another case of acute pericarditis with effusion and recurrence probably due to H capsulatum. Report of Case A 17-year-old white man entered the University of Illinois Research and Educational Hospitals on April 8, 1960. On March 25 and March 26, I960, he had noted a mild sore throat without constitutional symptoms. At 5 am on March 27 he awakened with sharp, tight anterior chest pain accompanied by dyspnea and diaphoresis. After emergency admission to another hospital, he was treated with methylprednisolone, 4 mg t.i.d., symptomatic drugs for pain, and bed

Chronic Cavitary Histoplasmosis of Lung

Four main clinical types of disease result from infection by the fungus Histoplasma capsulatum: (1) the primary complex; (2) acute pulmonary histoplasmosis; (3) chronic cavitary pulmonary histoplasmosis; (4) disseminated systemic histoplasmosis.Chronic cavitary histoplasmosis of the lung is indistinguishable clinically and radiographically from pulmonary tuberculosis. In this disease, however, the histoplasmin skin test and the histoplasmin complement fixation test are positive in more than 80% of cases and sputum cultures are usually positive for Histoplasma capsulatum. The mortality rate of the chronic cavitary type is greater than 30%. The antibiotic, amphotericin B, is the most effective drug in treatment. If surgical resection of the cavitary lesion is feasible, under amphotericin coverage, this is the treatment of choice.During the past year, two patients with chronic cavitary histoplasmosis illustrating the aforementioned features were diagnosed at the Toronto Hospital for Tuberculosis.

Acute pericarditis due to Histoplasma capsulatum.

Case Studies1 May 1963Acute Pericarditis due to Histoplasma CapsulatumMARSHALL M. KAPLAN, M.D., LOUIS M. SHERWOOD, M.D.MARSHALL M. KAPLAN, M.D.Search for more papers by this author, LOUIS M. SHERWOOD, M.D.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-58-5-862 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptSkin sensitivity to Histoplasma capsulatum in patients with pericardial calcification was first reported in 1955 by Billings and Couch (1). They described 2 patients with pericardial calcifications, positive histoplasmin skin tests, and negative reactions to tuberculin. Neither patient had a past medical history suggestive of acute pericarditis, and the presumptive diagnosis was chronic calcific pericarditis secondary to histoplasmosis. Several similar patients (2-7) have since been reported, and in some (4-7) there was clinical evidence that the pericarditis was constrictive in nature.Acute pericarditis attributed toH. capsulatumhas been adequately documented in only 7 patients. In 1958, Heiner (8) reported...

Pericarditis due to histoplasmosis

Two additional cases of pericarditis due to histoplasmosis, including the second known case of constrictive pericarditis, have been reported. This makes a total in the available literature of 3 proved cases, and 6 cases which are presumptive because of positive histoplasmin skin and/or serologic tests in patients with anergy to tuberculin.

Histoplasmin skin test. Survey of elementary school children in Frederick County, Md.

In a histoplasmin skin test survey of elementary school children in Frederick County, Md., the percentage of positive reactors was found to be 26.5% and 42.4% among 917 second graders and 1,007 sixth graders, respectively. These percentages were comparable to those obtained in studies of similar age groups in some areas of the Ohio and Mississippi River Valleys where histoplasmosis has long been known to be highly endemic. The present study and other accumulated data indicate that histoplasmosis is probably as prevalent in some of the Middle Atlantic states as in any other part of the country. Additional skin test surveys in other "nonendemic" areas might further modify the tenaciously held concept that histoplasmosis in the United States is limited to its Middle Western region.

Histoplasmosis survey of preschool children in Panama.

SummaryA survey of 631 preschool children in Panama and the Canal Zone revealed an over-all prevalence rate of 6.3 per cent hypersensitivity to histoplasmin and 3.5 per cent hypersensitivity to PPD skin tests.Among forty children with positive histoplasmin skin tests there was evidence of clinical disease in only three. Roentgenographs of the chest revealed infiltration or adenopathy in six, and calcifications in four. Complement-fixation tests were positive in nineteen.

Roentgenologic Manifestations in the Lungs in Milk Allergyl

Asyndrome of chronic recurring upper respiratory and pulmonary infections apparently associated with ingestion of milk and milk products has been described by Heiner and Sears (1). It was felt advisable to call attention to the chest involvement and its roentgenologic manifestations in this condition. Unusually high levels of precipitating antibodies to various cow's milk proteins were found by the workers cited above in the serum of infants with chronic respiratory disease. More than 2,000 patients were tested at random for the presence of these antibodies by exposing their sera to raw milk antigen by a modified double diffusion agar-in-gel technic (2). In 8 cases,3 all in infants, 5 or more precipitation bands were demonstrated and severe clinical manifestations were present. Four of the group were shown by one of us (W. T. K.) to have strongly suggestive or positive laboratory evidence of idiopathic pulmonary hemosiderosis. Clinically, the children described by Heiner and Sears had recurring or continuous episodes of coryza, cough, wheezing, and pneumonia. They displayed also gastrointestinal manifestations of varying degrees, as vomiting, diarrhea, abdominal pain, and poor weight gain. These findings were associated with the ingestion of cow's milk products. The age of onset of symptoms varied from thirteen days to sixteen months, being at or under four months in all but 1 child. In 7 of the children there was no evidence of tuberculous or fungous infection. In 1 a healed primary complex was demonstrated on the chest roentgenogram, but old tuberculin (5 T.U.) and histoplasmin (1:100) skin tests were negative at forty-eight hours in all. Cystic fibrosis was also ruled out. The accompanying graph (Fig. 1) illustrates the incidence of the various clinical manifestations of the syndrome in 7 of the 8 patients. The eighth child was never completely evaluated because all attempts to induce his family to bring him back to the hospital after the first visit were futile. His history included cough of one week duration, tachypnea, fever, anorexia, and vomiting. He was pale and irritable, and exhibited physical signs of pneumonia; anemia, leukocytosis, and marked eosinophilia were present. The natural course of this disease is not definitely known, since recognition and treatment of the first case are of such recent date, the autumn of 1959. Three patients became asymptomatic spontaneously at the ages of fourteen, twenty-one, and thirty months, even though circulating precipitating antibodies were still present. In 4 patients still symptomatic, the withdrawal of milk products and, to a lesser extent, boiling of the milk before feeding improved or completely cleared the symptoms. One child of the last group was still having symptoms at thirty months of age, but became asymptomatic on milk substitute.

Generalized histoplasmosis in a Panamanian infant: case report.

SummaryA fatal case of generalized histoplasmosis in a 7 month old Panamanian infant is presented. In spite of negative histoplasmin skin test and x-ray of the chest, cultural studies were undertaken resulting in isolation of H. capsulatum from the patient's bone marrow and blood. Compatible diagnostic titers were obtained in the complement-fixation test.

Altered skin reactivity induced by repeated histoplasmin skin tests

T HERE recently came under our observation a patient who, four weeks prior to admission to the hospital, displayed a negative intradermal test with histoplasmin. Although all clinical studies for histoplasmosis were negative, a repeat intradermal test with histoplasmin shortly after admission was observed to be strongly positive. This aroused our interest in the possibility that repeated intradermal injections of test antigens of this type might transform negative skin reactions to positive ones as a result of altered skin reactivity. To test this possibility, repeated intradermal tests were performed with a variety of antigens in healthy young persons.

Histoplasma症の研究

Histoplasmin test and calcification herd of lung field were studied on the people in Okayama prefecture. And the results were as follows.1. The positive rate was 3.9% in 2, 970 people on the observation of histoplasmin skin test in each district and it showed such a high rate of 8.4% in Mitsuishi district.2. The positive rate was high in the miners and workers in the brickyard on the observation of professional distinction, and it showed close relation to the profession handling the ground and to the handled ground.3. No correlation was recognized between histoplasmin and the size of induration or redness of skin reaction. and also between the induration's size of histoplasmin test and the reddend size of tuberculin skin test.4. On the observation of lung calcification herd in each group of histoplasmin and tuberculin skin test, it showed the most high rate in the group with the positive histoplasminand negative tuberculin skin test, and the distribution of calcification herd in the lung field showed difference between the cases with the positive histoplasmin skin test and the cases with the positive tuberculin skin test and the calcification herd in the former showed a spread tendency to the lung fields.5. The adoption of the standard being used hitherto, i. e. the size of skin induration between 5 mm and 7 mm was appropraite for the decision of positive histoplasmin skin test. According to this standard, the positive rate of histoplasmin skin test was 0.37% in Okayama prefecture.

Clinical, X-Ray, and Serologic Changes with Histoplasma Infection

AL TH O UGH considerable information about histoplasmosis has been accumulated since this f ungus infection was first described in 1906, much still needs to be learned about the frequency and severity of the disease accompanying primary infection. Following the classic work of Smith and his colleagues on Coccidioides infection in personnel of the U. S. Army (1), it was decided that such personnel, with their available medical care and complete records, would be an ideal group for a study of histoplasmosis. Consequently, in 1953 a study was initiated at Fort Leavenworth, Kans., by the U. S. Army Hospital on the post and the Public Health Service. Children of Army personnel participated. Trhe study was undertaken to determine the spectrum of illness accompanying Histoplasma infection. This was accomplished by observation of the clinical, X-ray, and serologic chaniges which accompanied conversion of the skin test from negative to positive. Its basic plan wvas to find a large number of children with a negative reaction to the histoplasmin skin test, observe these children over a period of time, and retest them to determine the infection, or conversion, rate. Clinical, X-ray, and serologic changes could thus be observed in a group who became infected and in a much larger group who did not and who therefore would serve as controls. Other interesting epidemiological information concerning infection was also collected.

On the Results of Histoplasmin Skin Test in Miyagi National Sanatorium

On the Results of Histoplasmin Skin Test in Miyagi National Sanatorium

Acute pulmonary histoplasmosis on the Isthmus of Panama.

A benign form of histoplasmosis was established by Palmer1and by Christie and Peterson,2in 1945, by a correlation between pulmonary calcifications and histoplasmin skin test, and by other investigators, later, by the demonstration of elevated antibody levels during an acute pulmonary illness.3In only a few cases of this entity has Histoplasma capsulatum been isolated from the patient. On the Isthmus of Panama, however, where in its fatal form the first three cases of the disease were described by Darling,4-6in 1905, the benign form of histoplasmosis has not been described. Even the fourth fatal case studied by Draheim et al.7was not encountered until 1951. This finding of only the rare fatal cases of histoplasmosis in a large population with a high skin-test-reaction rate to histoplasmin and closely associated with soil which is known to harbor the causative agent indicates that the primary