Histoplasmosis history and symptoms: Difference between revisions

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{{Histoplasmosis}}
{{Histoplasmosis}}


{{CMG}}
{{CMG}}; {{AE}} {{AKI}}


==Overview==
==Overview==
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==History and Symptoms==
==History and Symptoms==
===Acute Pulmonary Histoplasmosis===
===Acute Pulmonary Histoplasmosis===
It is an acute self limiting illness in patients exposed to the [[organism]] for the first time or the patient is exposed to a large amount of [[inoculum]] or is exposed to [[virulent]] strains of [[Histoplasma capsulatum|histoplasma]]. The symptoms of an acute infection include the following:<ref name="pmid792626">{{cite journal| author=Goodwin RA, Owens FT, Snell JD, Hubbard WW, Buchanan RD, Terry RT et al.| title=Chronic pulmonary histoplasmosis. | journal=Medicine (Baltimore) | year= 1976 | volume= 55 | issue= 6 | pages= 413-52 | pmid=792626 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=792626  }} </ref><ref name=cdc1>Chiller, TM. Chapter 3 Infectious Diseases Related to Travel. Histoplasmosis. Available at: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseases-related-to-travel/histoplasmosis. Accessed February 2, 2016.</ref><ref name="pmid28474430">{{cite journal| author=Kumari M, Udayakumar M, Kaushal M, Madaan GB| title=Unusual presentation of disseminated histoplasmosis in an immunocompetent patient. | journal=Diagn Cytopathol | year= 2017 | volume=  | issue=  | pages=  | pmid=28474430 | doi=10.1002/dc.23742 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28474430  }} </ref>
It is an acute self-limiting illness in patients exposed to the [[organism]] for the first time or the patient is exposed to a large amount of [[inoculum]] or is exposed to [[virulent]] strains of [[Histoplasma capsulatum|histoplasma]]. The symptoms of an acute infection include the following:<ref name="pmid792626">{{cite journal| author=Goodwin RA, Owens FT, Snell JD, Hubbard WW, Buchanan RD, Terry RT et al.| title=Chronic pulmonary histoplasmosis. | journal=Medicine (Baltimore) | year= 1976 | volume= 55 | issue= 6 | pages= 413-52 | pmid=792626 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=792626  }} </ref><ref name="cdc1">Chiller, TM. Chapter 3 Infectious Diseases Related to Travel. Histoplasmosis. Available at: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseases-related-to-travel/histoplasmosis. Accessed February 2, 2016.</ref><ref name="pmid28474430">{{cite journal| author=Kumari M, Udayakumar M, Kaushal M, Madaan GB| title=Unusual presentation of disseminated histoplasmosis in an immunocompetent patient. | journal=Diagn Cytopathol | year= 2017 | volume=  | issue=  | pages=  | pmid=28474430 | doi=10.1002/dc.23742 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28474430  }} </ref>
*The [[incubation period]] of [[histoplasmosis]] is typically 3–17 days for the [[acute]] disease.  
 
*A positive history for exposure to [[Histoplasma capsulatum]] and close contacts with similar complaints is hellpful to diagnose pulmonary [[histoplasmosis]].
*The [[incubation period]] of [[histoplasmosis]] is typically 3–17 days for the [[acute]] disease.
*A positive history for exposure to [[Histoplasma capsulatum]] and close contacts with similar complaints is helpful to diagnose pulmonary [[histoplasmosis]].
*[[Fever]]
*[[Fever]]
*[[Malaise]]
*[[Malaise]]
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===Chronic Cavitatory Pulmonary Histoplasmosis===
===Chronic Cavitatory Pulmonary Histoplasmosis===
It is usually seen in elderly patients with [[emphysema]] and presents with the following symptoms:  
It is usually seen in elderly patients with [[emphysema]] and presents with the following symptoms:  
*[[Fatigue]]
*[[Fatigue]]
*[[Fever]]
*[[Fever]]
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===Granulomatous Mediastinitis===
===Granulomatous Mediastinitis===
Majority of patients with [[Mediastinum|mediastinal]] [[lymph node]] involvement are asymptomatic but few patients present with symptoms resulting from compression on the [[esophagus]], [[Superior vena cava syndrome|superior vena cava]] and [[bronchus]], which include:
Majority of patients with [[Mediastinum|mediastinal]] [[lymph node]] involvement are asymptomatic but few patients present with symptoms resulting from compression on the [[esophagus]], [[Superior vena cava syndrome|superior vena cava]] and [[bronchus]], which include:
*[[Dysphagia]]
*[[Dysphagia]]
*[[Congestion]] of the face
*[[Congestion]] of the face
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===Mediastinal Fibrosis===
===Mediastinal Fibrosis===
It is a complication of [[Histoplasma capsulatum|histoplasma]] infection of the [[Mediastinum|mediastinal]] structures resulting in [[fibrosis]] and causing compression of surrounding structures in the [[mediastinum]]. The symptoms of [[fibrosis]] include the following:
It is a complication of [[Histoplasma capsulatum|histoplasma]] infection of the [[Mediastinum|mediastinal]] structures resulting in [[fibrosis]] and causing compression of the surrounding structures in the [[mediastinum]]. The symptoms of [[fibrosis]] include the following:
*It is seen in patients between the ages of 20 to 40 years of age.
 
*It is seen in patients between 20 to 40 years of age.
*It follows a gradual progression of symptoms with compression of the [[Superior vena cava syndrome|superior vena cava]], the [[pulmonary arteries]], [[pulmonary veins]], [[bronchi]], [[thoracic duct]], [[recurrent laryngeal nerve]], and [[right atrium]].
*It follows a gradual progression of symptoms with compression of the [[Superior vena cava syndrome|superior vena cava]], the [[pulmonary arteries]], [[pulmonary veins]], [[bronchi]], [[thoracic duct]], [[recurrent laryngeal nerve]], and [[right atrium]].
*Patients present with increasing [[dyspnea]], [[cough]], [[hemoptysis]], and [[chest pain]].
*Patients present with increasing [[dyspnea]], [[cough]], [[hemoptysis]], and [[chest pain]].
*[[Superior vena cava]] compression presents with features of distended [[neck veins]] and facial [[congestion]].
*[[Superior vena cava]] compression presents with features of distended [[neck veins]] and facial [[congestion]].
*[[Right heart failure]] presents with [[pedal edema]] and [[dyspnea]].
*[[Right heart failure]] presents with [[pedal edema]] and [[dyspnea]].
===Brocholithiasis===
===Brocholithiasis===
In patients with [[Calcified lesion|calcified]] nodules bursting into the [[bronchus]] present with features of brochial obstruction and [[inflammation]]. The features include the following:
In patients with [[Calcified lesion|calcified]] nodules bursting into the [[bronchus]] present with features of bronchial obstruction and [[inflammation]]. The features include the following:
*Lithoptysis: Spitting of tiny pieces of gravel like particles
 
*Lithoptysis:  
**Spitting of tiny pieces of gravel like particles.
*[[Dyspnea]]
*[[Dyspnea]]
*[[Hemoptysis]]
*[[Hemoptysis]]
*[[Cough]]  
*[[Cough]]
*Occasional [[wheezing]] can be present with significant airway obstruction
*Occasional [[wheezing]] can be present with significant airway obstruction.
 
===Chronic Progressive Disseminated Histoplasmosis===
===Chronic Progressive Disseminated Histoplasmosis===
*It is defined as a chronic gradually progressive infection in adults with an intact [[immune system]].
 
*It is defined as a gradually progressive chronic infection in adults with an intact [[immune system]].
*These patients present with features of: [[dyspnea]], [[cough]] and [[hemoptysis]].
*These patients present with features of: [[dyspnea]], [[cough]] and [[hemoptysis]].
===Disseminated Histoplasmosis===
===Disseminated Histoplasmosis===
It is seen in patients with risk factors resulting in a weakened [[immune system]]. Clinical features of [[Disseminated disease|disseminated]] [[histoplasmosis]] include the following:  
It is seen in patients with risk factors resulting in a weakened [[immune system]]. Clinical features of [[Disseminated disease|disseminated]] [[histoplasmosis]] include the following: <ref name="pmid28070050">{{cite journal| author=Zhang Y, Su X, Li Y, He R, Hu C, Pan P| title=[Clinical comparative analysis for pulmonary histoplasmosis and progressive disseminated histoplasmosis]. | journal=Zhong Nan Da Xue Xue Bao Yi Xue Ban | year= 2016 | volume= 41 | issue= 12 | pages= 1345-1351 | pmid=28070050 | doi=10.11817/j.issn.1672-7347.2016.12.016 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28070050  }} </ref>
 
*[[Fever]]
*[[Fever]]
*[[Malaise]]
*[[Malaise]]
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*Severe form of [[Disseminated disease|disseminated]] [[histoplasmosis]] presents with features of [[sepsis]], [[acute respiratory distress syndrome]] and [[disseminated intravascular coagulation]].
*Severe form of [[Disseminated disease|disseminated]] [[histoplasmosis]] presents with features of [[sepsis]], [[acute respiratory distress syndrome]] and [[disseminated intravascular coagulation]].
*'''Gastrointestinal involvement:''' Infection of the gastrointestinal tract is seen in patients with [[AIDS]] and presents with symptoms of [[bloody diarrhea]], [[abdominal distension]] and [[pain]].<ref name="pmid28457046">{{cite journal| author=Nasa M, Patel N, Lipi L, Sud R| title=Gastrointestinal Histoplasmosis and CMV Co-Infection in an Immunocompetent Host. | journal=J Assoc Physicians India | year= 2017 | volume= 65 | issue= 2 | pages= 94-95 | pmid=28457046 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28457046  }}</ref>
*'''Gastrointestinal involvement:''' Infection of the gastrointestinal tract is seen in patients with [[AIDS]] and presents with symptoms of [[bloody diarrhea]], [[abdominal distension]] and [[pain]].<ref name="pmid28457046">{{cite journal| author=Nasa M, Patel N, Lipi L, Sud R| title=Gastrointestinal Histoplasmosis and CMV Co-Infection in an Immunocompetent Host. | journal=J Assoc Physicians India | year= 2017 | volume= 65 | issue= 2 | pages= 94-95 | pmid=28457046 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28457046  }}</ref>
*'''Adrenal gland involvement:''' Infection of the [[adrenal gland]] presents with symptoms of [[fever]], [[malaise]], [[orthostatic hypotension]], [[nausea]], and [[vomiting]].
*'''Adrenal gland involvement:''' Infection of the [[adrenal gland]] presents with symptoms of [[fever]], [[malaise]], [[orthostatic hypotension]], [[nausea]], and [[vomiting]].<ref name="pmid27995051">{{cite journal| author=Rog CJ, Rosen DG, Gannon FH| title=Bilateral adrenal histoplasmosis in an immunocompetent man from Texas. | journal=Med Mycol Case Rep | year= 2016 | volume= 14 | issue=  | pages= 4-7 | pmid=27995051 | doi=10.1016/j.mmcr.2016.11.006 | pmc=5154969 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27995051  }}</ref>
*'''Mucosal Involvement:''' Superficial and deep [[ulcerations]] with nodules and verrucous lesions involving the [[tongue]], [[buccal mucosa]], [[lips]], [[pharynx]] and [[larynx]] can be present.
*'''Mucosal Involvement:''' Superficial and deep [[ulcerations]] with nodules and verrucous lesions involving the [[tongue]], [[buccal mucosa]], [[lips]], [[pharynx]] and [[larynx]] can be present.
*'''Genitourinary involvement:''' [[Histoplasma capsulatum|Histoplasma]] infection of the genitourinary involvement can result in testicular abscess, prostatic abscess, [[epididymitis]], penile lesions, and urinary bladder [[ulcerations]]. Patients present with [[scrotal pain]], [[swelling]], [[dysuria]], [[pyuria]] and [[hematuria]].
*'''Genitourinary involvement:''' [[Histoplasma capsulatum|Histoplasma]] infection of the genitourinary involvement can result in testicular abscess, prostatic abscess, [[epididymitis]], penile lesions, and urinary bladder [[ulcerations]]. Patients present with [[scrotal pain]], [[swelling]], [[dysuria]], [[pyuria]] and [[hematuria]].<ref name="pmid28112039">{{cite journal| author=Sachdev R, Goel RK, Malviya S, Goel S, Gajendra S| title=Scrotal Histoplasmosis Masquerading as Fournier's Gangrene. | journal=Int J Surg Pathol | year= 2017 | volume=  | issue=  | pages= 1066896916687078 | pmid=28112039 | doi=10.1177/1066896916687078 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28112039  }}</ref>
*'''Articular involvement:''' The [[infection]] usually involves the [[tendons]] and [[joints]], patients present with features of [[joint pain]] and reduced [[range of motion]].
*'''Articular involvement:''' The [[infection]] usually involves the [[tendons]] and [[joints]], patients present with features of [[joint pain]] and reduced [[range of motion]].
*'''Endocarditis:''' [[Histoplasma capsulatum|Histoplasma]] infection can occur in the [[valves]], [[prosthetic valves]] and [[Atrial myxoma|atrial myxomas]]. Patients present with features of [[distal embolization]].
*'''Endocarditis:''' [[Histoplasma capsulatum|Histoplasma]] infection can occur in the [[valves]], [[prosthetic valves]] and [[Atrial myxoma|atrial myxomas]]. Patients present with features of [[distal embolization]].
*'''Meningitis:''' [[Histoplasmosis]] causes chronic [[meningitis]] and is characterized by affecting the basilar [[meninges]] resulting in a communicating [[hydrocephalus]]. Symptoms include [[headache]], [[Confusion|mental status changes]], and features of [[cranial nerve palsies]].
*'''Meningitis:''' [[Histoplasmosis]] causes chronic [[meningitis]] and is characterized by affecting the basilar [[meninges]] resulting in a communicating [[hydrocephalus]]. Symptoms include [[headache]], [[Confusion|mental status changes]], and features of [[cranial nerve palsies]].<ref name="pmid26251798">{{cite journal| author=Hariri OR, Minasian T, Quadri SA, Dyurgerova A, Farr S, Miulli DE et al.| title=Histoplasmosis with Deep CNS Involvement: Case Presentation with Discussion and Literature Review. | journal=J Neurol Surg Rep | year= 2015 | volume= 76 | issue= 1 | pages= e167-72 | pmid=26251798 | doi=10.1055/s-0035-1554932 | pmc=4520962 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26251798  }} </ref>
 
==References==
==References==
{{Reflist|2}}
{{Reflist|2}}
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[[Category:Fungal diseases]]
[[Category:Fungal diseases]]
[[Category:Rat carried diseases]]
[[Category:Rat carried diseases]]
[[Category:Emergency mdicine]]
[[Category:Disease]]
[[Category:Up-To-Date]]
[[Category:Infectious disease]]
[[Category:Pulmonology]]
[[Category:Gastroenterology]]

Latest revision as of 13:23, 14 June 2021

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Aravind Kuchkuntla, M.B.B.S[2]

Overview

Majority of the patients are asymptomatic and few develop acute pulmonary histoplasmosis presenting with fever, cough and dyspnea. Few patients develop rheumatological symptoms such as erythema nodosum and symmetrical joint pain. Severe form of disseminated histoplasmosis presents with features of sepsis, acute respiratory distress syndrome and disseminated intravascular coagulation.

History and Symptoms

Acute Pulmonary Histoplasmosis

It is an acute self-limiting illness in patients exposed to the organism for the first time or the patient is exposed to a large amount of inoculum or is exposed to virulent strains of histoplasma. The symptoms of an acute infection include the following:[1][2][3]

Chronic Cavitatory Pulmonary Histoplasmosis

It is usually seen in elderly patients with emphysema and presents with the following symptoms:

Granulomatous Mediastinitis

Majority of patients with mediastinal lymph node involvement are asymptomatic but few patients present with symptoms resulting from compression on the esophagus, superior vena cava and bronchus, which include:

Mediastinal Fibrosis

It is a complication of histoplasma infection of the mediastinal structures resulting in fibrosis and causing compression of the surrounding structures in the mediastinum. The symptoms of fibrosis include the following:

Brocholithiasis

In patients with calcified nodules bursting into the bronchus present with features of bronchial obstruction and inflammation. The features include the following:

  • Lithoptysis:
    • Spitting of tiny pieces of gravel like particles.
  • Dyspnea
  • Hemoptysis
  • Cough
  • Occasional wheezing can be present with significant airway obstruction.

Chronic Progressive Disseminated Histoplasmosis

Disseminated Histoplasmosis

It is seen in patients with risk factors resulting in a weakened immune system. Clinical features of disseminated histoplasmosis include the following: [4]

References

  1. ↑ Goodwin RA, Owens FT, Snell JD, Hubbard WW, Buchanan RD, Terry RT; et al. (1976). "Chronic pulmonary histoplasmosis". Medicine (Baltimore). 55 (6): 413–52. PMID 792626.
  2. ↑ Chiller, TM. Chapter 3 Infectious Diseases Related to Travel. Histoplasmosis. Available at: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseases-related-to-travel/histoplasmosis. Accessed February 2, 2016.
  3. ↑ Kumari M, Udayakumar M, Kaushal M, Madaan GB (2017). "Unusual presentation of disseminated histoplasmosis in an immunocompetent patient". Diagn Cytopathol. doi:10.1002/dc.23742. PMID 28474430.
  4. ↑ Zhang Y, Su X, Li Y, He R, Hu C, Pan P (2016). "[Clinical comparative analysis for pulmonary histoplasmosis and progressive disseminated histoplasmosis]". Zhong Nan Da Xue Xue Bao Yi Xue Ban. 41 (12): 1345–1351. doi:10.11817/j.issn.1672-7347.2016.12.016. PMID 28070050.
  5. ↑ Nasa M, Patel N, Lipi L, Sud R (2017). "Gastrointestinal Histoplasmosis and CMV Co-Infection in an Immunocompetent Host". J Assoc Physicians India. 65 (2): 94–95. PMID 28457046.
  6. ↑ Rog CJ, Rosen DG, Gannon FH (2016). "Bilateral adrenal histoplasmosis in an immunocompetent man from Texas". Med Mycol Case Rep. 14: 4–7. doi:10.1016/j.mmcr.2016.11.006. PMC 5154969. PMID 27995051.
  7. ↑ Sachdev R, Goel RK, Malviya S, Goel S, Gajendra S (2017). "Scrotal Histoplasmosis Masquerading as Fournier's Gangrene". Int J Surg Pathol: 1066896916687078. doi:10.1177/1066896916687078. PMID 28112039.
  8. ↑ Hariri OR, Minasian T, Quadri SA, Dyurgerova A, Farr S, Miulli DE; et al. (2015). "Histoplasmosis with Deep CNS Involvement: Case Presentation with Discussion and Literature Review". J Neurol Surg Rep. 76 (1): e167–72. doi:10.1055/s-0035-1554932. PMC 4520962. PMID 26251798.
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