Histoplasmosis natural history, complications and prognosis: Difference between revisions
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{{Histoplasmosis}} | {{Histoplasmosis}} | ||
{{CMG}} | {{CMG}}; {{AE}} {{AKI}} | ||
==Overview== | ==Overview== | ||
[[Histoplasmosis]] is an [[endemic]] fungal infection and infection occurs by inhalation of the microconidia present in the soil. The average [[incubation period]] is around 2 to 3 weeks. Majority of the patients are asymptomatic and few develop [[acute]] pulmonary [[histoplasmosis]] presenting with [[fever]], [[cough]] and [[dyspnea]]. In [[immunocompetent]] patients the infection is self limiting and symptoms resolve in 2 to 3 weeks. However patients in [[immunocompromised]] state can have complications due to the spread of infection to other organs and develop [[Disseminated disease|disseminated]] [[histoplasmosis]]. [[Prognosis]] of [[Disseminated disease|disseminated]] [[histoplasmosis]] is poor and is associated with increased [[mortality]]. | |||
==Natural history, complications and prognosis== | ==Natural history, complications and prognosis== | ||
===Natural history=== | ===Natural history=== | ||
The incubation period of histoplasmosis is typically 3–17 days for the acute disease. If left untreated immunocompromised patients can have complications such as pericarditis, broncholithiasis, pulmonary nodules, mediastinal granuloma, or mediastinal fibrosis. In persons who develop progressive, chronic, or disseminated disease, symptoms may persist for months or longer. Most people spontaneously recover 2–3 weeks after onset of symptoms, although fatigue may persist longer. | The [[incubation period]] of [[histoplasmosis]] is typically 3–17 days for the acute disease. If left untreated [[immunocompromised]] patients can have complications such as [[pericarditis]], broncholithiasis, pulmonary nodules, [[mediastinal]] [[granuloma]], or [[mediastinal]] [[fibrosis]]. In persons who develop progressive, [[chronic]], or [[Disseminated disease|disseminated]] disease, symptoms may persist for months or longer. Most people spontaneously recover 2–3 weeks after onset of symptoms, although [[fatigue]] may persist longer.<ref name="pmid23835880">{{cite journal| author=Sizemore TC| title=Rheumatologic manifestations of histoplasmosis: a review. | journal=Rheumatol Int | year= 2013 | volume= 33 | issue= 12 | pages= 2963-5 | pmid=23835880 | doi=10.1007/s00296-013-2816-y | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23835880 }} </ref><ref name="pmid 22167401">{{cite journal| author=McKinsey DS, McKinsey JP| title=Pulmonary histoplasmosis. | journal=Semin Respir Crit Care Med | year= 2011 | volume= 32 | issue= 6 | pages= 735-44 | pmid= 22167401 | doi=10.1055/s-0031-1295721 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22167401 }}</ref> | ||
===Complications=== | ===Complications=== | ||
Some of the complications observed among patients with acute or chronic | Some of the complications observed among patients with acute or [[chronic]] [[histoplasmosis]] include:<ref name=cdc2>Information for Healthcare Professionals about Histoplasmosis. Centers for Disease Control and Prevention. 2015. Available at: http://www.cdc.gov/fungal/diseases/histoplasmosis/health-professionals.html. Accessed February 2, 2016.</ref><ref name="pmid23444607">{{cite journal| author=Fernández Andreu CC, Illnait Zaragozi MT, Martínez Machín G, Perurena Lancha MR, Monroy Vaca E| title=[Histoplasmosis updating]. | journal=Rev Cubana Med Trop | year= 2011 | volume= 63 | issue= 3 | pages= 189-205 | pmid=23444607 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23444607 }}</ref> | ||
*Fibrosing [[mediastinitis]] | *Fibrosing [[mediastinitis]] | ||
*Mediastinal granuloma | *[[Mediastinal]] [[granuloma]] | ||
*Calcified lymph nodes | *[[Calcified lesion|Calcified]] [[Lymph node|lymph nodes]] | ||
*Adrenal hyperplasia | *[[Adrenal hyperplasia]] | ||
*Macular degeneration (ocular histoplasmosis) | *[[Macular degeneration]] (ocular [[histoplasmosis]]) | ||
* [[Pericarditis]] | * [[Pericarditis]] | ||
*Broncholithiasis | *Broncholithiasis | ||
*Pulmonary nodules | *Pulmonary nodules | ||
*Disseminated histoplasmosis | *[[Disseminated disease|Disseminated]] [[histoplasmosis]] | ||
===Prognosis=== | ===Prognosis=== | ||
Immunocompetent patients have excellent prognosis with symptoms resolving in 2 to 3 weeks. However, immunocompromised patients can have extensive spread of the infection and have poor prognosis. Mortality is high in HIV-infected persons who develop disseminated histoplasmosis. | [[Immunocompetent]] patients have excellent [[prognosis]] with symptoms resolving in 2 to 3 weeks. However, [[immunocompromised]] patients can have extensive spread of the infection and have poor prognosis. [[Mortality]] is high in [[HIV]]-infected persons who develop [[Disseminated disease|disseminated]] [[histoplasmosis]] and approximately 30% of [[HIV]]/[[AIDS]] patients diagnosed with [[histoplasmosis]] die from it.<ref name=cdc2>Information for Healthcare Professionals about Histoplasmosis. Centers for Disease Control and Prevention. 2015. Available at: http://www.cdc.gov/fungal/diseases/histoplasmosis/health-professionals.html. Accessed February 2, 2016.</ref><ref name="pmid 20635150">{{cite journal| author=Alves MD, Pinheiro L, Manica D, Fogliatto LM, Fraga C, Goldani LZ| title=Histoplasma capsulatum sinusitis: case report and review. | journal=Mycopathologia | year= 2011 | volume= 171 | issue= 1 | pages= 57-9 | pmid= 20635150 | doi=10.1007/s11046-010-9345-y | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20635150 }}</ref> | ||
==References== | ==References== | ||
Latest revision as of 15:42, 9 May 2017
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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
Histoplasmosis is an endemic fungal infection and infection occurs by inhalation of the microconidia present in the soil. The average incubation period is around 2 to 3 weeks. Majority of the patients are asymptomatic and few develop acute pulmonary histoplasmosis presenting with fever, cough and dyspnea. In immunocompetent patients the infection is self limiting and symptoms resolve in 2 to 3 weeks. However patients in immunocompromised state can have complications due to the spread of infection to other organs and develop disseminated histoplasmosis. Prognosis of disseminated histoplasmosis is poor and is associated with increased mortality.
Natural history, complications and prognosis
Natural history
The incubation period of histoplasmosis is typically 3–17 days for the acute disease. If left untreated immunocompromised patients can have complications such as pericarditis, broncholithiasis, pulmonary nodules, mediastinal granuloma, or mediastinal fibrosis. In persons who develop progressive, chronic, or disseminated disease, symptoms may persist for months or longer. Most people spontaneously recover 2–3 weeks after onset of symptoms, although fatigue may persist longer.[1][2]
Complications
Some of the complications observed among patients with acute or chronic histoplasmosis include:[3][4]
- Fibrosing mediastinitis
- Mediastinal granuloma
- Calcified lymph nodes
- Adrenal hyperplasia
- Macular degeneration (ocular histoplasmosis)
- Pericarditis
- Broncholithiasis
- Pulmonary nodules
- Disseminated histoplasmosis
Prognosis
Immunocompetent patients have excellent prognosis with symptoms resolving in 2 to 3 weeks. However, immunocompromised patients can have extensive spread of the infection and have poor prognosis. Mortality is high in HIV-infected persons who develop disseminated histoplasmosis and approximately 30% of HIV/AIDS patients diagnosed with histoplasmosis die from it.[3][5]
References
- ↑ Sizemore TC (2013). "Rheumatologic manifestations of histoplasmosis: a review". Rheumatol Int. 33 (12): 2963–5. doi:10.1007/s00296-013-2816-y. PMID 23835880.
- ↑ McKinsey DS, McKinsey JP (2011). "Pulmonary histoplasmosis". Semin Respir Crit Care Med. 32 (6): 735–44. doi:10.1055/s-0031-1295721. PMID 22167401 22167401 Check
|pmid=value (help). - ↑ 3.0 3.1 Information for Healthcare Professionals about Histoplasmosis. Centers for Disease Control and Prevention. 2015. Available at: http://www.cdc.gov/fungal/diseases/histoplasmosis/health-professionals.html. Accessed February 2, 2016.
- ↑ Fernández Andreu CC, Illnait Zaragozi MT, Martínez Machín G, Perurena Lancha MR, Monroy Vaca E (2011). "[Histoplasmosis updating]". Rev Cubana Med Trop. 63 (3): 189–205. PMID 23444607.
- ↑ Alves MD, Pinheiro L, Manica D, Fogliatto LM, Fraga C, Goldani LZ (2011). "Histoplasma capsulatum sinusitis: case report and review". Mycopathologia. 171 (1): 57–9. doi:10.1007/s11046-010-9345-y. PMID 20635150 20635150 Check
|pmid=value (help).