Primary oral histoplasmosis in India

Oral Localized Lesion on the Tongue in an Immunocompetent Individual: A Report of a Rare Case With a Comprehensive Review of the Literature

Histoplasmosis (HP) is a sporadic deep fungal disease that rarely shows oral lesions in various clinical forms. It is usually associated with immunocompromised states, but oral HP has also been reported in many immunocompetent individuals. An unusual case of focal oral HP in a 65-year-old immunocompetent male is reported from New Delhi, India (non-endemic region) presenting with oral ulcerative lesions on the floor of the mouth and lateral surface of the tongue. This case report highlights the importance of prompt diagnosis for the success of the treatment of oral HP along with a thorough review of the literature on HP in immunocompetent patients with oral manifestations. The average age of immunocompetent patients with oral HP is 49.65 years with a marked male predilection. The most common intraoral site is the tongue, followed by the gingiva. Also, five intraosseous cases of HP in immunocompetent patients are reported, among which four are seen in patients from Africa and in a much younger age group (mean: 17.25 years).

Primary Oral Histoplasmosis in Immunocompetent Host: Case Series with Review of Literature

Histoplasmosis, a systemic mycosis caused by Histoplasma capsulatum manifests clinically in immunocompromised subjects as acute or chronic pulmonary infection or as a progressive disseminated disease. In oral region it clinically presents as multiple, granular and painful ulcers or verrucous growth. It is rare to find primary oral lesion of histoplasmosis in immunocompetent patient free from systemic disease. In presence of any unusual oral lesion possibility of Histoplasmosis should be considered and prompt diagnosis be attained with exclusion of false negative results as non-specific manifestation of disease may lead to gruesome misdiagnosis of lesion and inadequate treatment. In the present paper two cases of oral histoplasmosis in immunocompetent host have been discussed along with updated review of literature.

Histoplasmosis in eastern India: the tip of the iceberg?

Systemic histoplasmosis has various clinical presentations and is of especially concern in immunocompromised patients. A high index of suspicion is required for its diagnosis. A total of 38 cases had been reported from India up to 1996. The most frequent occurrence of cases was around Calcutta in eastern India where the previous case was detected 20 years earlier. However, we have diagnosed 5 cases in the past 2 years from eastern India which are reported here. These cases may indicate under-diagnosis and under-reporting of histoplasmosis in India. All 5 patients had disseminated disease with multisystem involvement including 2 with bilateral adrenal enlargement. Two were diabetic and only 1 patient was infected with HIV.

Oral histoplasmosis in India: a case report and an overview of cases reported during 1968-92

Oral histoplasmosis in a 30-year-old male with no history of travel outside India is described. An ulcerating lesion was located on the hard palate. A chest X-ray was normal. Based on physical examination, regional lymph nodes, liver and spleen were not involved. The diagnosis was established by demonstrating yeast-like budding cells in a biopsy of the lesion and by isolating Histoplasma capsulatum in pure culture. The identity of the isolate was confirmed by a chemiluminescent DNA-probe assay and the exoantigen test. A review of the Indian literature from 1968 to 1992 revealed the occurrence of 25 authentic cases of histoplasmosis in India. In 19 cases, lesions were confined to the oral cavity confirming prior observation that histoplasmosis in Indian patients tends to occur primarily in extrapulmonary sites, particularly the oral cavity.

Spontaneous regression of oral histoplasmosis

A case of histoplasmosis with an unusual clinical presentation and subsequent disease course was diagnosed when a tooth extraction site failed to heal. Culture, biopsy, and serologic study confirmed the presence of Histoplasma capsulatum. Radiographs and sputum culture established pulmonary involvement. Oral and pulmonary lesions regressed without treatment. This case is presented to raise the question of whether all cases of histoplasmosis with oral involvement should be assumed to be disseminated disease requiring treatment with amphotercin B.