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Aissaoui H, Bourne-Watrin M, Lemarie B, Guillot G, Aboikoni A, Chhorn P, Gaudard D, Hadj-Amara G, Manasse R, Ouedraogo M, Salloum C, Demar M, Epelboin L, Kallel H, Adenis A, Nacher M, Drak Alsibai K, Louvel D. Histoplasmosis in Non-HIV Infected Patients: Another Neglected Infection in French Guiana. J Fungi (Basel) 2024; 10:400. [PMID: 38921386 PMCID: PMC11205039 DOI: 10.3390/jof10060400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Revised: 05/27/2024] [Accepted: 05/28/2024] [Indexed: 06/27/2024] Open
Abstract
(1) Background: Only a few studies on histoplasmosis in immunocompetent patients have been reported in French Guiana. Therefore, we conducted a detailed clinical description of hospitalized patients suffering with histoplasmosis among non-HIV patients. (2) Methods: This is a single-center, retrospective study conducted at Cayenne Hospital Center between 2008 and 2022. (3) Results: Our cohort was composed of 31 (91%) adults (>18 years of age) and 3 (9%) children, with a sex ratio, M:F, of 1:2. The median age was higher among the women than among the men (70 versus 54 years). The collection of respiratory samples constituted the majority of the performed examinations (38%). Fever (>37 °C) was found in 56% of patients. Surprisingly, the histoplasmosis was disseminated in 82% of patients with an overall case fatality rate of 14.7%. However, immunosuppressive conditions were found in 52% (16/31) of the adult patients, including lymphoid hemopathies, diabetes and immunosuppressive drugs. Conclusions: This disease, though rare and usually considered a mostly benign disease in non-HIV patients, presented a relatively high mortality rate in our cohort. Thus, histoplasmosis should be suspected, screened and investigated as a first line of defense in highly endemic areas, even in immunocompetent and non-HIV patients, especially those with fever or chronic respiratory symptoms.
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Affiliation(s)
- Houari Aissaoui
- Department of Medicine, Pneumology and Gastroenterology Units, Cayenne Hospital Center, Cayenne F-97300, French Guiana; (H.A.); (G.G.); (A.A.); (D.G.); (D.L.)
| | - Morgane Bourne-Watrin
- Unité des Maladies Infectieuses Tropicales (UMIT), Cayenne Hospital Center, Cayenne F-97300, French Guiana; (M.B.-W.); (L.E.)
| | - Benoit Lemarie
- Pneumology Department, Cochin University Hospital AP-HP, F-75014 Paris, France;
| | - Genevieve Guillot
- Department of Medicine, Pneumology and Gastroenterology Units, Cayenne Hospital Center, Cayenne F-97300, French Guiana; (H.A.); (G.G.); (A.A.); (D.G.); (D.L.)
| | - Alolia Aboikoni
- Department of Medicine, Pneumology and Gastroenterology Units, Cayenne Hospital Center, Cayenne F-97300, French Guiana; (H.A.); (G.G.); (A.A.); (D.G.); (D.L.)
| | | | - Dana Gaudard
- Department of Medicine, Pneumology and Gastroenterology Units, Cayenne Hospital Center, Cayenne F-97300, French Guiana; (H.A.); (G.G.); (A.A.); (D.G.); (D.L.)
| | - Ghazi Hadj-Amara
- Department of Pathology, Cayenne Hospital Center, Cayenne F-97300, French Guiana; (G.H.-A.); (R.M.)
| | - Ricardo Manasse
- Department of Pathology, Cayenne Hospital Center, Cayenne F-97300, French Guiana; (G.H.-A.); (R.M.)
| | - Mahamado Ouedraogo
- Laboratory of Mycology, Cayenne Hospital Center, Cayenne F-97300, French Guiana; (M.O.); (M.D.)
| | - Charles Salloum
- Department of Orthopidic Surgery and Neurosurgery, Cayenne Hospital Center, Cayenne F-97300, French Guiana;
| | - Magalie Demar
- Laboratory of Mycology, Cayenne Hospital Center, Cayenne F-97300, French Guiana; (M.O.); (M.D.)
| | - Loïc Epelboin
- Unité des Maladies Infectieuses Tropicales (UMIT), Cayenne Hospital Center, Cayenne F-97300, French Guiana; (M.B.-W.); (L.E.)
| | - Hatem Kallel
- Intensif Care Unit, Cayenne Hospital Center, Cayenne F-97300, French Guiana;
| | - Antoine Adenis
- Amazin PopHealth, Departement of Research and Innovation in Public Health (DRISP), Clinical Investigation Center (CIC Inserm 1424), Cayenne Hospital Center, Cayenne F-97300, French Guiana; (A.A.); (M.N.)
| | - Mathieu Nacher
- Amazin PopHealth, Departement of Research and Innovation in Public Health (DRISP), Clinical Investigation Center (CIC Inserm 1424), Cayenne Hospital Center, Cayenne F-97300, French Guiana; (A.A.); (M.N.)
| | - Kinan Drak Alsibai
- Department of Pathology, Cayenne Hospital Center, Cayenne F-97300, French Guiana; (G.H.-A.); (R.M.)
- Amazin PopHealth, Departement of Research and Innovation in Public Health (DRISP), Clinical Investigation Center (CIC Inserm 1424), Cayenne Hospital Center, Cayenne F-97300, French Guiana; (A.A.); (M.N.)
- Center of Biological Resources (CRB Amazonie), Cayenne Hospital Center, Cayenne F-97306, French Guiana
| | - Dominique Louvel
- Department of Medicine, Pneumology and Gastroenterology Units, Cayenne Hospital Center, Cayenne F-97300, French Guiana; (H.A.); (G.G.); (A.A.); (D.G.); (D.L.)
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Gligorijevic N, Kaljevic M, Radovanovic N, Jovanovic F, Joksimovic B, Singh S, Dumic I. Adrenal Abscesses: A Systematic Review of the Literature. J Clin Med 2023; 12:4601. [PMID: 37510716 PMCID: PMC10380332 DOI: 10.3390/jcm12144601] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 07/01/2023] [Accepted: 07/05/2023] [Indexed: 07/30/2023] Open
Abstract
Objective: To summarize the existing knowledge about adrenal gland abscesses, including etiology, clinical presentation, common laboratory and imaging findings, management and overall morbidity and mortality. Design: Systematic literature review. Methods: We performed a search in the PubMed database using search terms: 'abscess and adrenal glands', 'adrenalitis', 'infection and adrenal gland', 'adrenal abscess', 'adrenal infection' and 'infectious adrenalitis'. Articles from 2017 to 2022 were included. We found total of 116 articles, and after applying exclusion criteria, data from 73 articles was included in the final statistical analysis. Results: Of 84 patients included in this review, 68 were male (81%), with a mean age of 55 years (range: 29 to 85 years). Weight loss was the most frequent symptom reported in 58.3% patients, followed by fever in 49%. Mean duration of symptoms was 4.5 months. The most common laboratory findings were low cortisol (51.9%), elevated ACTH (43.2%), hyponatremia (88.2%) and anemia (83.3%). Adrenal cultures were positive in 86.4% cases, with Histoplasma capsulatum (37.3%) being the leading causative agent. Blood cultures were positive in 30% of patients. The majority of the adrenal infections occurred through secondary dissemination from other infectious foci and abscesses were more commonly bilateral (70%). A total of 46.4% of patients developed long-term adrenal insufficiency requiring treatment. Abscess drainage was performed in 7 patients (8.3%) and adrenalectomy was performed in 18 (21.4%) patients. The survival rate was 92.9%. Multivariate analysis showed that the only independent risk factor for mortality was thrombocytopenia (p = 0.048). Conclusion: Our review shows that adrenal abscesses are usually caused by fungal pathogens, and among these, Histoplasma capsulatum is the most common. The adrenal glands are usually involved in a bilateral fashion and become infected through dissemination from other primary sources of infection. Long-term adrenal insufficiency develops in 46% of patients, which is more common than what is observed in non-infectious etiology of adrenal gland disorders. Mortality is about 7%, and the presence of thrombocytopenia is associated with worse prognosis. Further prospective studies are needed to better characterize optimal testing and treatment duration in patients with this relatively rare but challenging disorder.
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Affiliation(s)
- Nikola Gligorijevic
- Division of General Internal Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, PA 15213, USA
| | - Marija Kaljevic
- Department of Hospital Medicine, Saint Francis Hospital and Medical Center, Hartford, CT 06105, USA
- Division of Internal Medicine, University of Connecticut, Farmington, CT 06030, USA
| | - Natasa Radovanovic
- Department of Endocrinology, Dartmouth-Hitchcock Medical Center, Geisel School of Medicine, Dartmouth College, Hanover, NH 03755, USA
| | - Filip Jovanovic
- Department of Internal Medicine, Merit Health Wesley, Hattiesburg, MS 39402, USA
| | - Bojan Joksimovic
- Department of Pathological Physiology, Faculty of Medicine Foca, University of East Sarajevo, 73300 Foca, Bosnia and Herzegovina
| | - Sandra Singh
- Clinic for Endocrinology, Diabetes and Metabolic Diseases, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Igor Dumic
- Department of Hospital Medicine, Mayo Clinic Health System, Eau Claire, WI 54703, USA
- Mayo Clinic College of Medicine and Science, Rochester, MN 55905, USA
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Ekeng BE, Emanghe UE, Davies AA, Oladele RO. A Critical Review of Diagnostic Methods for Disseminated Histoplasmosis with Special Focus on Resource-Limited Settings. CURRENT FUNGAL INFECTION REPORTS 2023. [DOI: 10.1007/s12281-023-00454-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
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Govindarajan A, Sous R, Venter F, Torrico T, Karapetians N, Heidari A, Cobos E, Petersen G. A Case of Disseminated Histoplasmosis From California, in the Setting of Secondary Hemophagocytic Lymphohistiocytosis: A Diagnostic Challenge. J Investig Med High Impact Case Rep 2023; 11:23247096231156007. [PMID: 36799482 PMCID: PMC9940204 DOI: 10.1177/23247096231156007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023] Open
Abstract
Histoplasma capsulatum is a geographically specific dimorphic fungus that can cause a spectrum of diseases. While most cases are asymptomatic pulmonary infections, in severe cases, particularly in immunocompromised patients, disseminated disease can occur. Histoplasmosis in California is limited to only a few case reports. In this article, we describe a rare case of disseminated histoplasmosis in a non-endemic region presenting with diagnostically challenging symptomatology, including altered mental status, status epilepticus, septic shock, and bilateral adrenal masses.
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Affiliation(s)
| | - Rowis Sous
- Department of Medicine, Kern Medical UCLA, Bakersfield, USA
| | | | - Tyler Torrico
- Department of Psychiatry, Kern Medical UCLA, Bakersfield, USA
| | | | - Arash Heidari
- Division of Infectious Diseases, Department of Medicine, Kern Medical UCLA, Bakersfield, USA
| | - Everardo Cobos
- Department of Medicine, Kern Medical UCLA, Bakersfield, USA
| | - Greti Petersen
- Department of Medicine, Kern Medical UCLA, Bakersfield, USA
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Bhattacharyya K, Pal S, Dutta A, Bhattachryya PP, Laskar S. Histoplasmosis of Adrenal Gland: A 5 Years' Review from a Multispecialty Diagnostic Centre. J Lab Physicians 2022. [DOI: 10.1055/s-0042-1757587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
Abstract
Objective Histoplasmosis is an infectious disease caused by the dimorphic fungus Histoplasma capsulatum. Histoplasmosis is considered to be endemic to India, especially the Gangetic belt. Disseminated histoplasmosis may affect almost all systems. Disseminated histoplasmosis with asymptomatic adrenal involvement has been described in immunocompromised patients, whereas isolated adrenal involvement as the presenting manifestation in immunocompetent is uncommon. We aimed to determine the clinicopathological and radiological findings of adrenal histoplasmosis in immunocompetent patients attending a multispecialty diagnostic center referred from different clinics and hospitals.
Materials and Methods All tissue samples were initially examined microscopically by performing potassium hydroxide (KOH) wet mounts, followed by culture on two tubes of Sabouraud dextrose agar and phase conversion. Histopathological correlation was done using tissue stains, hematoxylin and eosin, periodic acid–Schiff, and Gomori methenamine silver.
Results We evaluated 84 clinically suspected cases radiologically for adrenal mass. The pathological and microbiological work-up was done from these suspected cases. A total of 19 cases were evident from the tissue stain and fungal culture methods. The affected population were mostly above 45 years and male. Seven patients had bilateral adrenal involvement. All these patients received amphotericin B and/or itraconazole treatment, which led to symptomatic improvement in most cases.
Conclusion Diagnosis of invasive fungal infection requires a high index of suspicion, especially in immunocompetent patients presenting with nonspecific symptoms, clinical signs, and laboratory and radiological features that often resemble adrenal neoplasms. Clinical specimens, together with fungal culture, must be sent for cytopathology/histopathology for a definite diagnosis and appropriate management.
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Affiliation(s)
- Kumkum Bhattacharyya
- Department of Microbiology, Quadra Medical Services, Kolkata, West Bengal, India
- Department of Microbiology, Institute of Post Graduate Medcal Education & Research, Kolkata, West Bengal, India
| | - Suranjan Pal
- Department of Microbiology, Raiganj Government Medical College, Raiganj, Uttar Dinajpur, West Bengal, India
| | - Ashis Dutta
- Department of Pathology, Quadra Medical Services, Kolkata, West Bengal, India
| | | | - Saurabh Laskar
- Department of Microbiology, Quadra Medical Services, Kolkata, West Bengal, India
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Ahuja A, Bhardwaj M, Agarwal P. Cutaneous Histoplasmosis in HIV Seronegative Patients: A Clinicopathological Analysis. Dermatology 2021; 237:934-939. [PMID: 33626536 DOI: 10.1159/000513399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 11/27/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Diagnosis of extrapulmonary histoplasmosis in HIV seronegative and immunocompetent patients is often challenging, so a high index of suspicion is required. Cutaneous manifestation of infection shows a wide spectrum of lesions including erythematous plaques; maculopapules; crusted, verrucous, or desquamative papules and nodules; abscesses; and mucocutaneous ulcers among others. Due to the variations in its clinical presentation, histopathology plays a very important role in the detection of spores and the confirmation of diagnosis. OBJECTIVES The aim of our study was to analyze clinicopathological characteristics of cutaneous manifestations of biopsy-proven histoplasmosis in HIV seronegative individuals. We also examined the utility of Fite stain for the diagnosis of Histoplasma capsulatum on tissue biopsy sections. METHODS This was a retrospective, observational study on 7 patients who were HIV seronegative and clinically manifested with isolated cutaneous lesions or disseminated disease. Skin biopsy from the lesions was performed on all 7 patients. In addition to H&E staining and special stains for detecting fungus, Fite staining was performed on all of the cases to study its utility in detecting H. capsulatum spores. RESULTS The skin lesions were widely disseminated in all patients and the most common cutaneous lesions were papules, present in all 7 patients. On review of the H&E-stained slides, the most common pattern was histiocytic lobular panniculitis-like infiltrate observed in 4 cases. Fite stain highlighted the yeast as magenta-colored spores on a blue background in all cases, except for 1 with a granulomatous pattern. CONCLUSION A primary cutaneous manifestation of H. capsulatum infection in non-HIV-infected individuals is extremely rare. Fite stain could aid in differentiating the spores of H. capsulatum from those of other fungi, Cryptococcus and Candida in particular.
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Affiliation(s)
- Arvind Ahuja
- Department of Pathology, Atal Bihari Vajpayee Institute of Medical Sciences, Dr. RML Hospital, New Delhi, India,
| | - Minakshi Bhardwaj
- Department of Pathology, Atal Bihari Vajpayee Institute of Medical Sciences, Dr. RML Hospital, New Delhi, India
| | - Poojan Agarwal
- Department of Pathology, Atal Bihari Vajpayee Institute of Medical Sciences, Dr. RML Hospital, New Delhi, India
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Choudhary S, Srivastava A, Rupla R, Goel G. Rare clinical presentation of histoplasmosis. Int J Dermatol 2020; 60:e108-e110. [PMID: 33095476 DOI: 10.1111/ijd.15266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 07/27/2020] [Accepted: 09/23/2020] [Indexed: 01/19/2023]
Affiliation(s)
- Sanjiv Choudhary
- Department of Dermatology, All India Institute of Medical Sciences, Nagpur, Maharashtra, India
| | - Ankita Srivastava
- Department of Dermatology, All India Institute of Medical Sciences, Nagpur, Maharashtra, India
| | - Richa Rupla
- Department of Dermatology, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Garima Goel
- Department of Pathology, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
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Sheth MC, Paul RR, Mathews SS, Albert RR. Isolated Aspergillus Laryngitis: Spectrum, Management, and Review of Literature. J Voice 2020; 36:880.e13-880.e19. [PMID: 33004228 DOI: 10.1016/j.jvoice.2020.09.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 09/04/2020] [Accepted: 09/08/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE Isolated aspergillus laryngitis is rare and often diagnosed after surgical excision or biopsy for a suspected premalignant or malignant pathology. Unlike other systemic or localized aspergillosis, there are no specific guidelines for isolated laryngeal aspergillosis. Our experience of dealing with a wide variety of isolated laryngeal aspergillosis showed that this entity is very responsive to medical therapy, making extensive debridement (as often carried out in surgically accessible aspergillosis) unnecessary as it would invariably lead to long-term dysphonia. MATERIALS AND METHODS A retrospective analysis of all cases of isolated aspergillus laryngitis that presented to our hospital over the past 5 years was carried out. All patients with confirmed histopathological diagnosis of aspergillus infection were included. RESULTS Twelve patients (five males and seven females) aged 28-54 years, who were diagnosed with aspergillus laryngitis presented with dysphonia. The most common involved site was the true vocal cords. All patients underwent cautious biopsies either in the operating theatre or in-office using a channeled fiber-optic laryngoscope. On histopathological examination, eight had invasive aspergillus infection while others showed variety of noninvasive involvement including colonization of cysts and carcinoma in situ. The most common species isolated was Aspergillus fumigatus. Appropriate antifungal chemotherapy was prescribed after ruling out systemic involvement. None of the patients showed recurrence or residual lesions on follow-up and reported significantly improved voice. CONCLUSIONS This study highlights the wide spectrum of presentation of isolated aspergillus laryngitis with Aspergillus fumigatus being the most common organism isolated. Even the invasive variant is a medically treatable condition with voriconazole being the drug of choice. The importance of cautious biopsies and resections for voice preservation is also emphasized. To our knowledge, this is the largest report on isolated aspergillus laryngitis.
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Affiliation(s)
- Meet Chetan Sheth
- Department of ENT Unit -5, Christian Medical College, Vellore, India.
| | - Roshna Rose Paul
- Department of ENT Unit -5, Christian Medical College, Vellore, India
| | | | - Rita Ruby Albert
- Department of ENT Unit -5, Christian Medical College, Vellore, India
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Chen J, Li Y, Li Z, Chen G, Liu X, Ding L. Metagenomic next-generation sequencing identified Histoplasma capsulatum in the lung and epiglottis of a Chinese patient: A case report. Int J Infect Dis 2020; 101:33-37. [PMID: 32950741 DOI: 10.1016/j.ijid.2020.09.038] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 06/27/2020] [Accepted: 09/12/2020] [Indexed: 10/23/2022] Open
Abstract
Histoplasmosis is an endemic disease mainly occurring in North America and is rare in China. Confirmation of histoplasmosis should be based on a compatible clinical scenario and a positive culture or histopathology. However, there are still many cases that are misdiagnosed or missed, especially in individuals from non-endemic areas. In recent years, metagenomic next-generation sequencing (mNGS) has led to the accurate and timely diagnosis of some rare and complicated infectious diseases. We describe the case of a 27-year-old Chinese man who had chronic progressive pulmonary lesions without any symptoms for more than 1year, until the lesions reached the epiglottis and led to progressive pharyngeal pain. There were no positive results from bronchoalveolar lavage fluid (BALF) and epiglottis tissue cultures, or from epiglottis and lung pathological examinations, but mNGS was able to identify Histoplasma capsulatum in the epiglottis tissues and BALF as the cause of the lesions. The patient was treated successfully with itraconazole.
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Affiliation(s)
- Jiehua Chen
- Department of Infectious Diseases, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, 519000, Guangdong, China.
| | - Yingqin Li
- Department of Radiology, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, 519000, Guangdong, China.
| | - Zizi Li
- Department of Pathology, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, 519000, Guangdong, China.
| | - Gongqi Chen
- Department of Infectious Diseases, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, 519000, Guangdong, China.
| | - Xi Liu
- Department of Infectious Diseases, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, 519000, Guangdong, China.
| | - Li Ding
- Department of Infectious Diseases, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, 519000, Guangdong, China.
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Anot K, Sharma S, Gupta M, Kaur D. Disseminated histoplasmosis and tuberculosis: dual infection in a non-endemic region. BMJ Case Rep 2020; 13:13/8/e235531. [PMID: 32843417 DOI: 10.1136/bcr-2020-235531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Histoplasmosis is a systemic fungal infection caused by Histoplasma capsulatum, a dimorphic fungus that spreads commonly by contamination of soil with bird and bat droppings. The infection remains latent in most patients until manifested by reduced immune status, for example, HIV/AIDS, corticosteroid/immunosuppressive therapy or in solid organ transplant recipients. Tuberculosis and histoplasmosis may cooccur rarely in HIV and the clinical resemblance of both diseases may hinder identification of patients' harbouring dual infection, especially in regions non-endemic for histoplasmosis. We report a case of disseminated histoplasmosis with disseminated tuberculosis in an incidentally detected patient with HIV-positive who presented with reports of fever and skin rash for 10 days. The Mantoux positivity and CT of chest and abdomen revealing multiple necrotic lymph nodes coupled with bone marrow and skin biopsy divulging histoplasmosis and tuberculosis helped us clinch the concurrent infection.
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Affiliation(s)
- Karuna Anot
- Department of General Medicine, Government Medical College and Hospital, Chandigarh, India
| | - Sanjana Sharma
- Department of General Medicine, Government Medical College and Hospital, Chandigarh, India
| | - Monica Gupta
- Department of General Medicine, Government Medical College and Hospital, Chandigarh, India
| | - Daljinderjit Kaur
- Department of General Medicine, Government Medical College and Hospital, Chandigarh, India
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Samaddar A, Sharma A, Kumar Ph A, Srivastava S, Shrimali T, Gopalakrishnan M, Bohra GK. Disseminated histoplasmosis in immunocompetent patients from an arid zone in Western India: A case series. Med Mycol Case Rep 2019; 25:49-52. [PMID: 31453079 PMCID: PMC6702145 DOI: 10.1016/j.mmcr.2019.07.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 07/06/2019] [Accepted: 07/31/2019] [Indexed: 11/26/2022] Open
Abstract
Histoplasmosis is a systemic fungal disease caused by dimorphic fungus Histoplasma capsulatum and is more common in immunocompromised patients. We report two cases of disseminated histoplasmosis in immunocompetent individuals from a non-endemic zone in Western India. Rapid diagnostic tests like urinary antigen detection and molecular assays comprise the need of the hour as early initiation of antifungal therapy can be life-saving. Clinicians need to be aware of this entity to prevent misdiagnosis and initiate prompt effective management.
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Affiliation(s)
- Arghadip Samaddar
- Department of Microbiology, All India Institute of Medical Sciences, Jodhpur, 342005, Rajasthan, India
| | - Anuradha Sharma
- Department of Microbiology, All India Institute of Medical Sciences, Jodhpur, 342005, Rajasthan, India
| | - Akhilesh Kumar Ph
- Department of General Medicine, All India Institute of Medical Sciences, Jodhpur, 342005, Rajasthan, India
| | - Saumya Srivastava
- Department of Microbiology, All India Institute of Medical Sciences, Jodhpur, 342005, Rajasthan, India
| | - Twishi Shrimali
- Department of Microbiology, All India Institute of Medical Sciences, Jodhpur, 342005, Rajasthan, India
| | - Maya Gopalakrishnan
- Department of General Medicine, All India Institute of Medical Sciences, Jodhpur, 342005, Rajasthan, India
| | - Gopal Krishna Bohra
- Department of General Medicine, All India Institute of Medical Sciences, Jodhpur, 342005, Rajasthan, India
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Lin MJ, Mazzoni D, Gin D. Disseminated cutaneous-only histoplasmosis in a patient with AIDS. Australas J Dermatol 2019; 60:e330-e332. [PMID: 31250916 DOI: 10.1111/ajd.13108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Accepted: 05/29/2019] [Indexed: 11/26/2022]
Abstract
Histoplasmosis is an opportunistic fungal infection that occurs predominantly in immunocompromised patients. Cutaneous lesions in histoplasmosis are rare and typically occur in the absence of extra-cutaneous manifestations. We present a rare case of disseminated cutaneous-only histoplasmosis in a patient with recently diagnosed AIDS.
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Affiliation(s)
| | | | - Douglas Gin
- The Alfred Hospital, Prahran, Victoria, Australia
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Gupta N, Vinod KS, Mittal A, Kumar APA, Kumar A, Wig N. Histoplasmosis, heart failure, hemolysis and haemophagocytic lymphohistiocytosis. Pan Afr Med J 2019; 32:43. [PMID: 31143348 PMCID: PMC6522155 DOI: 10.11604/pamj.2019.32.43.14954] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 12/04/2018] [Indexed: 11/11/2022] Open
Abstract
Histoplasmosis is an endemic mycosis with global distribution, primarily reported in immunocompromised individuals. A 29-year old immunocompetent male presented with fever, hepatosplenomegaly and pancytopenia. His peripheral blood showed features suggestive of intravascular hemolysis and echocardiography showed features suggestive of pulmonary arterial hypertension. Bone marrow showed yeast with morphology suggestive of Histoplasma capsulatum. Further investigations revealed hyperferritinemia, hypofibrinogenemia and increased triglycerides. With a diagnosis of progressive disseminated histoplasmosis with secondary Haemophagocytic lymphohistiocytosis, he was successfully treated with amphotericin B followed by itraconazole. We report this case to highlight the atypical and rare manifestations of histoplasmosis.
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Affiliation(s)
- Nitin Gupta
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Kutty Sharada Vinod
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Ankit Mittal
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | | | - Arvind Kumar
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Naveet Wig
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
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Bansal N, Sethuraman N, Gopalakrishnan R, Ramasubramanian V, Kumar D S, Nambi P S, Chakrabarti A. Can urinary histoplasma antigen test improve the diagnosis of histoplasmosis in a tuberculosis endemic region? Mycoses 2019; 62:502-507. [PMID: 30734964 DOI: 10.1111/myc.12902] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 01/28/2019] [Accepted: 01/28/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Many patients with histoplasmosis are treated with anti-tubercular therapy (ATT) in tuberculosis endemic regions as diagnosis of histoplasmosis requires invasive sampling. We sought to study the utility of urinary Histoplasma antigen detection test. METHODS Case records of patients with a diagnosis of histoplasmosis prior to (Period A) and after (Period B) introduction of urinary Histoplasma antigen detection test were analysed in this single centre retrospective study. RESULTS Thirty-seven patients (18 in Period A, and 19 patients in Period B) were studied. There was nearly a threefold increase in diagnoses (from 0.39 cases to 1.18 cases per month) after the introduction of antigen test. Nine patients (24.3%) were immunocompromised (6 had HIV infection and 3 were on steroids), and 28 (75.6%) were immunocompetent. Empirical ATT had been given to 10 patients prior to histoplasmosis diagnosis. Invasive tissue sampling was required in only two patients in Period B to confirm the diagnosis. Immunocompromised patients were younger, were more likely to have skin and mucosal findings, anaemia and leucopenia as compared to immune-competent patients. CONCLUSION This study emphasises that histoplasmosis cases may be missed and patients may receive ATT unnecessarily. Histoplasma antigen increased the diagnostic yield by almost threefold in our study.
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Affiliation(s)
- Nitin Bansal
- Infectious Diseases, Apollo Hospitals, Chennai, India
| | | | | | | | | | | | - Arunaloke Chakrabarti
- Microbiology Post Graduate Institute of Medical Education and Research, Chandigarh, India
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15
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Shastri P, Gupta P. Fulminant Histoplasmosis Presenting as Pyrexia of Unknown Origin in Immunocompetent Adult Diabetic Patient. Indian J Crit Care Med 2019; 23:193-195. [PMID: 31130794 PMCID: PMC6521830 DOI: 10.5005/jp-journals-10071-23154] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Opportunistic infections are commonly seen in immunocompromised individuals such as those suffering from HIV infection, organ transplant recipients and connective tissue disorders. Histoplasmosis is one of the fungal opportunistic infections which is usually seen in immunosuppressed individuals but can also be seen in immunocompetent patients with frequent involvement of adrenal glands. We present a case of adult diabetic patient presenting as pyrexia of unknown origin in which bone marrow aspiration and biopsy lead to diagnosis of histoplasmosis without adrenal involvement. How to cite this article: Shastri P, Gupta P. Fulminant Histoplasmosis Presenting as Pyrexia of Unknown Origin in Immunocompetent Adult Diabetic Patient. Indian J Crit Care Med 2019;23(4):193–195.
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Affiliation(s)
- Prakash Shastri
- Critical Care and Emergency Medicine, Sir Gangaram Hospital, New Delhi, India
| | - Pallav Gupta
- Department of Histopathology, Sir Gangaram Hospital, New Delhi, India
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16
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Khullar G, Saxena AK, Ramesh V, Sharma S. Asymptomatic indurated plaque on the tongue in an immunocompetent man. Int J Dermatol 2018; 58:423-424. [PMID: 30229879 DOI: 10.1111/ijd.14225] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2018] [Accepted: 08/22/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Geeti Khullar
- Department of Dermatology and Sexually Transmitted Diseases, Vardhman Mahavir Medical College and Safdarjung Hospital, (Indian Council of Medical Research), Safdarjung Hospital Campus, New Delhi, India
| | - Ashok K Saxena
- Department of Dermatology and Sexually Transmitted Diseases, Vardhman Mahavir Medical College and Safdarjung Hospital, (Indian Council of Medical Research), Safdarjung Hospital Campus, New Delhi, India
| | - V Ramesh
- Department of Dermatology and Sexually Transmitted Diseases, Vardhman Mahavir Medical College and Safdarjung Hospital, (Indian Council of Medical Research), Safdarjung Hospital Campus, New Delhi, India
| | - Shruti Sharma
- Department of Pathology, National Institute of Pathology (Indian Council of Medical Research), Safdarjung Hospital Campus, New Delhi, India
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17
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Gupta A, Ghosh A, Singh G, Xess I. A Twenty-First-Century Perspective of Disseminated Histoplasmosis in India: Literature Review and Retrospective Analysis of Published and Unpublished Cases at a Tertiary Care Hospital in North India. Mycopathologia 2017; 182:1077-1093. [PMID: 29080114 DOI: 10.1007/s11046-017-0191-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2016] [Accepted: 08/08/2017] [Indexed: 11/29/2022]
Abstract
PURPOSE Published literature lacks systematic studies on disseminated histoplasmosis in India, and previous reviews on its epidemiology in India were conducted two decades back. Thus, we review the Indian studies published in this century to understand the recent epidemiology of histoplasmosis in India and do a retrospective analysis of all cases diagnosed at our institute. METHODS A literature of review search was done in Pubmed/Medline and Scopus. Studies published during January 2001-December 2015 were considered along with retrospective analysis of cases presented to us. A distinction was made in the clinical presentation of immunocompetent and immunocompromised cases. RESULTS Ninety-five included studies described 204 cases, and 10 cases from our retrospective analysis were included. The mean age at presentation was 45.1 ± 15.4 years [range 3-83, median 45, interquartile range 37-55], and male-to-female ratio was 6:1. Most cases were reported from northern and northeastern states of India along the rivers Ganges, Yamuna and Brahmaputra and in people associated with agricultural activity. About 33% of cases were immunocompromised, out of which immunosuppression due to HIV was seen in 72% cases. The mean age of presentation was significantly lower in immunocompromised cases (37.9 vs. 49.2 years; p < 0.00001, Mann-Whitney test), and mortality was also higher (10 vs. 27.5%, p = 0.01, Fisher's exact test). Adrenal involvement was in significantly higher proportion of immunocompetent patients compared to immunocompromised population. CONCLUSIONS Disseminated histoplasmosis is being increasingly recognized in India. There is a need to undertake well-designed, analytical studies utilizing appropriate diagnostic modalities to understand the epidemiology of this neglected disease in proper perspective.
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Affiliation(s)
- Ayush Gupta
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Arnab Ghosh
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Gagandeep Singh
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Immaculata Xess
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India.
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18
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Mahajan VK, Raina RK, Singh S, Rashpa RS, Sood A, Chauhan PS, Mehta KS, Rawat R, Sharma V. Case Report: Histoplasmosis in Himachal Pradesh (India): An Emerging Endemic Focus. Am J Trop Med Hyg 2017; 97:1749-1756. [PMID: 29016342 DOI: 10.4269/ajtmh.17-0432] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
We describe four cases of histoplasmosis indigenous to Himachal Pradesh (India) that will be of considerable public health interest. A 48-year-old human immunodeficiency virus (HIV)-negative man with cervical and mediastinal lymphadenopathy, hepatosplenomegaly, adrenal mass, and bone marrow involvement was treated as disseminated tuberculosis without benefit. Progressive disseminated histoplasmosis was diagnosed from the fungus in smears from adrenal mass. Another 37-year-old HIV-positive man was on treatment of suspected pulmonary tuberculosis. He developed numerous erythema nodosum leprosum-like mucocutanous lesions accompanied by fever, generalized lymphadenopathy, and weight loss. Pulmonary histoplasmosis with cutaneous dissemination was diagnosed when skin lesions showed the fungus in smears, histopathology, and mycologic culture. Both were successfully treated with amphotericin B/itraconazole. Third patient, a 46-year-old HIV-negative man, had oropharyngeal lesions, cervical lymphadenopathy, intermittent fever, hepatosplenomegaly, and deteriorating general health. Progressive disseminated oropharyngeal histoplasmosis was diagnosed from the fungus in smears and mycologic cultures from oropharyngeal lesions and cervical lymph node aspirates. He died despite initiating treatment with oral itraconazole. Another 32-year-old man 3 months after roadside trauma developed a large ulcer with exuberant granulation tissue over left thigh without evidence of immunosuppression/systemic involvement. He was treated successfully with surgical excision of ulcer under amphotericin B/itraconazole coverage as primary cutaneous histoplasmosis confirmed pathologically and mycologically. A clinical suspicion remains paramount for early diagnosis of histoplasmosis particularly in a nonendemic area. Most importantly, with such diverse clinical presentation and therapeutic outcome selection of an appropriate and customized treatment schedule is a discretion the treating clinicians need to make.
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Affiliation(s)
- Vikram K Mahajan
- Department of Dermatology, Venereology and Leprosy, Dr. R. P. Govt. Medical College, Kangra (Tanda), Himachal Pradesh, India
| | - Rashmi Kaul Raina
- Department of Pathology, Dr. R. P. Govt. Medical College, Kangra (Tanda), Himachal Pradesh, India
| | - Suman Singh
- Department of Pathology, Dr. R. P. Govt. Medical College, Kangra (Tanda), Himachal Pradesh, India
| | - Rattan Sagar Rashpa
- Department of Dermatology, Venereology and Leprosy, Dr. R. P. Govt. Medical College, Kangra (Tanda), Himachal Pradesh, India
| | - Anuradha Sood
- Department of Microbiology, Dr. R. P. Govt. Medical College, Kangra (Tanda), Himachal Pradesh, India
| | - Pushpinder S Chauhan
- Department of Dermatology, Venereology and Leprosy, Dr. R. P. Govt. Medical College, Kangra (Tanda), Himachal Pradesh, India
| | - Karaninder S Mehta
- Department of Dermatology, Venereology and Leprosy, Dr. R. P. Govt. Medical College, Kangra (Tanda), Himachal Pradesh, India
| | - Ritu Rawat
- Department of Dermatology, Venereology and Leprosy, Dr. R. P. Govt. Medical College, Kangra (Tanda), Himachal Pradesh, India
| | - Vikas Sharma
- Department of Dermatology, Venereology and Leprosy, Dr. R. P. Govt. Medical College, Kangra (Tanda), Himachal Pradesh, India
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Schulze AB, Heptner B, Kessler T, Baumgarten B, Stoica V, Mohr M, Wiewrodt R, Warneke VS, Hartmann W, Wüllenweber J, Schülke C, Schäfers M, Wilmes D, Becker K, Schmidt LH, Groll AH, Berdel WE. Progressive histoplasmosis with hemophagocytic lymphohistiocytosis and epithelioid cell granulomatosis: A case report and review of the literature. Eur J Haematol 2017; 99:91-100. [DOI: 10.1111/ejh.12886] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/19/2017] [Indexed: 01/08/2023]
Affiliation(s)
| | - Britta Heptner
- Department of Medicine A; University Hospital Muenster; Muenster Germany
| | - Torsten Kessler
- Department of Medicine A; University Hospital Muenster; Muenster Germany
| | - Birgit Baumgarten
- Department of Medicine A; University Hospital Muenster; Muenster Germany
| | - Viorelia Stoica
- Department of Medicine B; University Hospital Muenster; Muenster Germany
| | - Michael Mohr
- Department of Medicine A; University Hospital Muenster; Muenster Germany
| | - Rainer Wiewrodt
- Department of Medicine A; University Hospital Muenster; Muenster Germany
| | | | - Wolfgang Hartmann
- Gerhard Domagk Institute of Pathology; University Hospital Muenster; Muenster Germany
| | - Jörg Wüllenweber
- Institute of Medical Microbiology; University Hospital Muenster; Muenster Germany
| | - Christoph Schülke
- Department of Clinical Radiology; University Hospital Muenster; Muenster Germany
| | - Michael Schäfers
- Department of Nuclear Medicine; University Hospital Muenster; Muenster Germany
| | - Dunja Wilmes
- National Reference Center for Cryptococcosis, Scedosporiosis, and Endemic Mycoses; Robert Koch Institute; Berlin Germany
| | - Karsten Becker
- Institute of Medical Microbiology; University Hospital Muenster; Muenster Germany
| | | | - Andreas H. Groll
- Infectious Disease Research Program; Department of Pediatric Hematology/Oncology; Center for Bone Marrow Transplantation; University Hospital Muenster; Muenster Germany
| | - Wolfgang E. Berdel
- Department of Medicine A; University Hospital Muenster; Muenster Germany
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20
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Fatal disseminated histoplasmosis presenting as FUO in an immunocompetent Italian host. Leg Med (Tokyo) 2017; 25:66-70. [DOI: 10.1016/j.legalmed.2017.01.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Revised: 01/18/2017] [Accepted: 01/21/2017] [Indexed: 11/20/2022]
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21
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Rog CJ, Rosen DG, Gannon FH. Bilateral adrenal histoplasmosis in an immunocompetent man from Texas. Med Mycol Case Rep 2016; 14:4-7. [PMID: 27995051 PMCID: PMC5154969 DOI: 10.1016/j.mmcr.2016.11.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Revised: 11/27/2016] [Accepted: 11/28/2016] [Indexed: 12/31/2022] Open
Abstract
Disseminated histoplasmosis affecting the adrenal gland(s) of immunocompetent adults is a very rare infection. Here, we present a case of bilateral adrenal histoplasmosis in an immunocompetent, 62-year-old gentleman from Texas along with a brief review of the published literature. Given the risk of patient decompensation secondary to adrenal insufficiency and the wide availability of effective treatments, adrenal histoplasmosis must be considered even in immunocompetent adults who acquire adrenal masses.
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Affiliation(s)
- Colin J Rog
- Baylor College of Medicine, 1 Baylor Plaza, Houston, TX 77030, USA
| | - Daniel G Rosen
- Baylor College of Medicine, 1 Baylor Plaza, Houston, TX 77030, USA
| | - Francis H Gannon
- Baylor College of Medicine, 1 Baylor Plaza, Houston, TX 77030, USA
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22
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Typical Facial Lesions: A Window of Suspicion for Progressive Disseminated Histoplasmosis-A Case of Asian Prototype. Case Rep Infect Dis 2016; 2016:2865241. [PMID: 27752372 PMCID: PMC5056267 DOI: 10.1155/2016/2865241] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Accepted: 09/08/2016] [Indexed: 11/29/2022] Open
Abstract
Histoplasmosis is caused by a dimorphic fungus Histoplasma capsulatum in endemic areas, mainly America, Africa, and Asia. In India, it is being reported from most states; however, it is endemic along the Ganges belt. We report a case of an apparently immunocompetent male who presented with 3-month history of fever, cough, and weight loss with recent onset odynophagia and had hepatosplenomegaly and mucocutaneous lesions over the face. The differential diagnosis of leishmaniasis, tuberculosis, leprosy, fungal infection, lymphoproliferative malignancy, and other granulomatous disorders was considered, but he succumbed to his illness. Antemortem skin biopsy and bone marrow aspiration along with postmortem liver, lung, and spleen biopsy showed disseminated histoplasmosis. This case highlights the need for an early suspicion of progressive disseminated histoplasmosis in the presence of classical mucocutaneous lesions even in an immunocompetent patient suffering from a febrile illness. Cure rate approaches almost 100% with early treatment, whereas it is universally fatal if left untreated.
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Ghosh R, Mishra P, Sen S, Maiti PK, Chatterjee G. Experience of Varied Presentation of Chronic Progressive Disseminated Histoplasmosis in Immunocompetent Patients: A Diagnostic Conundrum. Indian J Dermatol 2016; 61:580. [PMID: 27688460 PMCID: PMC5029257 DOI: 10.4103/0019-5154.190128] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We report two cases of chronic progressive disseminated histoplasmosis with unusual and rare clinical picture in a patient with no underlying risk factor. One 50-year-old male, presented with hoarseness of voice, chronic cough, with a history of nonresponding anti-tubercular therapy, revealed mucocutaneous lesions on examination. Fungating vocal cord lesions were visualized on bronchoscopy, raised suspicion of carcinoma. The second case, a 22-year-old female, referred to hospital with suspected vasculitis, with complaints of "off and on" fever with decreased oral intake, arthralgia, who later developed generalized nodular skin eruptions. On investigation, human immunodeficiency virus test was found to be negative in both the cases. Histopathological findings of skin biopsy, adrenal and bone marrow aspirates raised suspicion, whereas fungal cultures confirmed Histoplasma infection. Although diagnosis was delayed, but both of them were successfully treated with amphotericin B.
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Affiliation(s)
- Roumi Ghosh
- Department of Microbiology, Institute of Postgraduate Medical Education and Research, Kolkata, West Bengal, India
| | - Pranshu Mishra
- Department of Dermatology, Institute of Postgraduate Medical Education and Research, Kolkata, West Bengal, India
| | - Sumit Sen
- Department of Dermatology, Institute of Postgraduate Medical Education and Research, Kolkata, West Bengal, India
| | - Prasanta Kumar Maiti
- Department of Microbiology, Institute of Postgraduate Medical Education and Research, Kolkata, West Bengal, India
| | - Govinda Chatterjee
- Department of Dermatology, Institute of Postgraduate Medical Education and Research, Kolkata, West Bengal, India
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24
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An Unusual Presentation of Disseminated Histoplasmosis: Case Report and Review of Pediatric Immunocompetent Patients from India. Mycopathologia 2015; 180:359-64. [PMID: 26126955 DOI: 10.1007/s11046-015-9917-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Accepted: 06/13/2015] [Indexed: 01/14/2023]
Abstract
Histoplasmosis is a progressive disease caused by dimorphic intracellular fungi and can prove fatal. Usually, it is present in immunocompromised individuals and immunocompetent individuals in the endemic zones. We report an unusual presentation of progressive disseminated histoplasmosis. The patient in the present case report was immunocompetent child and had fever, bone pains, gradual weight loss, lymphadenopathy and hepatosplenomegaly. Disseminated histoplasmosis (DH) was diagnosed on microscopic examination and fungal culture of bone marrow, blood, skin biopsy and lymph node aspirate. The patient died on seventh day of amphotericin B. In the absence of predisposing factors and classical clinical presentation of febrile neutropenia, lung, adrenal and oropharyngeal lesions, the disease posed a diagnostic challenge. Progressive disseminated histoplasmosis in children can be fatal despite timely diagnosis and therapy. In India, disseminated histoplasmosis is seen in immunocompetent hosts. All the pediatrics immunocompetent cases from India are also reviewed.
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25
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Cutaneous Manifestation of Underlying Disseminated Histoplasmosis in an Immunocompetent Host of Nonendemic Area with Reversible CD4 Cell Depletion and its Recovery on Antifungal Therapy. Mycopathologia 2015; 180:223-7. [PMID: 25894510 DOI: 10.1007/s11046-015-9892-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Accepted: 04/06/2015] [Indexed: 10/23/2022]
Abstract
We present the case of an 18-year-old male patient admitted with complaints of fever and rapid weight loss since 3 months. Patient had multiple umbilicated papular to nodular lesions over chin and forehead region. Complete blood count revealed bicytopenia. An excisional biopsy of the skin lesions had revealed cutaneous histoplasmosis. On further investigations for bicytopenia, histoplasmosis had been diagnosed on bone marrow trephine biopsy. For the immune status, patient's serology against HIV was negative and his CD4 lymphocyte counts were low at 161. Patient received antifungal therapy including amphotericin B and itraconazole. He showed remarkable improvement in his general condition and blood counts. A repeat CD4 count showed normal counts, and idiopathic CD4 lymphocytopenia was excluded. Disseminated histoplasmosis presenting as cutaneous lesions in an immunocompetent host is very rare, and we are not aware of any case report in the literature where there is reversible depletion of CD4 counts following antifungal treatment in an immunocompetent host of nonendemic area.
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In vitro antifungal susceptibility profile and correlation of mycelial and yeast forms of molecularly characterized Histoplasma capsulatum strains from India. Antimicrob Agents Chemother 2014; 58:5613-6. [PMID: 24982084 DOI: 10.1128/aac.02973-14] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The antifungal susceptibility profiles of the mycelial and yeast forms of 23 Histoplasma capsulatum strains from pulmonary and disseminated histoplasmosis patients in India are reported here. The MIC data of this dimorphic fungus had good agreement between both forms for azoles, amphotericin B, and caspofungin. Therefore, the use of mycelial inocula for H. capsulatum antifungal susceptibility testing is suggested, which is less time-consuming vis-à-vis the yeast form, which requires 6 to 8 weeks for conversion.
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