Fatal histoplasmosis in a non-HIV patient in French Guiana

Disseminated histoplasmosis in Peruvian non-HIV patients: an underrecognized endemic disease

BACKGROUND

Histoplasmosis is a worldwide mycosis with endemic areas throughout Latin America. Disseminated histoplasmosis (DH) has been described in Peru, but there are few reports about its clinical presentation in non-HIV patients.

METHODS

Case series was done with review of clinical and laboratory charts from Hospital Cayetano Heredia and Instituto de Medicina Tropical Alexander von Humboldt. Eight patients meet the case definition: HIV negative test and definitive diagnosis of DH (isolation of H. capsulatum in culture and/or presence of yeasts on the histopathology), between 2000-2019.

RESULTS

Six were men with median age of 53 years [IQR 35-63,5], most of them were farmers or merchants and with a history of being born in or traveled to the jungle. The median time of illness until diagnosis was 390 days [IQR 60-730] and in 7 out 8 cases the diagnosis was made by isolation of fungi in culture. Isolates required 11 days [IQR 10-18] to become detectable in culture. Six cases had another concomitant disease that probably caused an immunosuppression.

CONCLUSION

DH form occurs rarely in apparently healthy people. In this series, men in their fifties, working in farming or merchant, with history of being born in or traveled to the jungle were the most frequent epidemiological characteristics. Culture and histopathology were used for the diagnosis but obtaining the results required several days. It is necessary the use of other faster techniques and to strengthen the clinical awareness about this disease.

Miliary Histoplasmosis in a Patient with Rheumatoid Arthritis

Miliary histoplasmosis is a rare presentation that may mimic miliary tuberculosis. We report a case of miliary histoplasmosis in a 52-year-old male who was being treated with hydroxychloroquine, methotrexate, and sulfasalazine for his rheumatoid arthritis and presented to the emergency department with shortness of breath and fevers. Computed tomography (CT) chest revealed miliary pulmonary nodules. Urine Histoplasma antigen and serum Histoplasma antigen were negative; however, Coccidioides immitis complement immunofixation assay and Coccidioides IgM were positive. The patient was initiated on treatment for pulmonary coccidioidomycosis and immunosuppression was held. However, a few days later, Histoplasma capsulatum was isolated from cultures from bronchoscopy. This case highlights the difficulty in diagnosing histoplasmosis in immunocompromised patients and the importance of having a broad differential diagnosis for miliary pulmonary nodules. Tissue culture and histopathology remain the gold standard for the diagnosis of histoplasmosis. Further research needs to be conducted to determine the optimal duration of histoplasmosis treatment in immunocompromised patients.

Chronic Pulmonary Histoplasmosis and its Clinical Significance: an Under-reported Systemic Fungal Disease

Histoplasmosis is a systemic fungal mycosis caused by Histoplasmacapsulatum. It is a dimorphic fungus which lives as a saprophyte in the environment and occasionally infects immunosuppressed people. H capsulatum is a ubiquitous fungus present throughout the globe and is more common in the temperate world. Human infection with H capsulatum occurs through respiratory route by inhalation of spores present in the air as droplet nuclei. Pulmonary histoplasmosis is difficult to diagnose, more so in the regions where tuberculosis is endemic, and many infected patients remain asymptomatic. In the case of immunosuppression, clinical symptoms of pulmonary infection may be seen along with chances of dissemination. We report a case of chronic pulmonary histoplasmosis in an immunocompetent individual.