Histoplasmosis of the oral cavity, oropharynx and larynx

Metagenomic next-generation sequencing identified Histoplasma capsulatum in the lung and epiglottis of a Chinese patient: A case report

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.

Subacute histoplasmosis with focal involvement of the epiglottis: importance of differential diagnosis

Histoplasmosis is an endemic mycosis of the Americas, Africa, and Asia. In Spain, it is the most common imported endemic mycosis appearing in the literature, and its incidence is on the rise. Proper differential diagnosis of the disease must be taken into consideration by otorhinolaryngologists, as the clinical manifestations of histoplasmosis may simulate more prevalent diseases such as cancer or tuberculosis. We present the case of a Spanish patient with focal involvement of the larynx and offer a review of the relevant literature.

Oral histoplasmosis in an HIV-negative patient

Histoplasmosis is a deep mycosis caused by Histoplasma capsulatum, which has been found in soil with accumulated excreta of bats and birds. This disease has variable clinical findings with only pulmonary or systemic involvement. Upper aerodigestive lesions are found mainly associated with systemic disease, affecting particularly patients with immunosuppression conditions mainly caused by HIV. However, it is uncommon in immunocompetent patients. This report describes a case of oro-laryngeal-esophageal histoplasmosis in a HIV-seronegative patient without detectable systemic involvement.

Molecular detection of Cellulosimicrobium cellulans as the etiological agent of a chronic tongue ulcer in a human immunodeficiency virus-positive patient

Ulcerations appeared on the tongue of a 48-year-old human immunodeficiency virus-positive man. Histological findings of the biopsy specimen and the fact that the patient had resided in Louisiana led us to suspect "American histoplasmosis". A new ulcer appeared while the patient was being treated with itraconazole, and the gene for 16S rRNA of Cellulosimicrobium cellulans was amplified. The lesions healed during treatment with oral penicillin and azithromycin.

[Histoplasmosis of the oral cavity]

Histoplasmosis is an endemic mycosis. Histoplasma capsulatum, and duboisiï are the pathogenic agents in humans. The disease is reported as endemic in more than 30 countries. Three clinical forms are distinguished; acute, chronic and disseminated. Oral lesions may take on different clinical aspects which are often associated with disseminated histoplasmosis. Disseminated histoplasmosis is frequently diagnosed in immunocompromised hosts. High risk of mortality dictates rapid diagnosis and treatment.

Epiglottic histoplasmosis presenting in a nonendemic region: a clinical mimic of laryngeal carcinoma

Histoplasma capsulatum is a dimorphic fungus endemic to North America. Histoplasmosis is primarily an inhalation-acquired mycosis that is encountered rarely outside of endemic regions. In nonendemic regions, histoplasmosis may present a diagnostic challenge and both clinical and laboratory vigilance are required to accurately identify infection. Unusual clinical presentations with limited physical findings may compound the difficulty in diagnosis. We describe a 78-year-old retired soil science professor who presented with an eroded epiglottic mass secondary to disseminated histoplasmosis in a nonendemic region (Alberta). Clinically, this mass was thought to represent a primary laryngeal carcinoma, as no other buccal or oropharyngeal ulcers were identified. Histoplasmosis was confirmed by tissue biopsy and a positive immunodiffusion test for immunoglobulin G. Disseminated histoplasmosis is often associated with laryngeal and oropharyngeal disease; however, isolated epiglottic histoplasmosis is rare. Histoplasmosis should be included in the differential diagnosis of neoplasms and chronic ulcers of the upper aerodigestive tract.

Laryngeal Histoplasmosis

Histoplasma capsulatum is an endemic fungus found in moist, fertile soil; in North America, it is most prevalent in the river valleys of the central United States. Most primary infections in the immunocompetent host are asymptomatic or are thought to be a flu-like illness. Disseminated histoplasmosis most commonly occurs in immunosuppressed patients. Histoplasmosis infection involving the larynx is an extremely rare manifestation. Here, we describe the case of an immunocompetent man with symptomatic, acute pulmonary histoplasmosis with laryngeal involvement who presented with a chief complaint of hoarseness. We also review the literature of immunocompetent patients with laryngeal histoplasmosis.

Diagnosis and Management of Candida and Other Fungal Infections of the Head and Neck

Fungi are common inhabitants of the oral and nasal mucosa, and therefore the differentiation between colonization and pathogenicity in the setting of upper respiratory tract infection symptoms can be difficult. Fungal head and neck infections occur in both immunocompetent and immunocompromised persons, and patients with neutropenia, diabetes mellitus, corticosteroid use, and HIV infection are particularly susceptible to serious and potentially life-threatening infections. Invasive fungal head and neck infections generally require extensive surgical debridement and prolonged systemic antifungal therapy, and frequently carry a poor prognosis when the underlying immunosuppression cannot be corrected. In contrast, noninvasive fungal head and neck infections often respond to short courses of systemic or topical antifungal therapy, or require limited surgical debridement alone.

Non-plaque-induced gingival lesions

The origin of gingival inflammation is occasionally different from that of routine plaque-associated gingivitis, and such non-plaque-associated types of gingivitis often present characteristic clinical features. Examples of such forms of gingivitis are specific bacterial, viral, and fungal infections. Specific bacterial infections of gingiva may be due to Neisseria gonorrhea, Treponema pallidum, streptococci, and other organisms. The most important viral infections of gingiva are herpes simplex virus type 1 and 2 and varicella-zoster virus. Fungal infections may be caused by several fungi, the most important of these being Candida species including C. albicans, C. glabrata, C. krusei, C. tropicalis, C. parapsilosis, and C. guillermondii. Gingival histoplasmosis is a granulomatous disease caused by the fungus Histoplasma capsulatum and, as for the other specific infections of gingiva, a confirmed diagnosis may require histopathologic examination and/or culture. Atypical gingivitis may also occur as gingival manifestations of dermatological diseases, the most relevant of these being lichen planus, pemphigoid, pemphigus vulgaris, erythema multiforme, and lupus erythematosus. Non-plaque induced gingival inflammation can be caused by allergic reactions to dental restorative materials, toothpastes, mouthwashes, and foods. In addition, gingival inflammation may result from toxic reactions, foreign body reactions, or mechanical and thermal trauma.

Oral histoplasmosis: a case report

We report a case of biopsy-proven histoplasmosis in an 81-year-old man with mouth ulcers. The initial infection was probably contracted whilst he was a prisoner of war in Sumatra, and was reactivated during intercurrent illness with congestive cardiac failure and oral corticosteroid treatment for idiopathic thrombocytopaenic purpura. Of particular note is the latent period of 50 years, and a positive cytoplasmic antineutrophil cytoplasmic antibody (cANCA) titre.