Chronic pulmonary histoplasmosis in the State of Rio de Janeiro, Brazil

Gastrointestinal Histoplasmosis Mimicking Crohn's Disease

Disseminated histoplasmosis is a life-threatening disease usually seen in immunocompromised patients living in endemic areas. We present an apparently immunocompetent patient with gastrointestinal histoplasmosis who was initially diagnosed with biopsy-proven Crohn's disease. Following discontinuation of anti-inflammatory drugs and institution of antifungal therapy, his gastrointestinal illness completely improved. Specific fungal staining should be routinely included in histopathologic assessment of tissue specimens diagnosed as Crohn's disease.

Clinical features and endemic trend of histoplasmosis in China: A retrospective analysis and literature review

INTRODUCTION

Histoplasmosis is a rare mycosis with nonspecific clinical manifestation and a high misdiagnosis rate, which is an epidemic disease that occurred in several endemic areas. Cases of histoplasmosis were sporadic in China.

OBJECTIVE

We detected the clinical characteristics and endemic trend of histoplasmosis to understand it more profoundly.

METHOD

The clinical data of 34 cases of histoplasmosis hospitalized in Xiangya Hospital of Central South University from 2003 to 2016 were analyzed retrospectively. The relevant literature were reviewed roundly which were about histoplasmosis from 2001 to 2019 reported in the Chinese mainland.

RESULTS

Thirty-four patients were included in the study, male predominance. About 44.1% were combined with underlying disease and HIV infection was observed in eight patients. Common clinical manifestations were fever (94.1%), followed by lymphadenopathy (70.6%) and anemia (67.6%). Organ involvement included lungs (52.9%), oral cavity (5.9%) and intestine (5.9%). Patients were diagnosed by bone marrow smears (44.1%), lymph node biopsy (41.1%), lung tissue biopsy (8.8%) and intestinal tissue biopsy (5.9%). About 70.6% received amphotericin B, while 38.2% received itraconazole therapy and 79.4% were improved. About 611 cases of histoplasmosis in the Chinese mainland were obtained in the study from the related literature, with 217 (37.0%) cases occurred in Yunnan province, 69 (11.9%) cases in Hunan province and 67 (11.6%) cases in Hubei province. All of them were high incidence area of histoplasmosis.

CONCLUSION

Histoplasmosis is a rare mycosis with high diagnosis rate and has a prominent geographical distribution in China, which should be considered highly in clinical work.

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.

Chronic cavitary pulmonary histoplasmosis

Histoplasmosis is a systemic mycosis caused by the thermally dimorphic fungus Histoplasma capsulatum, which can be isolated from soil contaminated with droppings from birds or bats. Chronic cavitary pulmonary histoplasmosis is one of the rarest clinical presentations of this disease. The differential diagnosis with tuberculosis should be made in patients presenting with cavitated lesions in upper lung segments. We report the case of a female patient with chronic cavitary pulmonary histoplasmosis who had presented with progressive dyspnea and worsening of the radiological pattern over a four-year period.

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.

Histoplasmose pulmonar cavitária crônica simulando tuberculose

OBJETIVO: Avaliar os casos de histoplasmose pulmonar crônica ocorridos nos últimos anos, atendidos no Complexo Hospitalar Santa Casa de Porto Alegre (RS). MÉTODOS: Foram revisados os casos atendidos nos últimos 25 anos no Complexo Hospitalar Santa Casa de Porto Alegre e descritos quatro casos diagnosticados por cultivo e/ou achado histopatológico, corroborados por teste soromicológico. São comentados os casos da literatura brasileira. RESULTADOS: As manifestações clínicas preponderantes foram tosse produtiva, dispnéia, febre, anorexia e emagrecimento. Nos achados radiológicos pulmonares predominaram enfisema, cavidades cistóides, bronquiectasias e espessamento pleural. Os pacientes apresentaram história epidemiológica de contato com fezes de galinha. Num paciente, houve colonização de cavidade por Aspergillus fumigatus. CONCLUSÃO: A histoplasmose pulmonar crônica deve ser considerada na presença de lesões cavitárias em lobos superiores em pacientes com doença pulmonar obstrutiva crônica, baciloscopia negativa no escarro e não reatores à tubeculina. Hemoptise em vigência de lesões tardias ou doença curada sugerem colonização aspergilar.

Genetic diversity of Histoplasma capsulatum strains isolated from soil, animals, and clinical specimens in Rio de Janeiro State, Brazil, by a PCR-based random amplified polymorphic DNA assay

Little is known about the genetic strain diversity and geographical range of Histoplasma capsulatum isolated in Rio de Janeiro State, Brazil. We characterized 13 environmental, 7 animal, and 28 clinical H. capsulatum isolates by using a PCR-based random amplified polymorphic DNA (RAPD) assay. DNA fingerprinting of these soil, animal, and clinical specimens was performed with four primers (1253, 1281, D-9355, and D-10513) and generated amplicons with considerable polymorphism. Although all of the isolates exhibited more than 80% genetic relatedness, they could be clustered into four to six genotypes for each primer. The RAPD profiles of H. capsulatum isolated from Rio de Janeiro State could be distinguished from those of the U.S. strains included in this study (Downs, G222B, G-186B, and FLS1) by showing less than 70% similarity to each primer. The genetic polymorphisms between H. capsulatum strains isolated from animals and soil obtained in the same geographic areas were 100% similar, suggesting that an environmental microniche could be acting as a source of infection for animals and the local human population.