1
|
Szvalb AD, Yepez Guevara E, Euscher E, Nahmod KA, Kontoyiannis DP. Acute Peritoneal Histoplasmosis Mimicking Ovarian Cancer and Review of the Literature on Histoplasma Peritonitis. Open Forum Infect Dis 2023; 10:ofac705. [PMID: 36686636 PMCID: PMC9850267 DOI: 10.1093/ofid/ofac705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Accepted: 01/08/2023] [Indexed: 01/11/2023] Open
Abstract
Peritoneal histoplasmosis is a rare entity with few cases reported in the literature. We present a case of isolated acute peritoneal histoplasmosis that mimicked an advanced ovarian malignancy in a patient undergoing antitumor necrosis factor therapy for rheumatoid arthritis. We also reviewed the literature on Histoplasma peritonitis.
Collapse
Affiliation(s)
- Ariel D Szvalb
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Eduardo Yepez Guevara
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Elizabeth Euscher
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Karen A Nahmod
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Dimitrios P Kontoyiannis
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| |
Collapse
|
2
|
Ounsinman T, Chongtrakool P, Angkasekwinai N. Continuous ambulatory peritoneal dialysis-associated Histoplasma capsulatum peritonitis: a case report and literature review. BMC Infect Dis 2020; 20:717. [PMID: 32993529 PMCID: PMC7526214 DOI: 10.1186/s12879-020-05441-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 09/23/2020] [Indexed: 11/25/2022] Open
Abstract
Background Fungal peritonitis (FP) is a rare complication of peritoneal dialysis. We herein describe the second case in Asia of Histoplasma capsulatum peritonitis associated with continuous ambulatory peritoneal dialysis (CAPD). Case presentation An 85-year-old woman with end-stage renal disease (ESRD) who had been on CAPD for 3 years and who had a history of 3 prior episodes of peritonitis presented with intermittent abdominal pain for 2 weeks and high-grade fever for 3 days. Elevated white blood cell (WBC) count and rare small oval budding yeasts were found in her peritoneal dialysis (PD) fluid. From this fluid, a white mold colony was observed macroscopically after 7 days of incubation, and numerous large, round with rough-walled tuberculate macroconidia along with small smooth-walled microconidia were observed microscopically upon tease slide preparation, which is consistent with H. capsulatum. The peritoneal dialysis (PD) catheter was then removed, and it also grew H. capsulatum after 20 days of incubation. The patient was switched from CAPD to hemodialysis. The patient was successfully treated with intravenous amphotericin B deoxycholate (AmBD) for 2 weeks, followed by oral itraconazole for 6 months with satisfactory result. The patient remains on hemodialysis and continues to be clinically stable. Conclusion H. capsulatum peritonitis is an extremely rare condition that is associated with high morbidity and mortality. Demonstration of small yeasts upon staining of PD fluid, and isolation of slow growing mold in the culture of clinical specimen should provide important clues for diagnosis of H. capsulatum peritonitis. Prompt removal of the PD catheter and empirical treatment with amphotericin B or itraconazole is recommended until the culture results are known.
Collapse
Affiliation(s)
- Thanat Ounsinman
- Division of Infectious Diseases and Tropical Medicine, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Piriyaporn Chongtrakool
- Department of Microbiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Nasikarn Angkasekwinai
- Division of Infectious Diseases and Tropical Medicine, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
| |
Collapse
|
3
|
Fino-Velásquez LM, Zambrano-Muñoz FS, Vega-Molina A, Sierra-Umaña SF, Rosero-Paredes SJ, Barrios-Villegas JE, Arce-Cuervo J, Urrutia-Corredor LC, Díaz-Rojas CA. Peritoneal histoplasmosis. Case report. Case reports 2019. [DOI: 10.15446/cr.v5n2.78652] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Introduction: Histoplasmosis is an opportunistic granulomatous fungal infection. Peritoneal histoplasmosis (PH) is a rare form of disseminated histoplasmosis (DH).Case description: A 44-year-old male patient with history of HIV infection, systemic lupus erythematosus with lupus nephritis, and chronic kidney disease on peritoneal dialysis, presented with recurrent ascites without clear etiology in the serial study of ascitic fluid. Contrast computed tomography of the abdomen showed a nonspecific peritoneal nodule, for which laparoscopy and biopsy were performed, identifying Histoplasma capsulatum infection. The subject received 15 days of in-hospital treatment with amphotericin B deoxycholate with good evolution, no recurrence of ascites, and indefinite outpatient management with itraconazole.Discussion: The first case of PH was described in 1970 but this is the first case reported in Colombia. Most cases of PH have been associated with peritoneal dialysis. Its diagnosis is based on the study of ascitic fluid and its treatment follows the guidelines of other forms DH.Conclusions: PH is a rare entity that requires high clinical suspicion, especially in immunocompromised patients.
Collapse
|
4
|
Sardar A, Thajudeen B, Kadambi PV. Histoplasma Peritonitis: An Extremely Rare Complication of Peritoneal Dialysis. Case Rep Nephrol 2018; 2018:8015230. [PMID: 29862101 PMCID: PMC5971350 DOI: 10.1155/2018/8015230] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Accepted: 03/12/2018] [Indexed: 11/18/2022] Open
Abstract
Bacterial peritonitis is a common complication of peritoneal dialysis, but fungal peritonitis is unusual and is mostly due to Candida species. Peritonitis due to Histoplasma capsulatum is rare and we report one such case. A 63-year-old female presented with progressively worsening abdominal pain, fever, and altered mental status. She had end-stage renal disease and had been on peritoneal dialysis for 4 years. She had abdominal tenderness without rebound or guarding. Laboratory studies and CT of abdomen were significant for leukocytosis and peritoneal membrane thickening, respectively. Peritoneal dialysis fluid study was consistent with peritonitis and culture of the fluid grew Histoplasma capsulatum. Treatment recommendations include removal of catheter and initiation of antifungal therapy. With the availability of newer antifungals, medical management without removal of PD catheter is possible, but at the same time if there is no response to treatment within a week, PD catheter should be removed promptly.
Collapse
Affiliation(s)
- Asjad Sardar
- Division of Nephrology, Department of Medicine, University of Arizona, Tucson, AZ, USA
| | - Bijin Thajudeen
- Division of Nephrology, Department of Medicine, University of Arizona, Tucson, AZ, USA
| | - Pradeep V. Kadambi
- Department of Medicine, University of Florida College of Medicine-Jacksonville, Jacksonville, FL, USA
| |
Collapse
|
5
|
Carreto-Binaghi LE, Damasceno LS, Pitangui Nde S, Fusco-Almeida AM, Mendes-Giannini MJ, Zancopé-Oliveira RM, Taylor ML. Could Histoplasma capsulatum Be Related to Healthcare-Associated Infections? Biomed Res Int 2015; 2015:982429. [PMID: 26106622 DOI: 10.1155/2015/982429] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Revised: 05/12/2015] [Accepted: 05/12/2015] [Indexed: 02/07/2023]
Abstract
Healthcare-associated infections (HAI) are described in diverse settings. The main etiologic agents of HAI are bacteria (85%) and fungi (13%). Some factors increase the risk for HAI, particularly the use of medical devices; patients with severe cuts, wounds, and burns; stays in the intensive care unit, surgery, and hospital reconstruction works. Several fungal HAI are caused by Candida spp., usually from an endogenous source; however, cross-transmission via the hands of healthcare workers or contaminated devices can occur. Although other medically important fungi, such as Blastomyces dermatitidis, Paracoccidioides brasiliensis, and Histoplasma capsulatum, have never been considered nosocomial pathogens, there are some factors that point out the pros and cons for this possibility. Among these fungi, H. capsulatum infection has been linked to different medical devices and surgery implants. The filamentous form of H. capsulatum may be present in hospital settings, as this fungus adapts to different types of climates and has great dispersion ability. Although conventional pathogen identification techniques have never identified H. capsulatum in the hospital environment, molecular biology procedures could be useful in this setting. More research on H. capsulatum as a HAI etiologic agent is needed, since it causes a severe and often fatal disease in immunocompromised patients.
Collapse
|
6
|
Barocas JA, Gauthier GM. Peritonitis caused by Blastomyces dermatitidis in a kidney transplant recipient: case report and literature review. Transpl Infect Dis 2014; 16:634-41. [PMID: 24862205 DOI: 10.1111/tid.12234] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2014] [Revised: 01/28/2014] [Accepted: 02/08/2014] [Indexed: 11/27/2022]
Abstract
Blastomyces dermatitidis is a dimorphic fungus endemic to the midwestern, south-central, and southeastern United States known to cause disseminated infection in immunocompromised individuals. We report a case of B. dermatitidis peritonitis in a renal allograft recipient with new-onset ascites and cytomegalovirus encephalitis. Peritoneal blastomycosis is a rare clinical entity and, to our knowledge, this patient represents the first known case of peritoneal blastomycosis in a solid organ transplant recipient. We review the clinical characteristics of B. dermatitidis peritonitis as well as the literature on fungal peritonitis with emphasis on dimorphic fungal pathogens. Clinical features suggestive of fungal peritonitis include new-onset ascites, abdominal pain, and fevers, especially with antecedent or concomitant pneumonia. A high index of clinical suspicion, along with the use of culture and non-culture diagnostics, is needed for early diagnosis and prompt initiation of therapy.
Collapse
Affiliation(s)
- J A Barocas
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | | |
Collapse
|
7
|
Abstract
BACKGROUND A 62-year-old man with a history of end-stage renal disease secondary to hypertension who was on continuous ambulatory peritoneal dialysis (CAPD), presented to a peritoneal dialysis clinic with subacute onset of abdominal pain, mainly in the epigastric region. INVESTIGATIONS Full medical history, physical examination, laboratory tests, cultures of peritoneal dialysis fluid, radiography, ultrasonography and CT scanning of the abdomen and pelvis. DIAGNOSIS Isolated fungal peritonitis caused by infection with Histoplasma capsulatum. MANAGEMENT Removal of the peritoneal dialysis catheter, treatment with itraconazole for 6 months.
Collapse
|
8
|
Marcic SM, Kammeyer PL, Aneziokoro C, Bartnicki L, Yong S, Leehey DJ. "Culture-negative" peritonitis due to Histoplasma capsulatum. Nephrol Dial Transplant 2006; 21:3002. [PMID: 16782994 DOI: 10.1093/ndt/gfl323] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|
9
|
Abstract
Of 156 cases of histoplasmosis observed in the State of Rio Grande do Sul (Brazil), during a 21-year period (1978-1999) 137 were included in this study. Sixty-seven per cent of the patients had hematogeneous disseminated histoplasmosis, 24% had a self-limited syndrome (acute pulmonary histoplasmosis, histoplasmoma or primary pulmonary lymph node complex), and 9 per cent had chronic pulmonary histoplasmosis. Clinical, mycological, and epidemiological data were reviewed and commented.
Collapse
Affiliation(s)
- L C Severo
- Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, RS, Brasil.
| | | | | | | | | |
Collapse
|
10
|
Shin JH, Lee SK, Suh SP, Ryang DW, Kim NH, Rinaldi MG, Sutton DA. Fatal Hormonema dematioides peritonitis in a patient on continuous ambulatory peritoneal dialysis: criteria for organism identification and review of other known fungal etiologic agents. J Clin Microbiol 1998; 36:2157-63. [PMID: 9650991 PMCID: PMC105020 DOI: 10.1128/jcm.36.7.2157-2163.1998] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
We report a fatal case a fungal peritonitis caused by the yeast-like dematiaceous mould Hormonema dematioides in a 45-year-old woman. The woman had a 13-year history of insulin-dependent diabetes mellitus and had been on continuous ambulatory peritoneal dialysis for chronic renal failure. H. dematioides was repeatedly isolated from the dialysate culture specimens collected on days 3, 9, 16, and 20 of her hospital stay. Preliminary culture reports on day 7 of the growth of a yeast-like fungus, a probable Candida species, prompted the administration of fluconazole (FLU). Intraperitoneal and intravenous FLU failed to eliminate the mould, and the patient expired on day 21 of her hospital stay. We use this case to present what appears to be the first report of fungal peritonitis due to H. dematioides, to provide laboratorians with criteria for differentiating this organism from the similar mould Aureobasidium pullulans and from various yeast genera, and to provide a review of known fungal taxa inciting peritonitis.
Collapse
Affiliation(s)
- J H Shin
- Department of Clinical Pathology, Chonnam University Medical School, Kwangju, Korea
| | | | | | | | | | | | | |
Collapse
|