amphotericin-b and Histoplasmosis

The knowledge of central nervous system (CNS) histoplasmosis is limited to case reports and series.. Our objective was to synthesise clinical, radiological and laboratory characteristics of CNS histoplasmosis to improve our understanding of this rare disease.. We performed a systematic review using Pubmed/MEDLINE, Embase and LILACS databases accessed on March 2023 without publication date restrictions. Inclusion criteria comprised: (1) histopathological, microbiological, antigen or serological evidence of histoplasmosis; (2) CNS involvement based on cerebrospinal fluid pleocytosis or neuroimaging abnormalities. We classified the certainty of the diagnosis in proven (CNS microbiological and histopathological confirmation), probable (CNS serological and antigen confirmation) or possible (non-CNS evidence of histoplasmosis). Metaproportion was used to provide a summary measure with 95% confidence intervals for the clinical, radiological and laboratory characteristics. Chi-squared test was used to compare mortality between pairs of antifungal drugs.. We included 108 studies with 298 patients. The median age was 31 years, predominantly male, and only 23% were immunocompromised (134/276, 95%CI: 3-71), mainly due to HIV infection. The most common CNS symptom was headache (130/236, 55%, 95%CI: 49-61), with a duration predominantly of weeks or months. Radiological presentation included histoplasmoma (79/185, 34%, 95%CI: 14-61), meningitis (29/185, 14%, 95%CI: 7-25), hydrocephalus (41/185, 37%, 95%CI: 7-83) and vasculitis (18/185, 6%, 95%CI: 1-22). There were 124 proven cases, 112 probable cases and 40 possible cases. The majority of patients presented positive results in CNS pathology (90%), serology (CSF: 72%; serum: 70%) or CSF antigen (74%). Mortality was high (28%, 56/198), but lower in patients who used liposomal amphotericin B and itraconazole. Relapse occurred in 13% (23/179), particularly in HIV patients, but less frequently in patients who used itraconazole.. Central nervous system histoplasmosis usually presents subacute-to-chronic symptoms in young adults. Neuroimaging patterns included not only focal lesions but also hydrocephalus, meningitis and vasculitis. Positive results were commonly found in CSF antigen and serology. Mortality was high, and treatment with liposomal amphotericin B followed by itraconazole may decrease mortality.

Topics: Adult; Antifungal Agents; Central Nervous System; Female; Histoplasmosis; HIV Infections; Humans; Hydrocephalus; Itraconazole; Male; Meningitis; Vasculitis; Young Adult

Hemophagocytic lymphohistiocytosis (HLH) secondary to

Topics: Amphotericin B; Antifungal Agents; Histoplasmosis; HIV Infections; Humans; Lymphohistiocytosis, Hemophagocytic; Male; Middle Aged

The Republic of Congo (RoC) is one of the African countries with the most histoplasmosis cases reported. This review summarizes the current status regarding epidemiology, diagnostic tools, and treatment of histoplasmosis in the RoC. A computerized search was performed from online databases Medline, PubMed, HINARI, and Google Scholar to collect literature on histoplasmosis in the RoC. We found 57 cases of histoplasmosis diagnosed between 1954 and 2019, corresponding to an incidence rate of 1-3 cases each year without significant impact of the AIDS epidemic in the country. Of the 57 cases, 54 (94.7%) were cases of Histoplasma capsulatum var. duboisii (Hcd) infection, African histoplasmosis. Three cases (5.3%) of Histoplasma capsulatum var. capsulatum infection were recorded, but all were acquired outside in the RoC. The patients' ages ranged between 13 months to 60 years. An equal number of cases were observed in adults in the third or fourth decades (n = 14; 24.6%) and in children aged ≤15 years. Skin lesions (46.3%), lymph nodes (37%), and bone lesions (26%) were the most frequent clinical presentations. Most diagnoses were based on histopathology and distinctive large yeast forms seen in tissue. Amphotericin B (AmB) was first line therapy in 65% of the cases and itraconazole (25%) for maintenance therapy. The occurrence of African histoplasmosis in apparently normal children raises the possibility that African histoplasmosis is linked to environmental fungal exposure.

Topics: Adolescent; Adult; Amphotericin B; Antifungal Agents; Bone and Bones; Child; Child, Preschool; Congo; Environmental Exposure; Female; Histoplasma; Histoplasmosis; Humans; Infant; Itraconazole; Lymph Nodes; Male; Middle Aged; Skin; Young Adult

Histoplasmosis is a global disease endemic to regions of all six inhabited continents. The areas of highest endemicity lie within the Mississippi and Ohio River Valleys of North America and parts of Central and South America. As a result of climate change and anthropogenic land utilization, the conditions suitable for

Topics: Amphotericin B; Antifungal Agents; Histoplasma; Histoplasmosis; Humans; Immunocompromised Host; Itraconazole; Pneumonia; Radiography

Progressive disseminated histoplasmosis (PDH) is a serious fungal infection that affects people living with HIV. The best way to treat the condition is unclear.. We assessed evidence in three areas of equipoise. 1. Induction. To compare efficacy and safety of initial therapy with liposomal amphotericin B versus initial therapy with alternative antifungals. 2. Maintenance. To compare efficacy and safety of maintenance therapy with 12 months of oral antifungal treatment with shorter durations of maintenance therapy. 3. Antiretroviral therapy (ART). To compare the outcomes of early initiation versus delayed initiation of ART.. We searched the Cochrane Infectious Diseases Group Specialized Register; Cochrane CENTRAL; MEDLINE (PubMed); Embase (Ovid); Science Citation Index Expanded, Conference Proceedings Citation Index-Science, and BIOSIS Previews (all three in the Web of Science); the WHO International Clinical Trials Registry Platform, ClinicalTrials.gov, and the ISRCTN registry, all up to 20 March 2020.. We evaluated studies assessing the use of liposomal amphotericin B and alternative antifungals for induction therapy; studies assessing the duration of antifungals for maintenance therapy; and studies assessing the timing of ART. We included randomized controlled trials (RCT), single-arm trials, prospective cohort studies, and single-arm cohort studies.. Two review authors assessed eligibility and risk of bias, extracted data, and assessed certainty of evidence. We used the Cochrane 'Risk of bias' tool to assess risk of bias in randomized studies, and ROBINS-I tool to assess risk of bias in non-randomized studies. We summarized dichotomous outcomes using risk ratios (RRs), with 95% confidence intervals (CI).. We identified 17 individual studies. We judged eight studies to be at critical risk of bias, and removed these from the analysis. 1. Induction We found one RCT which compared liposomal amphotericin B to deoxycholate amphotericin B. Compared to deoxycholate amphotericin B, liposomal amphotericin B may have higher clinical success rates (RR 1.46, 95% CI 1.01 to 2.11; 1 study, 80 participants; low-certainty evidence). Compared to deoxycholate amphotericin B, liposomal amphotericin B has lower rates of nephrotoxicity (RR 0.25, 95% CI 0.09 to 0.67; 1 study, 77 participants; high-certainty evidence). We found very low-certainty evidence to inform comparisons between amphotericin B formulations and azoles for induction therapy. 2. Maintenance We found no eligible study that compared less than 12 months of oral antifungal treatment to 12 months or greater for maintenance therapy. For both induction and maintenance, fluconazole performed poorly in comparison to other azoles. 3. ART We found one study, in which one out of seven participants in the 'early' arm and none of the three participants in the 'late' arm died.. Liposomal amphotericin B appears to be a better choice compared to deoxycholate amphotericin B for treating PDH in people with HIV; and fluconazole performed poorly compared to other azoles. Other treatment choices for induction, maintenance, and when to start ART have no evidence, or very low certainty evidence. PDH needs prospective comparative trials to help inform clinical decisions.

Topics: Amphotericin B; Anti-HIV Agents; Antifungal Agents; Cohort Studies; Deoxycholic Acid; Drug Administration Schedule; Fluconazole; Histoplasmosis; HIV Infections; Humans; Induction Chemotherapy; Itraconazole; Kidney; Liposomes; Maintenance Chemotherapy; Randomized Controlled Trials as Topic

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).. 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.. 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.

Topics: Administration, Intravenous; Administration, Oral; Aged, 80 and over; Amphotericin B; Antifungal Agents; Asia; Deoxycholic Acid; Drug Combinations; Female; Histoplasma; Histoplasmosis; Humans; Itraconazole; Kidney Failure, Chronic; Peritoneal Dialysis, Continuous Ambulatory; Peritonitis; Treatment Outcome

Case report We report the case of a young Cameroonian woman who presented with cough, hyperthermia, weight loss, pancytopenia, and hepatosplenomegaly. A positive HIV serology was discovered and a chest radiography revealed a 'miliary pattern'. Bone marrow aspiration pointed out yeast inclusions within macrophages. Given the morphological aspect, the clinical presentation and immunosuppression, histoplasmosis was retained as a working hypothesis. Antiretroviral and amphotericin B treatments were promptly initiated. Review Given the immigration wave that Europe is currently experiencing, we think it is important to share experience and knowledge, especially in non-endemic areas such as Europe, where clinicians are not used to face this disease. Histoplasmosis is due to Histoplasma capsulatum var. capsulatum, a dimorphic fungus. Infection occurs by inhaling spores contained in soils contaminated by bat or bird droppings. The clinical presentation depends on the immune status of the host and the importance of inoculum, varying from asymptomatic to disseminated forms. AIDS patients are particularly susceptible to develop a severe disease. Antigen detection, molecular biology techniques, and microscopic examination are used to make a rapid diagnosis. However, antigen detection is not available in Europe and diagnosis needs a strong clinical suspicion in non-endemic areas. Because of suggestive imagery, clinicians might focus on tuberculosis. Our case illustrates the need for clinicians to take histoplasmosis in the differential diagnosis, depending on the context and the patient's past history.

Topics: Adult; AIDS-Related Opportunistic Infections; Amphotericin B; Anti-Retroviral Agents; Antifungal Agents; Bone Marrow Cells; Female; Histoplasma; Histoplasmosis; HIV Infections; Humans; Pancytopenia

Histoplasmosis is an endemic fungus in several regions of the United States. The diagnosis and treatment of this infection can be challenging in pediatric oncology patients. We present 5 patients diagnosed with histoplasmosis while receiving treatment at a midsize pediatric oncology center in Iowa. Two cases occurred in patients with acute lymphoblastic leukemia and 3 cases in patients with solid tumors. All patients were treated with antifungal therapy and demonstrated excellent clinical response. Histoplasmosis should be considered as a potential cause of nonspecific febrile illness, pulmonary masses, and bone marrow suppression in immunocompromised patients in endemic regions. Prompt and accurate diagnosis can facilitate timely antifungal therapy and avoidance of prolonged hospital stays, invasive testing, unnecessary antibiotics, and unwarranted anticancer therapies.

Topics: Abdominal Neoplasms; Adolescent; Amphotericin B; Antifungal Agents; Antineoplastic Combined Chemotherapy Protocols; Bone Marrow; Burkitt Lymphoma; Child; Child, Preschool; Combined Modality Therapy; Desmoplastic Small Round Cell Tumor; Diagnosis, Differential; Early Diagnosis; Endemic Diseases; Febrile Neutropenia; Histoplasmosis; Humans; Immunocompromised Host; Infant; Iowa; Itraconazole; Lung; Lung Neoplasms; Opportunistic Infections; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Sarcoma

To explore the clinical characteristics, imaging manifestation, diagnosis and treatment for histoplasmosis and to improve therapeutic level, we retrospectively analyzed the clinical data of 8 patients with biopsy-confirmed histoplasmosis from 2004 to 2014 in the Second Xiangya Hospital of Central South University and reviewed relevant literatures. The main clinical symptoms of histoplasmosis included fever, cough, expectoration, chest pain, blood-stained sputum, lymphadenectasis, etc. The major lung imaging features were mass, node or pneumonia-like performance. No case was diagnosed as histoplasimosis firstly. Four patients whose imaging manifestations were focal pulmonary lesion received lobectomy of lung lesions or wedge resection. Clinical and imaging manifestations in 3 patients, who treated with amphotericin B or its liposomal, itraconazole or fluconazole, were improved. The clinical symptoms and imaging findings of histoplasmosis are nonspecific. It is easy for the physicians to misdiagnose histoplasmosis as bacterial infection, lung cancer, tuberculosis lymphoma, etc. Therefore, it is significant and necessary to carry out multiple biopsies combined with multiple etiological examinations for patients with difficult diagnosis.. 为探讨组织胞浆菌病(histoplasmosis，HP)的临床特点、影像学表现和诊疗方法，以提高该疾病的诊治率，回顾性分析了中南大学湘雅二医院2004年至2014年经病理组织学确诊的8例住院HP患者的临床资料。8例HP患者的临床表现主要有发热、咳嗽、咳痰、胸痛、痰中带血、淋巴结肿大等；肺部影像学表现主要为团块状、结节样或肺炎型改变。无1例患者首诊考虑肺部真菌病。4例表现为局灶肺部病变的患者均采用手术切除，3例患者采用两性霉素脂质体、伏立康唑、伊曲康唑抗真菌治疗，均获有效治疗。HP的临床症状及影像学表现无特异性，易误诊为细菌感染、肺癌、结核、淋巴瘤等，早期积极地多次多部位的病理活检联合多次病原学检查对提高疾病的诊断率和预后有重要的意义。.

Topics: Amphotericin B; Biopsy; Diagnostic Errors; Histoplasmosis; Humans; Lung; Lung Neoplasms; Pneumonia; Retrospective Studies; Sputum

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.

Topics: Amphotericin B; Antifungal Agents; Child; Fatal Outcome; Female; Fungemia; Histoplasma; Histoplasmosis; Humans; India

Granulomatous diseases are caused by multiple infectious and noninfectious causes. Deep fungal infections can present in the skin or extracutaneously, most commonly with lung manifestations. An Azole or amphotericin B is the universal treatment. Blastomycosis-like pyoderma is a clinically similar condition, which is caused by a combination of hypersensitivity and immunosuppression. Successful treatment has been reported with antibiotics and, more recently, the vitamin A analog, acitretin. Granuloma inguinale and lymphogranuloma venereum cause ulcerative genital lesions with a granulomatous appearance on histology. The Centers for Disease Control and Prevention recommens treatment of these genital infections with doxycycline.

Topics: Acitretin; Amphotericin B; Anti-Bacterial Agents; Antifungal Agents; Azoles; Blastomycosis; Coccidioidomycosis; Cryptococcosis; Dermatomycoses; Doxycycline; Granuloma Inguinale; Histoplasmosis; Humans; Keratolytic Agents; Lymphogranuloma Venereum; Mycoses; Pyoderma; Sexually Transmitted Diseases; Sporotrichosis

Topics: Adenocarcinoma; Amphotericin B; Antifungal Agents; Colonic Neoplasms; Diagnosis, Differential; Gastrointestinal Diseases; Histoplasmosis; Humans; Itraconazole; Male; Middle Aged; Omentum; Peritoneal Neoplasms

Topics: Adolescent; Adult; Amphotericin B; Antifungal Agents; Child; Child, Preschool; Coccidioides; Coccidioidomycosis; Colon; Cryptococcosis; Cryptococcus; Duodenal Ulcer; Endemic Diseases; Female; Histoplasma; Histoplasmosis; Humans; Itraconazole; Job Syndrome; Male; Middle Aged; Mutation; STAT3 Transcription Factor; Treatment Outcome; Triazoles; United States

Histoplasmosis is the most common endemic mycosis in the North America, Central America, and many countries of South America and also occurs in China, India, Southeast Asia, Africa, Australia, and Europe. Clinical syndromes are not specific and histoplasmosis often is overlooked in the evaluation of patients with community-acquired pneumonia, chronic cavitary pneumonia resembling tuberculosis or anaerobic infection, granulomatous inflammatory diseases such as sarcoidosis or Crohn disease, and malignancy. The diagnosis depends on understanding the geographic distribution, common clinical presentations, and tests used for diagnosis of histoplasmosis. While histoplasmosis resolves without treatment in most patients, treatment is indicated in all immunocompromised patients and those with progressive disseminated disease or chronic pulmonary disease. Treatment is appropriate in most patients with acute pulmonary disease but rarely in those with other pulmonary or mediastinal manifestations. The preferred agents include liposomal amphotericin B for more severe cases and itraconazole for milder cases and "step-down" therapy following response to amphotericin B.

Topics: Amphotericin B; Antifungal Agents; Geography, Medical; Histoplasma; Histoplasmosis; Humans; Immunocompromised Host; Itraconazole; Lung; Mediastinal Diseases; Pneumonia; Radiography

Mucocutaneous histoplasmosis is frequently reported in patients with acquired immune deficiency syndrome (AIDS), but it is rare in immunocompetent hosts. Disseminated histoplasmosis involving skin and larynx in a 50-year-old immunocompetent male is described from a non-endemic area in India. The infection appeared to be imported from Thailand. The patient responded very well to intravenous amphotericin B followed by itraconazole. A review of all cases of histoplasmosis occurring in immunocompetent patients from India is reported. Most cases are reported from the Gangetic plains. Adrenals are the most common organ involved in immunocompetent patients, but adrenal insufficiency is not common. Skin lesions and oral ulcers are seen in more than one-third of patients. Predisposing factors like exposure to birds, farming, mining, diabetes were observed in few patients.

Topics: Administration, Intravenous; Administration, Oral; Amphotericin B; Antifungal Agents; Histoplasmosis; Humans; India; Itraconazole; Larynx; Male; Middle Aged; Skin

Disseminated histoplasmosis in South America is associated with AIDS in 70-90 % of cases. It is visceral and cutaneous, compromising the oral, pharynx, and laryngeal mucous membranes. The involvement of the nasal mucosa is unusual. Two patients with perforation of the nasal septum as the only sign of their disease were clinically and histopathologically diagnosed as leishmaniasis. The revision of the biopsies and the culture of nasal discharge secretions showed that the pathogens seen were not amastigotes but Histoplasma capsulatum. Other mycotic lesions were not detected, nor there was history of cutaneous leishmaniasis. The leishmanin skin test, available only for the male patient, was negative. The PCR and immunofluorescence antibody titers for Leishmania were negative in both patients. They were HIV positive; in the male, his CD4+ T cell count was 60/mm(3) and in the female 133/mm(3). The nasal ulcer was the only manifestation of histoplasmosis and the first of AIDS in both patients. The male patient recovered with amphotericin B and itraconazole treatment. The female has improved with itraconazole. Both patients received antiretroviral treatment. Nasal mucous membrane ulcers should include histoplasmosis among the differential diagnosis. In conclusion, two patients had perforation of their nasal septum as the only manifestation of histoplasmosis, a diagnosis confirmed by nasal mucosa biopsy and by culture of H. capsulatum, findings which demonstrated that both patients had AIDS.

Topics: Acquired Immunodeficiency Syndrome; Adult; Amphotericin B; Antifungal Agents; Female; Histoplasma; Histoplasmosis; Humans; Itraconazole; Male; Nasal Septal Perforation; South America

Histoplasma capsulatum is a common endemic mycosis. Infection typically goes unnoticed by an individual, but in immunosuppressed patients, it may become disseminated. We report a case of disseminated histoplasmosis occurring 6 weeks after a kidney transplant. We discuss disseminated histoplasmosis and review its characteristic clinical, laboratory, and histologic manifestations, as well as current treatment modalities.

Topics: Amphotericin B; Antifungal Agents; Bone Marrow; Dermatomycoses; Histoplasmosis; Humans; Immunocompromised Host; Kidney Transplantation; Lung; Male; Middle Aged; Pyrimidines; Triazoles; Voriconazole

Histoplasmosis occurs in specific endemic areas, including the mid-western United States, Africa and most of Latin America. Sporadic cases have also been reported in China. The aim of this study was to summarise the epidemiological and clinical data of histoplasmosis in China. We searched the PubMed, CBMdisk and CNKI databases to identify publications related to histoplasmosis in China. Case reports/series on patients with histoplasmosis were included. A comprehensive literature review identified additional cases. The relevant material was evaluated and reviewed. Overall, 300 cases of histoplasmosis were reported in China from 1990 to 2011, and 75% were from regions through which the Yangtze River flows. Most of the patients were autochthonous infections. Of these, 43 patients had pulmonary histoplasmosis and 257 patients had disseminated histoplasmosis. Common underlying diseases included HIV infection, diabetes mellitus and liver diseases. Fever was the most frequently reported clinical feature in disseminated histoplasmosis, followed by splenomegaly and hepatomegaly. Cases of histoplasmosis had a prominent geographical distribution in China. Histoplasmosis should be considered in the diagnosis of patients with relevant symptoms and a history of travel to or residence in these areas.

Topics: AIDS-Related Opportunistic Infections; Amphotericin B; Antifungal Agents; Case-Control Studies; China; Databases, Factual; Disease Transmission, Infectious; Endemic Diseases; Fever; Histoplasma; Histoplasmosis; HIV; Humans; Lung Diseases, Fungal; Travel

Endovascular infection is an uncommon but devastating manifestation of histoplasmosis, which is often diagnosed late in disease.. To evaluate the clinical and pathologic characteristics of patients with endovascular infections caused by Histoplasma capsulatum.. All cases of patients with documented endovascular histoplasmosis at a single tertiary care center in an endemic region during the period 1993-2010 were reviewed.. Patients presented with a subacute febrile illness and a history of endovascular devices. All patients had positive Histoplasma serology. Routine bacterial culture results were negative for all patients. In addition to yeast forms typical of histoplasmosis, pathologic findings also revealed mycelial forms in 4 of 5 patients. Inflammation was scant. Urinary antigen detection was positive in 4 of 5 patients and Histoplasma blood culture results were positive for 3 of 5 patients. Four patients were treated with a combination of surgical and medical therapy, which consisted of amphotericin B followed by itraconazole; these 4 patients had complete resolution of symptoms and no documented relapse. One patient died before planned surgery.. Histoplasma capsulatum endovascular infections are clinically characterized by a subacute febrile illness with negative bacterial cultures in patients with prosthetic endografts or valves. Noninvasive diagnostics are often the initial clue to the diagnosis. Combined medical and surgical treatment is associated with survival. On histopathologic examination both mycelial and yeast forms are often observed, with absent to minimal tissue inflammatory reaction.

Topics: Adult; Aged; Amphotericin B; Antifungal Agents; Endocarditis; Endovascular Procedures; Female; Histoplasma; Histoplasmosis; Humans; Itraconazole; Male; Middle Aged

Histoplasma capsulatum has not typically been associated with sinusitis in either immunocompetent or immunocompromised hosts. We report a case of sinusitis caused by H. capsulatum in a patient with chronic lymphocytic leukemia and discuss the reported cases of this rare clinical manifestation of histoplasmosis in the medical literature.

Topics: Aged; Amphotericin B; Antifungal Agents; Deoxycholic Acid; Drug Combinations; Histoplasma; Histoplasmosis; Humans; Immunocompromised Host; Itraconazole; Leukemia, Lymphocytic, Chronic, B-Cell; Male; Sinusitis; Treatment Outcome

Topics: Acquired Immunodeficiency Syndrome; Adult; AIDS-Related Opportunistic Infections; Amphotericin B; Antifungal Agents; Antigens, Fungal; Biopsy; Chronic Disease; Female; Histoplasma; Histoplasmosis; Humans; Lip Diseases; Mouth Mucosa; Staining and Labeling; Ulcer

Infection with Histoplasma capsulatum occurs commonly in areas in the Midwestern United States and Central America, but symptomatic disease requiring medical care is manifest in very few patients. The extent of disease depends on the number of conidia inhaled and the function of the host's cellular immune system. Pulmonary infection is the primary manifestation of histoplasmosis, varying from mild pneumonitis to severe acute respiratory distress syndrome. In those with emphysema, a chronic progressive form of histoplasmosis can ensue. Dissemination of H. capsulatum within macrophages is common and becomes symptomatic primarily in patients with defects in cellular immunity. The spectrum of disseminated infection includes acute, severe, life-threatening sepsis and chronic, slowly progressive infection. Diagnostic accuracy has improved greatly with the use of an assay for Histoplasma antigen in the urine; serology remains useful for certain forms of histoplasmosis, and culture is the ultimate confirming diagnostic test. Classically, histoplasmosis has been treated with long courses of amphotericin B. Today, amphotericin B is rarely used except for severe infection and then only for a few weeks, followed by azole therapy. Itraconazole is the azole of choice following initial amphotericin B treatment and for primary treatment of mild to moderate histoplasmosis.

Topics: Amphotericin B; Antifungal Agents; Central Nervous System Diseases; Endocarditis; Histoplasmosis; Humans; Lung Diseases, Fungal; Mediastinitis

Histoplasmosis is an endemic and systemic mycosis, caused by the dimorphic fungus Histoplasma capsulatum var capsulatum. Disseminated disease in immunocompromised patients generally results from the reactivation of latent foci after a prolonged period of asymptomatic infection. We report a case of laryngeal histoplasmosis as the unique clinical manifestation of a progressive form of the disease in a patient with advanced HIV/AIDS disease. Histopathological analysis of laryngeal biopsy smears revealed granulomas containing Histoplasma-like organisms. Treatment with amphotericin B followed by itraconazole resulted in complete remission of laryngeal lesions. To our knowledge, this is the third case report of laryngeal histoplasmosis in a patient with AIDS.

Topics: AIDS-Related Opportunistic Infections; Amphotericin B; Antifungal Agents; Antiretroviral Therapy, Highly Active; Deglutition Disorders; Histoplasmosis; Humans; Itraconazole; Laryngitis; Male; Middle Aged; Treatment Refusal

Topics: Adult; AIDS-Related Opportunistic Infections; Amphotericin B; Antiretroviral Therapy, Highly Active; Histoplasmosis; HIV Infections; Humans; Immunosuppressive Agents; Itraconazole; Male; Risk Factors; Skin Diseases, Papulosquamous

Disseminated histoplasmosis is a disease with a high case-fatality rate, especially in patients with the acquired immunodeficiency syndrome (AIDS). The disease can occur in various sites, such as the lungs, eyes, oral cavity, larynx, nervous system, gastrointestinal tract and, more rarely, the nasal sinus region. It is a cosmopolitan mycosis with a high prevalence in Brazil. Nasal manifestation of the disease is rare, with only three cases reported in the literature, but it is part of the differential diagnosis for other granulomatous diseases, such as Wegener's granulomatosis, tegumentary leishmaniasis and nasal lymphoma. The authors of this study present a literature review and report a case of nasal histoplasmosis in a patient with AIDS. No record of such an aggressive presentation has been reported previously in the literature.

Topics: Acquired Immunodeficiency Syndrome; Adult; Amphotericin B; Antifungal Agents; Female; Histoplasmosis; Humans; Injections, Intravenous; Nose Deformities, Acquired; Nose Diseases; Treatment Outcome

Disseminated Histoplasmosis is a severe and often-fatal opportunistic infection when left untreated among patients with AIDS. Occurring in 3-5 percent of patients with AIDS living in the areas of endemicity, this infection should be suspected in patients with a CD4 cell count of <150 cells/microL presenting with non-specific clinical signs such as fever, weight loss, and lymphadenopathy. We report our experience to increase awareness of the clinical spectrum of disseminated histoplasmosis and its similarity to other infections and malignancies and update the reader on recommended therapeutic modalities.

Topics: Adult; AIDS-Related Opportunistic Infections; Amphotericin B; Antifungal Agents; Histoplasma; Histoplasmosis; Humans; Male; Treatment Outcome

Two cases of Histoplasma meningitis are presented, illustrating the difficulty in diagnosis and treatment. The first case occurred in a patient with acquired immunodeficiency syndrome as a relapse of disseminated histoplasmosis and resolved after prolonged treatment and ongoing antiretroviral therapy. The second case occurred in a cardiac allograft recipient as meningitis and focal brain lesions that responded to liposomal amphotericin B, but the patient died shortly after therapy was completed. Unfortunately, there are no prospective studies addressing the diagnosis and management of patients with histoplasmosis of the central nervous system from which to provide evidence-based guidelines for care. In the absence of such data, an approach will be presented on the basis of our experience and opinions.

Topics: Acquired Immunodeficiency Syndrome; Adult; Aged; Amphotericin B; Antifungal Agents; Female; Fluconazole; Histoplasmosis; Humans; Immunocompromised Host; Male; Meningitis, Fungal; Mycological Typing Techniques; Sensitivity and Specificity

We describe 16 HIV-infected patients with disseminated histoplasmosis (14 men, mean age 28 +/- 7.84 years), diagnosed at Hospital Eva Perón in Argentina during the period of October 1993 to July 2000. Disseminated histoplasmosis occurred in 5.3% of HIV-infected patients over the study period. The main symptoms included fever, weight loss and hepatosplenomegaly in 93.8%. Other relevant findings were respiratory compromise (56.3%), digestive symptoms (43.8%), mucocutaneous lesions (75%) and multiple lymphadenopathy (69%). Treatment consisted of amphotericin B 1 mg/kg/day up to a total dose of 1 g, followed by 400 mg/day of oral itraconazole. Mortality in the acute phase was 19% and 37.5% of patients relapsed.

Topics: Adolescent; Adult; AIDS-Related Opportunistic Infections; Amphotericin B; Antifungal Agents; Argentina; Female; Fever; Fluconazole; Hepatomegaly; Histoplasmosis; Humans; Itraconazole; Male; Recurrence; Respiration Disorders; Splenomegaly; Weight Loss

We report four cases of cerebral histoplasmosis and discuss features of six additional cases reported in the medical literature in the past 10 years, when azoles have been available for therapy. Most patients with this disease are immunocompromised or have a history that suggests heavy exposure to Histoplasma capsulatum. Fever and other clinical findings of systemic toxicity caused by disseminated histoplasmosis may be absent; 5 of 10 patients did not manifest these findings. Although the mainstay of treatment for central nervous system histoplasmosis remains amphotericin B, 9 of the 10 patients received itraconazole or fluconazole either as initial therapy or after a course of treatment with amphotericin B.

Topics: Adult; Aged; Amphotericin B; Antifungal Agents; Fatal Outcome; Female; Histoplasmosis; Humans; Male; Middle Aged

Histoplasmosis is a systemic fungal infection that infects millions of people living in areas where the infection is endemic. However, most people with histoplasmosis have a self-limited illness that does not require treatment with an antifungal agent. Patients who do require treatment are those who are immunosuppressed, those who are exposed to a large fungal inoculum that overwhelms their immune system, and those who have symptomatic disseminated infection, chronic pulmonary infection, or focal organ involvement. The treatment of choice for severe histoplasmosis is amphotericin B, while itraconazole is given for mild to moderate histoplasmosis. Most patients who require initial treatment with amphotericin B respond quickly and can then be switched to itraconazole to finish the course of therapy.

Topics: Amphotericin B; Antifungal Agents; Histoplasmosis; Humans; Itraconazole; Severity of Illness Index

Histoplasmosis is an endemic infection in most of the United States and can be found worldwide. The spectrum of this illness ranges from asymptomatic infection to severe disseminated disease. Life-threatening illness is usually associated with an immunocompromised state; however, 20 percent of severe illnesses result from a heavy inoculum in healthy persons. Culture remains the gold standard for diagnosis but requires a lengthy incubation period. Fungal staining produces quicker results than culture but is less sensitive. Testing for antigen and antibodies is rapid and sensitive when used for particular disease presentations. An advantage of antigen detection is its usefulness in monitoring disease therapy. Antifungal therapy is indicated in chronic or disseminated disease and severe, acute infection. Amphotericin B is the agent of choice in severe cases; however, patients must be monitored for nephrotoxicity and hypokalemia. Itraconazole is effective in moderate disease and is well tolerated, even with long-term use. Hepatotoxicity, the most severe adverse effect of itraconazole, is uncommon and usually transient.

Topics: Amphotericin B; Antifungal Agents; Diagnosis, Differential; Fluconazole; Histoplasmosis; Humans; Itraconazole

Histoplasmosis is an endemic mycosis, which is most prevalent in the Ohio and Mississippi valleys of North America. The causative organism is a dimorphic fungus, Histoplasma capsulatum. Histoplasmosis can present as a self-limited disease or cause life-threatening diseases resulting in considerable morbidity and mortality. Treatment is appropriate in patients with diffuse acute pulmonary infection, chronic pulmonary infection, mediastinal granuloma causing obstruction of important structures, or disseminated infection. Other chronic forms of disease such as fibrosing mediastinitis and broncholithiasis are unresponsive to pharmacologic treatment. Options for therapy include amphotericin B or one of its lipid formulations, and ketoconazole, itraconazole, or fluconazole. Recently, newer antifungal agents have been evaluated in animals models of histoplasmosis. Of these, a new triazole, posaconazole (SCH56592) appears most promising. Generally, amphotericin B or one of the lipid formulations is recommended as initial treatment in patients with more extensive diseases, felt to be ill enough to require hospitalization, and itraconazole for those who have milder illness, or to complete treatment after patients respond to amphotericin B. The role of intravenous formulation of itraconazole for severe histoplasmosis is unknown because studies comparing it with amphotericin B have not been conducted.

Topics: Amphotericin B; Antifungal Agents; Histoplasmosis; Humans; Triazoles

We report the first case of clinically diagnosed endogenous endophthalmitis caused by Histoplasma capsulatum var. capsulatum in a patient with the acquired immune deficiency syndrome.. Interventional case report and literature review.. Pars plana vitrectomy and scleral buckling procedure in the left eye with intravenous and intravitreal amphotericin in both eyes.. The clinical features, culture results, visual outcome, and complications were studied.. This case demonstrates a bilateral endophthalmitis with severe subretinal exudation, choroidal granulomas, and intraretinal hemorrhage leading to exudative bilateral retinal detachments. Vitreous cultures grew H. capsulatum var. capsulatum. Treatment consisted of intravenous amphotericin, intravitreal amphotericin (both eyes), pars plana vitrectomy (left eye), and scleral buckling procedure (left eye) with resulting counting fingers vision (right eye) and 20/300 (left eye). Four cases of Histoplasma endophthalmitis have been reported previously, all of which had a documented history of disseminated histoplasmosis and resulted in enucleation.. H. capsulatum should be considered a possible etiologic agent of endophthalmitis, especially in patients with a history of disseminated histoplasmosis and/or immune deficiency.

Topics: Adult; AIDS-Related Opportunistic Infections; Amphotericin B; Antifungal Agents; Endophthalmitis; Eye Infections, Fungal; Histoplasma; Histoplasmosis; Humans; Male; Retinal Detachment; Retinal Diseases; Scleral Buckling; Vitrectomy; Vitreous Body

Two unusual clinical presentations of urogenital histoplasmosis are described. A review of the literature on urogenital histoplasmosis is provided.

Topics: Aged; Amphotericin B; Antifungal Agents; Follow-Up Studies; Histoplasma; Histoplasmosis; Humans; Itraconazole; Male; Male Urogenital Diseases; Middle Aged

Endemic mycoses remain a major public health problem in several countries and they are becoming increasingly frequent with the spread of HIV infection. Amphotericin B remains the drug of choice during the acute stage of life-threatening endemic mycoses occurring in both immunocompetent and immunocompromised hosts. Ketoconazole is effective in non-AIDS patients with non-life-threatening histoplasmosis, blastomycosis, or paracoccidioidomycosis. Itraconazole is the treatment of choice for non-life-threatening Histoplasma capsulatum or Blastomyces dermatitidis infections occurring in immunocompetent individuals and is the most efficient secondary prophylaxis of histoplasmosis in AIDS patients. Itraconazole is also effective in lymphocutaneous and visceral sporotrichosis, in paracoccidioidomycosis, for Penicillum marneffei infection, and is an alternative to amphotericin B for Histoplasma duboisii infection. Coccidioidomycosis may be effectively treated with prolonged and sometimes life-long itraconazole or fluconazole therapy. Fluconazole has relatively poor efficacy against histoplasmosis, blastomycosis and sporotrichosis. New antifungal agents have been tested in vitro or in animal models and may soon be evaluated in clinical trials.

Topics: AIDS-Related Opportunistic Infections; Amphotericin B; Blastomycosis; Coccidioidomycosis; Histoplasmosis; Humans; Mycoses; Paracoccidioidomycosis; Sporotrichosis

Systemic fungal infections cause almost 25% of the infection-related deaths in leukaemic patients. Particularly those with prolonged neutropenia are at risk but mycoses also feature in critically ill intensive care patients and in individuals who are treated for solid tumours and AIDS, or who received an organ transplant. The spread of AIDS and the more aggressive cytotoxic chemotherapy in combination with an improved management of haemorrhages and bacterial infections in leukaemic and other cancer patients facilitated the occurrence of these invasive fungal infections. These life-threatening complications remain both difficult to diagnose and to treat and therefore carry a poor prognosis. For many years, the only realistic option to treat systemic infections was amphotericin B, whose administration was known to be associated with numerous adverse effects. Now less toxic formulations of amphotericin have become available for clinical use, as well as several new triazoles that appear to provide an effective and less toxic alternative for the treatment of certain fungal infections.

Topics: AIDS-Related Opportunistic Infections; Amphotericin B; Antifungal Agents; Aspergillosis; Candidiasis; Cryptococcosis; Deoxycholic Acid; Drug Combinations; Fluconazole; Flucytosine; Fungemia; Histoplasmosis; Humans; Immunocompromised Host; Mycoses; Zygomycosis

We report a very rare case of disseminated pharyngo-laryngeal histoplasmosis with systemic spread in a 10-year-old, immunocompetent child from Guyana. The main signs were a marked deterioration in his general condition, hepato-splenomegaly, multiple lymphadenopathy and ulcerated pharyngo-laryngeal lesions. The diagnosis was made from brushings of the ulcerative lesions, a lymph node biopsy and serological tests performed in the national reference center for histoplasmosis. The initial treatment was with amphotericin B, which was then replaced by oral itraconazole. We report here the main epidemiological, clinical and therapeutic characteristics.

Topics: Amphotericin B; Antifungal Agents; Child; Guyana; Histoplasmosis; Humans; Itraconazole; Laryngeal Diseases; Male; Paris; Pharyngeal Diseases

Two patients with African histoplasmosis manifested by ulcers and cutaneous swellings are described. The inguinal lymph nodes were also involved in one patient. Treatment with amphotericin B combined with ketoconazole was successful.

Topics: Amphotericin B; Antifungal Agents; Child; Drug Therapy, Combination; Histoplasma; Histoplasmosis; Humans; Ketoconazole; Male; Treatment Outcome

The so-called exotic pulmonary mycoses are imported diseases in France. They are infrequent or exceptional and for this reason can be underdiagnosed or recognized with delay. Nevertheless, they are easily treatable infections with available antifungal agents. As a rule, the site of primary infection is the lung with ensuing clearance or chronic local infection and/or dissemination. Immunocompromised hosts are more prone to develop severe forms or reactivation of the disease.

Topics: AIDS-Related Opportunistic Infections; Amphotericin B; Anti-Infective Agents; Antifungal Agents; Blastomycosis; Coccidioidomycosis; Diagnosis, Differential; Histoplasmosis; Humans; Itraconazole; Ketoconazole; Lung Diseases, Fungal; Paracoccidioidomycosis; Penicillium; Sporotrichosis; Sulfadiazine; Travel; Trimethoprim, Sulfamethoxazole Drug Combination

American pulmonary histoplasmosis is a deep mycosis imported from North America caused by the inhalation of Histoplasma capsulatum. It is endemic in several countries throughout the world and occasional cases have been reported in France, mainly imported from out lying French territories. The most frequent clinical forms observed in immunocompetent subjects are generally benign or silent and usually limited to a fortuitously discovered pulmonary nodule. Massive exposure may lead to an acute primary invasion producing a miliary aspect. Chronic forms simulating tuberculosis are exceptional. Inversely, opportunistic histoplasmosis in AIDS patients can produce an severe multiple organ disease. Ideally, mycelium should be isolated for diagnosis, a task which is easier in disseminated or operated nodular forms. More often, the epidemiological context, clinical and radiological features, the elimination of differential diagnoses and, retrospectively, serology are sufficient for diagnosis. The clinical course is usually favorable. Itraconazole is the treatment of choice for symptomatic or complicated forms.

Topics: Africa; AIDS-Related Opportunistic Infections; Amphotericin B; Antifungal Agents; Asia; Australia; Bronchoalveolar Lavage Fluid; Diagnosis, Differential; Histoplasma; Histoplasmosis; Humans; Itraconazole; Ketoconazole; Latin America; Lung Diseases, Fungal; Radiography, Thoracic; Tomography, X-Ray Computed; United States

The deep mycoses are uncommon infections, usually acquired from the inhalation or ingestion of fungal spores, sometimes from the soil in areas of endemicity, such as in the Americas and south-east Asia, or from decaying vegetable matter. They are also seen in immunocompromised persons and, increasingly, in HIV-infected persons. Respiratory involvement is frequent, with granuloma formation, and mucocutaneous involvement may be seen. Oral lesions of the deep mycoses are typically chronic but non-specific, though nodular or ulcerative appearances are common. Person-to-person transmission is rare. In HIV disease, the most common orofacial involvement of deep mycoses has been in histoplasmosis, cryptococcosis, aspergillosis and zygomycosis. Diagnosis is usually confirmed by lesional biopsy although culture may also be valuable. Treatment is with amphotericin or an azole.

Topics: Acquired Immunodeficiency Syndrome; Adult; AIDS-Related Opportunistic Infections; Amphotericin B; Aspergillosis; Azoles; Cryptococcosis; Female; Histoplasmosis; HIV Infections; Humans; Lung Diseases, Fungal; Male; Middle Aged; Mouth Diseases; Mucormycosis; Mycoses; Sinusitis

The South-East Asian region is not known to be a major endemic area for histoplasmosis. We have recently diagnosed several cases of disseminated histoplasmosis in patients from this region. We report on a well documented indigenous case of disseminated histoplasmosis in a 62-year-old poultry farmer and review the literature for other reported cases of clinical histoplasmosis in the South-East Asian region. Sporadic cases of indigenous chronic pulmonary and non-meningeal disseminated histoplasmosis in immunocompetent hosts have been reported as well as examples of disseminated histoplasmosis in immunocompromised hosts. These reports suggest that histoplasmosis is endemic to certain areas in South-East Asia and that there may be a large number of undiagnosed and subclinical cases. The recent advances in diagnostic tests for histoplasmosis are also reviewed with reference to the experience of using these tests in the reported case.

Topics: Amphotericin B; Antifungal Agents; Asia, Southeastern; Biopsy, Needle; Histoplasmosis; Humans; Male; Middle Aged; Tomography, X-Ray Computed

Topics: Amphotericin B; Aspergillosis; Candidiasis; Child; Coccidioidomycosis; Cytokines; Diagnosis, Differential; Fluconazole; Histoplasmosis; Humans; Itraconazole; Mucormycosis; Mycoses; Prognosis

Amphotericin B (AmB), the drug of choice for the treatment of most systemic fungal infections, is marketed under the trademark Fungizone, as an AmB-deoxycholate complex suitable for intravenous administration. The association between AmB and deoxycholate is relatively weak; therefore, dissociation occurs in the blood. The drug itself interacts with both mammalian and fungal cell membranes to damage cells, but the greater susceptibility of fungal cells to its effects forms the basis for its clinical usefulness. The ability of the drug to form stable complexes with lipids has allowed the development of new formulations of AmB based on this property. Several lipid-based formulations of the drug which are more selective in damaging fungal or parasitic cells than mammalian cells and some of which also have a better therapeutic index than Fungizone have been developed. In vitro investigations have led to the conclusion that the increase in selectivity observed is due to the selective transfer of AmB from lipid complexes to fungal cells or to the higher thermodynamic stability of lipid formulations. Association with lipids modulates AmB binding to lipoproteins in vivo, thus influencing tissue distribution and toxicity. For example, lipid complexes of AmB can be internalized by macrophages, and the macrophages then serve as a reservoir for the drug. Furthermore, stable AmB-lipid complexes are much less toxic to the host than Fungizone and can therefore be administered in higher doses. Experimentally, the efficacy of AmB-lipid formulations compared with Fungizone depends on the animal model used. Improved therapeutic indices for AmB-lipid formations have been demonstrated in clinical trials, but the definitive trials leading to the selection of an optimal formulation and therapeutic regimen have not been done.

Topics: Amphotericin B; Animals; Aspergillosis; Blastomycosis; Candidiasis; Cell Death; Cell Membrane; Clinical Trials as Topic; Coccidioidomycosis; Cryptococcosis; Detergents; Drug Carriers; Drug Delivery Systems; Drug Industry; Histoplasmosis; Immunity, Active; Leishmania; Leishmaniasis, Visceral; Lipoproteins; Mice; Molecular Structure; Phospholipids; Rabbits

A 39-year-old woman infected with human immunodeficiency virus had disseminated histoplasmosis that presented with nodules on her tongue. This is the seventh reported case of biopsy- and/or culture-proven oropharyngeal histoplasmosis in patients with acquired immunodeficiency syndrome. We review those previous reports and discuss the clinical features of disseminated histoplasmosis in patients with acquired immunodeficiency syndrome.

Topics: Adult; AIDS-Related Opportunistic Infections; Amphotericin B; Biopsy; Female; Histoplasmosis; HIV Infections; Humans; Tongue Diseases

We report three cases of colonic histoplasmosis observed in a non-endemic area in patients with AIDS. The patients presented with fever, abdominal pain and an abdominal mass in the right lower quadrant. Diagnosis was obtained using Gomori-Crocott staining of endoscopic or surgical biopsies. One patient died without specific treatment and two patients had a complete remission when treated with intravenous amphotericin B but suffered a relapse when given oral itraconazole. Thus, physicians in areas where intestinal histoplasmosis is not endemic should be aware of the condition. Diagnosis can easily be obtained using Gomori-Crocott staining of colonoscopic biopsies; this should avoid unnecessary laparotomies and allow specific treatment to be instituted rapidly.

Topics: Adult; AIDS-Related Opportunistic Infections; Amphotericin B; Antifungal Agents; Colonic Diseases; Female; France; Histoplasmosis; Humans; Male

Topics: Amphotericin B; Antifungal Agents; Aspergillosis; Blastomycosis; Candidiasis; Clinical Trials as Topic; Coccidioidomycosis; Cryptococcosis; Fluconazole; Flucytosine; Hematologic Diseases; Histoplasmosis; Humans; Itraconazole; Ketoconazole; Kidney; Mycoses; Thrombophlebitis

Histoplasmosis has become an important mycosis in regions of endemicity in North and Central America. Traditionally, treatment has been reserved for patients with disseminated or chronic pulmonary histoplasmosis. The availability of safe and effective oral regimens, however, has offered alternatives to amphotericin B. Administration of amphotericin B is highly effective as therapy and produces a rapid clinical response; it remains the treatment of choice for patients with severe or moderately severe manifestations of histoplasmosis. Ketoconazole and itraconazole are well tolerated and are effective alternatives to amphotericin B for treatment of patients with milder illnesses or for use following response to amphotericin B. The determination of fluconazole's role in therapy for histoplasmosis awaits completion of ongoing trials. Continued research is needed to develop better-tolerated fungicidal alternatives to amphotericin B and oral agents with better absorption and drug interaction profiles than those of itraconazole and ketoconazole. Preventive strategies should be explored to reduce the frequency of histoplasmosis among individuals from regions of endemicity who are at high risk for more severe manifestations of histoplasmosis.

Topics: Amphotericin B; Fluconazole; Histoplasmosis; Humans; Itraconazole; Ketoconazole; Serologic Tests

In patients with AIDS with cryptococcosis, prompt diagnosis is essential. Poor results with conventional therapy (amphotericin-5FC) have led to exploration of the azoles. Both fluconazole and itraconazole have given good short-term results with less toxicity. However, cure is achieved far less often than in other compromised hosts. Fluconazole is also useful to prevent relapse after successful initial amphotericin therapy, particularly from genitourinary foci. In both histoplasmosis and aspergillosis, itraconazole has produced impressive therapeutic results, and in histoplasmosis, secondary prophylaxis as well. In coccidioidomycosis results thus far have not been better than conventional amphotericin therapy, especially in initial treatment.

Topics: Acquired Immunodeficiency Syndrome; Amphotericin B; Coccidioidomycosis; Cryptococcosis; Drug Therapy, Combination; Fluconazole; Histoplasmosis; Humans; Itraconazole; Meningitis, Cryptococcal

A 41-year-old man infected with HIV-1 developed fever up to 39.8 degrees C together with nonproductive cough and dyspnoea. Lactate dehydrogenase concentration rose from a level of 998 U/l to 6307 U/l. As pneumocystis carinii pneumonia was at first suspected he was treated with co-trimoxazole (1600 mg sulfamethoxazole and 320 mg trimethoprim, four times daily). But the symptoms did not abate. Bone-marrow puncture revealed numerous macrophages containing ovoid inclusions typical of Histoplasma capsulatum varietas capsulatum. The diagnosis of disseminated histoplasmosis was confirmed by culture and serologically by an increase in Histoplasma polysaccharide antigen. On treatment with amphotericin B (at first 10 mg, then 50 mg daily for 4 weeks) the symptoms regressed within a few days. After the concentrations of lactate dehydrogenase and Histoplasma antigen had become normal again, maintenance treatment was changed to itraconazole (200 mg twice daily), after a total amphotericin B dose of 1150 mg. The patient has remained free of recurrence.

Topics: Adult; AIDS-Related Opportunistic Infections; Amphotericin B; Antigens, Fungal; Diagnosis, Differential; Drug Therapy, Combination; Dyspnea; Histoplasma; Histoplasmosis; HIV-1; Humans; Itraconazole; Male

Primary gastrointestinal infection is an uncommon manifestation of histoplasmosis. It is almost always associated with disseminated disease and/or an immunocompromised host. The ileum and cecum are the most common sites involved. We report two cases of primary gastrointestinal histoplasmosis in HIV-seropositive men who presented with annular constricting right colon lesions.

Topics: Adult; Amphotericin B; Biopsy; Colonic Diseases; Colonic Neoplasms; Diagnosis, Differential; Histoplasmosis; HIV Seropositivity; Humans; Male

To review the pharmacotherapy of disseminated histoplasmosis (DH) in patients with AIDS. The article provides an overview of the pathophysiology, epidemiology, clinical presentation and diagnosis of this disease. Clinical trials reporting intervention with antifungal therapy are reviewed, with an emphasis on efficacy and toxicity of these agents.. A MEDLINE search from 1976 to the present was performed to identify pertinent biomedical literature, including reviews.. All available reviews and clinical trials in AIDS patients were evaluated, as were all available case series and interventional clinical trials.. DH in patients with HIV infection is an AIDS-defining opportunistic infection caused by Histoplasma capsulatum. It is most frequently observed in HIV-infected patients living in or traveling to endemic regions. The clinical presentation most often includes fever and weight loss, but may be complicated by comorbid illness such as other opportunistic infections. Diagnosis is best established by histologic examination of peripheral blood smear or bone marrow aspirate, or isolation of the organism in cultures of blood, bone marrow, and respiratory secretions. Serologic examinations may provide supportive diagnostic information. Detection of histoplasma polysaccharide antigen (HPA) in serum or urine may prove to be a promising approach for the rapid diagnosis and therapeutic monitoring of DH in AIDS patients. In contrast to immunocompetent hosts, high relapse rates are reported after therapy in AIDS patients. Therefore, initial (induction) therapy is routinely followed by long-term (maintenance) therapy to prevent relapse. Issues regarding the selection, dosage, and duration of therapy, as well as prophylaxis of patients at highest risk, still need to be addressed by controlled clinical trials.. Amphotericin B is presently the drug of choice for induction therapy. Maintenance therapy with either amphotericin B or an oral azole antifungal agent active against H. capsulatum is necessary to prevent relapse. Itraconazole, a triazole antifungal agent, may provide effective alternative therapy for both induction and maintenance treatment of DH.

Topics: AIDS-Related Opportunistic Infections; Amphotericin B; Antifungal Agents; Clinical Trials as Topic; Fluconazole; Histoplasmosis; Humans; Itraconazole; Ketoconazole; United States

Histoplasmosis is an infection caused by the dimorphic fungus, Histoplasma capsulatum. The initial site of entry is usually the lung, but dissemination to skin occurs in some patients, particularly those with human immunodeficiency virus (HIV) infection in whom it is part of a widespread infection. The organisms have to be distinguished from other yeasts in skin such as Cryptococcus neoformans and small forms of Blastomyces dermatitidis.

Topics: Acquired Immunodeficiency Syndrome; Amphotericin B; Antifungal Agents; Dermatomycoses; Histoplasmosis; Humans; Lung Diseases, Fungal

Topics: Amphotericin B; Antifungal Agents; Cell Wall; Coccidioidomycosis; Fungi; Histoplasmosis; Humans; Meningitis, Cryptococcal; Mycoses

Recurrent outbreaks of histoplasmosis in Indianapolis since 1978 have expanded our understanding of histoplasmosis. Histoplasmosis has emerged as the leading opportunistic infection in patients with AIDS from Indianapolis. Clinical manifestations of histoplasmosis are influenced by host factors. Underlying lung disease predisposes to chronic pulmonary histoplasmosis, and immunosuppressive medications or disorders predispose to dissemination. Inflammatory manifestations, including arthritis, erythema nodosum, and pericarditis, commonly occur with acute histoplasmosis. Diagnosis of histoplasmosis requires understanding of the accuracy and limitations of cultural and serological methods. More recently, radioimmunoassay for polysaccharide antigen has offered a new diagnostic approach. Amphotericin B remains the gold standard for treatment and is highly effective, even in immunocompromised individuals. Itraconazole shows promise as an alternative to amphotericin B for treatment of less severely ill patients. The role of fluconazole in therapy remains unknown until ongoing clinical trials are completed. Histoplasmosis cannot be cured in individuals with AIDS and in a small proportion of other individuals with other underlying immunosuppressive conditions. In such cases, long-term maintenance treatment is required to prevent relapse. Antigen detection has proven useful for following progress during treatment and for identifying relapse.

Topics: Amphotericin B; Disease Outbreaks; Fluconazole; Histoplasmosis; Humans; Indiana; Itraconazole; Ketoconazole

Topics: Amphotericin B; Antifungal Agents; Aspergillosis; Aspergillosis, Allergic Bronchopulmonary; Blastomycosis; Coccidioidomycosis; Cryptococcosis; Fluconazole; Flucytosine; Histoplasmosis; Humans; Itraconazole; Ketoconazole; Lung Diseases, Fungal

Endocardial involvement associated with disseminated histoplasmosis has been infrequently documented, especially among patients with prosthetic valves. The therapeutic approach to these patients is also not yet clearly defined. A 54-year-old man with prosthetic valve endocarditis due to histoplasmosis was successfully treated with amphotericin B. A review of the literature suggests that the optimal form of therapy is likely a combination of surgical replacement of the involved valve and high dose amphotericin B. Successful therapy with amphotericin B alone may, however, be achieved if surgery is not a viable option.

Topics: Amphotericin B; Bioprosthesis; Endocarditis; Heart Valve Prosthesis; Histoplasmosis; Humans; Male; Middle Aged; Mitral Valve

Histoplasmosis is a serious opportunistic infection in patients with AIDS, often representing the first manifestation of the syndrome. Most infections occurring within the endemic region are caused by exogenous exposure, while those occurring in nonendemic areas may represent endogenous reactivation of latent foci of infection or exogenous exposure to microfoci located within those nonendemic regions. However, prospective investigations are needed to prove the mode of acquisition. The infection usually begins in the lungs even though the chest roentgenogram may be normal. Clinical findings are nonspecific; most patients present with symptoms of fever and weight loss of at least 1 month's duration. When untreated, many cases eventually develop severe clinical manifestations resembling septicemia. Chest roentgenograms, when abnormal, show interstitial or reticulonodular infiltrates. Many cases have been initially misdiagnosed as disseminated mycobacterial infection or Pneumocystis carinii pneumonia. Patients are often concurrently infected with other opportunistic pathogens, supporting the need for a careful search for co-infections. Useful diagnostic tests include serologic tests for anti-H. capsulatum antibodies and HPA, silver stains of tissue sections or body fluids, and cultures using fungal media from blood, bone marrow, bronchoalveolar lavage fluid, and other tissues or body fluids suspected to be infected on clinical grounds. Treatment with amphotericin B is highly effective, reversing the clinical manifestations of infection in at least 80% of cases. However, nearly all patients relapse within 1 year after completing courses of amphotericin B of 35 mg/kg or more, supporting the use of maintenance treatment to prevent recurrence. Relapse rates are lower (9 to 19%) in patients receiving maintenance therapy with amphotericin B given at doses of about 50 mg weekly or biweekly than with ketoconazole (50-60%), but controlled trials comparing different maintenance regimens have not been conducted. Until results of such trials become available, our current approach is to administer an induction phase of 15 mg/kg of amphotericin B given over 4 to 6 weeks, followed by maintenance therapy with 50 to 100 mg of amphotericin B given once or twice weekly, or biweekly. If results of a prospective National Institutes of Allergy and Infectious Disease study of itraconazole maintenance therapy document its effectiveness, alternatives to amphotericin B may be reasonab

Topics: Acquired Immunodeficiency Syndrome; Amphotericin B; Diagnosis, Differential; Histoplasmosis; Humans; Pneumonia, Pneumocystis

Histoplasmosis, though usually a silent pulmonary infection, may progress to a severe, sometimes fatal disseminated infection. In the chronic form of disseminated histoplasmosis, granulomatous lesions of the upper aerodigestive tract are common. These lesions can be mistaken for carcinoma on initial presentation, as in the case we have presented here. The clinical course of patients with acute, subacute, or chronic disseminated forms of this disease correlates well with the histopathologic findings. Diagnosis is best made by culture or biopsy of a characteristic lesion. Although amphotericin B remains the standard treatment of disseminated histoplasmosis, the imidazole compounds such as ketoconazole, either alone or in combination with amphotericin B, have also been shown to be effective.

Topics: Adult; Amphotericin B; Child; Chronic Disease; Diagnosis, Differential; Histoplasmosis; Humans; Infant; Ketoconazole; Male; Middle Aged; Tongue Diseases; Tongue Neoplasms

Histoplasmosis occurs throughout the world but is more common within the endemic areas of North America, particularly in fertile river valleys. Disease manifestations range from asymptomatic infection in the normal host with low-inoculum exposure to rapidly fatal, disseminated infection in the severely immunocompromised host, emphasizing the importance of cellular immunity in defense against Histoplasma capsulatum. Diagnosis depends on a high index of suspicion, knowledge of the clinical and epidemiologic features of the infection, and a thorough understanding of the uses and limitations of fungal cultural and serological laboratory procedures. Recently, a method has been developed for rapid diagnosis based on detection of a polysaccharide antigen in body fluids of patients with histoplasmosis. Amphotericin B remains the preferred treatment for more severe forms of histoplasmosis, particularly in the immunocompromised host, but oral treatment with ketoconazole or newer imidozoles appears to be effective in less severe infections in non-immunocompromised individuals.

Topics: Amphotericin B; Histoplasma; Histoplasmosis; Humans; Immune Tolerance; Ketoconazole; Time Factors; United States

Histoplasmosis is caused by Histoplasma capsulatum, a dimorphic fungus. Because histoplasmosis is usually a self-limited disease in the majority of cases, treatment often is not needed in the normal host. However, severe cases of acute pulmonary histoplasmosis require therapy. Amphotericin B is considered the treatment of choice.

Topics: Adult; Amphotericin B; Child; Complement Fixation Tests; Female; Histoplasmosis; Humans; Immune Tolerance; Infant; Lung Diseases, Fungal; Male; Middle Aged; Sex Factors; Skin

Topics: Acquired Immunodeficiency Syndrome; Amphotericin B; Cryptococcosis; Histoplasmosis; Humans; Immune Tolerance; Immunity, Cellular; Mycoses; Opportunistic Infections

Prior to the development of ketoconazole, the treatment of systemic histoplasmosis and blastomycosis was limited to AMB. The convenience of oral dosing, combined with avoidance of the significant toxicities associated with AMB, make ketoconazole an attractive alternative for the treatment of selected forms of histoplasmosis and blastomycosis. Although high-dose (800 mg/day) ketoconazole is generally more effective than low-dose (400 mg/day), therapy should be initiated at the lower dose due to significantly more adverse effects at higher doses; the daily dose should be increased in patients with progressive disease. Caution should be exercised when ketoconazole is used to treat patients with GU tract disease and in patients with naturally occurring or pharmacologically induced achlorhydria. Thus, AMB remains the drug of choice for difficult to treat cases of histoplasmosis and blastomycosis; however, recent studies have established ketoconazole as the drug of choice in immunocompetent patients with non-life-threatening, non-meningeal H capsulatum and B dermatitidis disease.

Topics: Amphotericin B; Blastomycosis; Histoplasmosis; Humans; Ketoconazole; Lung Diseases, Fungal

Topics: Age Factors; Aged; Amphotericin B; Blastomycosis; Coccidioidomycosis; Histoplasmosis; Humans; Ketoconazole; Recurrence; Sporotrichosis; United States

Genitourinary fungal infections have become increasingly common in clinical practice. We review the literature on such infections, emphasizing recognition of fungal disease, predisposing factors, pathogenesis, and approaches to therapy.

Topics: Amphotericin B; Aspergillosis; Blastomycosis; Candidiasis; Coccidioidomycosis; Cryptococcosis; Female; Genital Diseases, Female; Genital Diseases, Male; Histoplasmosis; Humans; Infant, Newborn; Male; Mycoses; Urinary Tract Infections

The deep mycoses are increasing in importance both as opportunistic infections and from exposure in geographically defined areas. Diagnosis may be difficult in both groups. Mucosal involvement may be non-specific (e.g., in disseminated candidiasis) or highly predictive of disseminated disease (e.g., histoplasmosis, blastomycosis and paracoccidioidomycosis). Skin involvement is generally uncommon in disseminated aspergillosis, mucormycosis and cryptococcosis but is more common in candidemia and coccidioidomycosis. Manifestations of mucosal and cutaneous lesions of the deep mycoses are reviewed and the need for an aggressive diagnostic approach stressed. Culture is more specific than histopathologic examination alone but the latter may have to suffice in some cases. Control of underlying disease and administration of amphotericin B remain the mainstays of therapy. Ketoconazole is being evaluated as an alternative in therapy of some deep mycoses.

Topics: Amphotericin B; Aspergillosis; Blastomycosis; Candidiasis; Candidiasis, Cutaneous; Coccidioidomycosis; Cryptococcosis; Dermatomycoses; Flucytosine; Histoplasmosis; Humans; Immunosuppression Therapy; Ketoconazole; Miconazole; Mouth Diseases; Mouth Mucosa; Mucormycosis; Mycoses; Paracoccidioidomycosis; Sporotrichosis; Travel

Mycotic pneumonias are common problems seen in small companion animals because of the wide environmental distribution of fungi and their use of airborne spores for reproduction. This article outlines the important clinical features and pathogenesis of mycotic pneumonias and includes a detailed discussion of the therapeutic approach to patients with these infections.

Topics: Amphotericin B; Animals; Aspergillosis; Blastomycosis; Cat Diseases; Cats; Coccidioidomycosis; Cryptococcosis; Dog Diseases; Dogs; Histoplasmosis; Ketoconazole; Lung Diseases, Fungal; Pneumonia

In the past 20 years, there has been a marked increase in the number of reported cases of meningitis and brain abscess due to fungi and yeasts. This increase is due in part to better diagnostic techniques and greater awareness of the possibility of fungal invasion of the nervous system; but the increase can also be attributed to a growing pool of severely compromised hosts, many of whom are undergoing treatment with adrenal glucocorticoids or immunosuppressive agents. The diagnosis and treatment of aspergillosis, blastomycosis, candidiasis, coccidioidomycosis, cryptococcosis, infections caused by dematiaceous fungi, histoplasmosis, paracoccidioidomycosis, petriellidosis, and sporotrichosis, as well as relatively rare infections of the central nervous system caused by other fungi, are discussed. The efficacy of amphotericin B and 5-fluorocytosine in the treatment of CNS fungal and yeast infections is also evaluated.

Topics: Adult; Amphotericin B; Antifungal Agents; Aspergillosis; Blastomycosis; Candidiasis; Central Nervous System Diseases; Chromoblastomycosis; Cladosporium; Coccidioidomycosis; Cryptococcosis; Female; Fungi; Histoplasmosis; Humans; Male; Meningitis; Meningoencephalitis; Middle Aged; Mucormycosis; Mycoses; Paracoccidioidomycosis; Phialophora; Sporotrichosis

Topics: Amphotericin B; Antifungal Agents; Aspergillosis; Blastomycosis; Candidiasis; Chromoblastomycosis; Coccidioidomycosis; Cryptococcosis; Flucytosine; Histoplasmosis; Humans; Imidazoles; Ketoconazole; Lung Diseases, Fungal; Miconazole; Mycoses; Nausea; Piperazines; Vomiting

Fungal infections of the gastrointestinal tract have risen to higher levels of prevalence in the past decade. Major factors accounting for this increase are social changes, such as the increased ease and frequency of travel, which exposes the individual to environmental conditions that may result in fungal infection; increasing use of antibiotic and hormonal medications by otherwise healthy persons; and improved therapy for other diseases, such as polychemotherapy of cancer with its immunosuppressive effects. Both noninvasive and invasive fungal disease of the intestinal tract in otherwise healthy individuals can be successfully treated. The invasive fungal infections in patients with severe prior underlying disease are often first diagnosed postmortem, but improvement in serologic techniques now offers a possibility of earlier diagnosis and therapeutic intervention.

Topics: Amphotericin B; Antifungal Agents; Candidiasis; Diarrhea; Enteritis; Histoplasmosis; Humans; Imidazoles; Immunosuppression Therapy; Ketoconazole; Miconazole; Mycoses; Neoplasms; Nystatin; Paracoccidioidomycosis; Piperazines; Sulfadiazine

Topics: Adult; Aged; Amphotericin B; Arthritis, Infectious; Cryptococcosis; Female; Flucytosine; Histoplasmosis; Humans; Male; Middle Aged

Topics: Amphotericin B; Blastomycosis; Histoplasmin; Histoplasmosis; Humans; Lung Diseases, Fungal; Skin Tests

Topics: Amphotericin B; Aspergillosis; Blastomycosis; Candidiasis; Coccidioidomycosis; Complement Fixation Tests; Cryptococcosis; Fluorouracil; Histoplasmosis; Humans; Lung Diseases, Fungal; Skin Tests; Stilbamidines

Topics: Amphotericin B; Animals; Antifungal Agents; Aspergillosis; Blastomycosis; Candicidin; Candidiasis; Coccidioidomycosis; Colistin; Cryptococcosis; Dermatomycoses; Drug Resistance, Microbial; Emetine; Flucytosine; Griseofulvin; Histoplasmosis; Humans; Imidazoles; Minocycline; Natamycin; Nystatin; Polyenes; Tolnaftate

Topics: Age Factors; Air Microbiology; Amphotericin B; Biopsy; Environmental Exposure; Histoplasma; Histoplasmin; Histoplasmosis; Humans; Lung; Lung Diseases, Fungal; Recurrence; Skin Tests; Soil Microbiology

Topics: Amphotericin B; Angiography; Bronchography; Child; Female; Histoplasmosis; Humans; Lung Diseases, Fungal; Male; Pleural Effusion; Pulmonary Edema; Pulmonary Fibrosis; Tomography

Topics: Actinomycosis; Amphotericin B; Antifungal Agents; Aspergillosis; Blastomycosis; Candidiasis; Coccidioidomycosis; Cryptococcosis; Flucytosine; Histoplasmosis; Humans; Mucormycosis; Mycoses; Nocardia Infections; Sporotrichosis

Topics: Amphotericin B; Animals; Chorioretinitis; Diagnosis, Differential; Eye Diseases; Fundus Oculi; Histoplasma; Histoplasmosis; Humans; Light Coagulation; Toxoplasmosis, Ocular

Topics: Adolescent; Adult; Aged; Amphotericin B; Child; Child, Preschool; Histoplasmosis; Humans; Infant; Lung Diseases, Fungal; Middle Aged

Topics: Amphotericin B; Child; Coccidioidomycosis; Crohn Disease; Diagnosis, Differential; Female; Gastrointestinal Diseases; Histoplasma; Histoplasmosis; Humans; Male; Radiography; Skin Tests

Topics: Administration, Oral; Adolescent; Aged; Amphotericin B; Anemia; Anterior Chamber; Blastomycosis; Bronchi; Child; Cryptococcosis; Drug Resistance, Microbial; Fungi; Histoplasmosis; Humans; Injections; Injections, Intravenous; Injections, Spinal; Kidney Diseases; Male; Microbial Sensitivity Tests; Middle Aged; Mycoses; Thrombophlebitis; Water-Electrolyte Balance

Topics: Amphotericin B; Aspergillosis; Candida; Candidiasis; Child; Child, Preschool; Coccidioidomycosis; Coccidiosis; Cryptococcosis; Endocarditis; Granuloma; Histoplasmosis; Humans; Infant; Kidney; Kidney Function Tests; Meningitis; Mycoses; Pneumonia

Topics: Adult; Amphotericin B; Candidiasis; Female; Gastrointestinal Diseases; Histoplasmosis; Humans; Infant; Leukemia; Lymphoma; Male; Mucormycosis; Mycoses; Nystatin

Topics: Actinomycosis; Adolescent; Adult; Amphotericin B; Animals; Aspergillosis; Basidiomycota; Blastomycosis; Candidiasis; Cephalosporins; Child; Chromoblastomycosis; Coccidioidomycosis; Conjunctiva; Cryptococcosis; Drug Synergism; Eye Diseases; Female; Fungi; Geotrichosis; Guinea Pigs; Histoplasmosis; Humans; Male; Mucor; Mycetoma; Mycoses; Natamycin; Nystatin; Penicillium; Pityriasis; Rabbits; Rhinosporidiosis; Sporotrichosis; Tinea

Topics: Amphotericin B; Animals; Birds; Chorioretinitis; Europe; Eye Diseases; Haplorhini; Histoplasma; Histoplasmin; Histoplasmosis; History of Medicine; Humans; Rabbits; Rats; United States

Topics: Amphotericin B; Complement Fixation Tests; Diagnosis; Diagnosis, Differential; Epidemiology; Fungi; Histoplasmosis; Humans; Lung Diseases; Lung Diseases, Fungal; Skin Tests; Surgical Procedures, Operative

Topics: Actinomycosis; Amphotericin B; Anti-Bacterial Agents; Aspergillosis; Candidiasis; Cryptococcosis; Griseofulvin; Histoplasmosis; Humans; Nystatin; Penicillins

Topics: Actinomycosis; Amphotericin B; Anti-Bacterial Agents; Aspergillosis; Blastomycosis; Candidiasis; Coccidioidomycosis; Cryptococcosis; Griseofulvin; Histoplasmosis; Humans; Iodides; Mucormycosis; Mycoses; Nocardia Infections; Nystatin; Penicillins; Sporotrichosis; Stilbamidines; Sulfadiazine; Surgical Procedures, Operative; Toxicology

Topics: Amphotericin B; Blastomycosis; Cryptococcosis; Histoplasmosis; Humans

Histoplasmosis is a major AIDS-defining illness in Latin America. Liposomal amphotericin B (L-AmB) is the drug of choice for treatment, but access is restricted due to the high drug and hospitalization costs of the conventional long regimens.. Prospective randomized multicenter open-label trial of 1- or 2-dose induction therapy with L-AmB versus control for disseminated histoplasmosis in AIDS, followed by oral itraconazole therapy. We randomized subjects to: (i) single dose 10 mg/kg of L-AmB; (ii) 10 mg/kg of L-AmB on D1, and 5 mg/kg of L-AmB on D3; (iii) 3 mg/kg of L-AmB daily for 2 weeks (control). The primary outcome was clinical response (resolution of fever and signs/symptoms attributable to histoplasmosis) at day 14.. A total of 118 subjects were randomized, and median CD4+ counts, and clinical presentations were similar between arms. Infusion-related toxicity, kidney toxicity at multiple time-points, and frequency of anemia, hypokalemia, hypomagnesemia, and liver toxicity were similar. Day 14 clinical response was 84% for single-dose L-AmB, 69% 2-dose L-AmB, and 74% for control arm (P = .69). Overall survival on D14 was 89.0% (34/38) for single-dose L-AmB, 78.0% (29/37) for 2-dose L-AmB, and 92.1% (35/38) for control arm (P = .82).. One day induction therapy with 10 mg/kg of L-AmB in AIDS-related histoplasmosis was safe. Although clinical response may be non-inferior to standard L-AmB therapy, a confirmatory phase III clinical trial is needed. A single induction dose would markedly reduce drug-acquisition costs (>4-fold) and markedly shorten and simplify treatment, which are key points in terms of increased access.

Topics: Acquired Immunodeficiency Syndrome; Antifungal Agents; Drug-Related Side Effects and Adverse Reactions; Histoplasmosis; HIV; Humans; Prospective Studies

Clearance of Histoplasma antigen has been used as a marker for response to treatment of progressive disseminated histoplasmosis (PDH) in patients with AIDS. Advancements in Histoplasma antigen detection permit accurate quantification of antigen concentration. We compared the clearance of antigenemia and antigenuria during effective treatment of PDH. Urine and serum specimens were serially collected from patients with AIDS who were successfully treated for PDH as part of two prospective clinical trials. Samples were stored frozen until they were tested in the quantitative Histoplasma antigen enzyme immunoassay. The kinetics of antigen clearance during the first 12 weeks of therapy were assessed in urine and serum during treatment with liposomal or deoxycholate amphotericin B followed by itraconazole and, in a separate analysis, in patients receiving only itraconazole. Latent class growth analysis was performed to define patterns of antigen clearance over time. In patients receiving amphotericin B, antigen levels declined the most during the first 2 weeks of treatment and antigenemia decreased more rapidly than antigenuria (5.90 ng/ml per week versus 4.21 ng/ml per week, respectively; P = 0.09). Mean reductions of antigen levels from baseline at weeks 2 and 12 were greater in sera than in urine: 11.26 ng/ml versus 7.65 ng/ml (P = 0.0948) and 18.52 ng/ml versus 14.64 ng/ml (P = 0.0440), respectively. In patients who received itraconazole alone, most of the decline in antigenuria occurred later during treatment and was overall slower than that seen with amphotericin B (P < 0.0001). Results of latent class growth modeling showed two distinct trajectories for each parameter. With effective therapy, Histoplasma antigenemia decreases more rapidly than antigenuria, providing a more sensitive early laboratory marker for response to treatment. Antigenuria declines earlier with amphotericin B than with itraconazole.

Topics: Acquired Immunodeficiency Syndrome; Amphotericin B; Antifungal Agents; Antigens, Fungal; Drug Monitoring; Histoplasmosis; Humans; Immunoenzyme Techniques; Itraconazole

In patients with moderate to severe histoplasmosis associated with AIDS, the preferred treatment has been the deoxycholate formulation of amphotericin B. However, serious side effects are associated with use of amphotericin B.. To compare amphotericin B with liposomal amphotericin B for induction therapy of moderate to severe disseminated histoplasmosis in patients with AIDS.. Randomized, double-blind, multicenter clinical trial.. 21 sites of the U.S. National Institute of Allergy and Infectious Diseases Mycoses Study Group.. 81 patients with AIDS and moderate to severe disseminated histoplasmosis.. Clinical success, conversion of baseline blood cultures to negative, and acute toxicities that necessitated discontinuation of treatment.. Clinical success was achieved in 14 of 22 patients (64%) treated with amphotericin B compared with 45 of 51 patients (88%) receiving liposomal amphotericin B (difference, 24 percentage points [95% CI, 1 to 52 percentage points]). Culture conversion rates were similar. Three patients treated with amphotericin B and one treated with liposomal amphotericin B died during induction (P = 0.04). Infusion-related side effects were greater with amphotericin B (63%) than with liposomal amphotericin B (25%) (P = 0.002). Nephrotoxicity occurred in 37% of patients treated with amphotericin B and 9% of patients treated with liposomal amphotericin B (P = 0.003).. Liposomal amphotericin B seems to be a less toxic alternative to amphotericin B and is associated with improved survival.

Topics: AIDS-Related Opportunistic Infections; Amphotericin B; Antifungal Agents; Chemical and Drug Induced Liver Injury; Double-Blind Method; Histoplasmosis; Humans; Liposomes; Safety

Animal studies have shown that fungal burden correlates with survival during treatment with new antifungal therapies for histoplasmosis. The purpose of this report is to compare the clearance of fungal burden in patients with histoplasmosis treated with liposomal amphotericin B versus itraconazole. In two separate closed clinical trials that evaluated the efficacy of liposomal amphotericin B and itraconazole treatment of disseminated histoplasmosis in patients with AIDS, blood was cultured for fungus and blood and urine were tested for Histoplasma antigen. The clinical response rates were similar; 86% with liposomal amphotericin B (n = 51) versus 85% with itraconazole (n = 59). Of the patients with positive blood cultures at enrollment, after 2 weeks of therapy cultures were negative in over 85% of the liposomal amphotericin B group versus 53% of the itraconazole group (P = 0.0008). Furthermore, after 2 weeks, median antigen levels in serum fell by 1.6 U in the liposomal amphotericin B group versus 0.1 U in the itraconazole group (P = 0.02), and those in urine fell by 2.1 U in the liposomal amphotericin B group and 0.2 U in the itraconazole group (P = 0.0005). The more rapid clearance of fungemia supports the use of liposomal amphotericin B rather than itraconazole for initial treatment of moderately severe or severe histoplasmosis.

Topics: Adolescent; AIDS-Related Opportunistic Infections; Amphotericin B; Antifungal Agents; Fungemia; Histoplasma; Histoplasmosis; Humans; Itraconazole; Liposomes; Treatment Outcome

To assess the efficacy and safety of itraconazole in preventing relapse of histoplasmosis after induction therapy with amphotericin B in patients with the acquired immunodeficiency syndrome (AIDS) and disseminated histoplasmosis.. A prospective, multicenter, open-label clinical trial, with follow-up for at least 52 weeks.. Tertiary care hospitals participating in a clinical investigation sponsored by the National Institutes of Allergy and Infectious Diseases (AIDS Clinical Trial Group and Mycoses Study Group).. Forty-two patients with AIDS who had successfully completed induction therapy for disseminated histoplasmosis amphotericin B, at least 15 mg/kg body weight given over 4 to 12 weeks.. Itraconazole, 200 mg given orally twice daily.. Response to therapy, specifically prevention of histoplasmosis relapse, was the main outcome measure. Secondary end points were survival and the effect of therapy on Histoplasma capsulatum variety capsulatum antigen levels in urine and serum. Plasma itraconazole concentrations were measured to document drug absorption and compliance with therapy.. The median follow-up was 109 weeks, and median survival was 98 weeks. Two relapses occurred (5%; 95% CI, 0.5% to 16%), one in a patient withdrawn from the study 18 weeks earlier and one in a patient who did not comply with the study therapy. Patients with elevated antigen levels at study entry showed clearance of antigen from urine and serum; urine specimens became negative in 43% of patients (CI, 26% to 59%), and serum specimens became negative in 75% of patients (CI, 56% to 94%). Only one patient discontinued treatment because of itraconazole toxicity (hypokalemia).. Itraconazole, 200 mg twice daily, is safe and effective in preventing relapse of disseminated histoplasmosis in patients with AIDS. Antigen clearance from blood and urine correlates with clinical efficacy.

Topics: Adolescent; Adult; AIDS-Related Opportunistic Infections; Amphotericin B; Antifungal Agents; Antigens, Fungal; Female; Histoplasma; Histoplasmosis; Humans; Itraconazole; Ketoconazole; Male; Middle Aged; Patient Compliance; Prospective Studies; Recurrence

Topics: Acquired Immunodeficiency Syndrome; Amphotericin B; Anemia; Erythropoietin; Histoplasmosis; Humans; Recombinant Proteins; Zidovudine

Topics: Adrenocorticotropic Hormone; Adult; Amphotericin B; Chorioretinitis; Clinical Trials as Topic; Female; Glucocorticoids; Histoplasmosis; Humans; Injections, Intravenous; Kidney Diseases; Kidney Function Tests; Male; Sulfonamides; Vision Tests; Visual Perception

Topics: Adult; Amphotericin B; Complement Fixation Tests; Histoplasmosis; Humans; Lung Diseases, Fungal; Male; Middle Aged; Tuberculosis, Pulmonary

Topics: Adult; Amphotericin B; Blastomycosis; Clinical Trials as Topic; Coccidioidomycosis; Cryptococcosis; Female; Histoplasmosis; Humans; Male; Middle Aged; Sporotrichosis

Histoplasmosis, a common mycosis in the south-central United States, may be life threatening in immunocompromised patients. We describe a 4-year-old female with Down syndrome and acute lymphoblastic leukemia who developed hemolytic anemia, thrombocytopenia, and renal failure, consistent with thrombotic microangiopathy. Bone marrow biopsy revealed non-necrotizing granulomas with GMS staining demonstrating budding yeast. Serum Histoplasma antigen testing was positive, providing further evidence for the diagnosis of progressive disseminated histoplasmosis. Treatment with amphotericin B, plasma exchange, and ventilator, vasopressor, and renal replacement support led to a full recovery. Providers should have a low threshold for histoplasmosis testing in ill immunocompromised patients, who are at greater risk for infection-related morbidity.

Topics: Amphotericin B; Child; Child, Preschool; Down Syndrome; Female; Histoplasmosis; Humans; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Thrombotic Microangiopathies

Histoplasmosis is an endemic fungal infection caused by the fungus Histoplasma capsulatum. The disseminated form is associated with a high morbidity and mortality in pediatrics. Here we report the case of an immunocompetent female patient diagnosed with disseminated histoplasmosis. She was 3 years old and presented with protracted febrile syndrome and hepatosplenomegaly confirmed by ultrasound. Lab tests showed normocytic anemia and leukopenia. Diagnosis was made by periportal and perisplenic lymph node biopsy. The culture was positive for Histoplasma capsulatum and histopathological studies showed granulomatous lymphadenitis with intracellular yeast-like elements. Amphotericin B was administered at 1 mg/kg/day for 6 weeks, with a favorable clinical course. Disseminated histoplasmosis should be considered in patients from endemic areas who present the triad of fever, hepatosplenomegaly, and cytopenias so as to provide a timely treatment, improve prognosis, and reduce the mortality from this disease.. La histoplasmosis es una micosis endémica producida por el hongo Histoplasma capsulatum. La forma diseminada en pediatría conlleva alta morbimortalidad. Reportamos el caso de una niña inmunocompetente con diagnóstico de histoplasmosis diseminada. Paciente de 3 años de edad con cuadro clínico de síndrome febril prolongado acompañado de hepatoesplenomegalia confirmada por ecografía. Laboratorio con anemia normocítica, normocrómica y leucopenia. Se arribó al diagnóstico por biopsia de ganglio periportal y periesplénico. El cultivo fue positivo para Histoplasma capsulatum y en estudios histopatológicos se observó linfadenitis granulomatosa con elementos levaduriformes intracelulares. Realizó tratamiento con anfotericina B 1 mg/kg/día durante 6 semanas con favorable resolución clínica. Se debe considerar histoplasmosis diseminada en aquellos pacientes provenientes de zonas endémicas que presentan la tríada de fiebre, hepatoesplenomegalia y citopenias, para poder brindar un tratamiento oportuno, mejorar el pronóstico y disminuir la mortalidad de la enfermedad.

Topics: Amphotericin B; Child; Child, Preschool; Female; Fever; Histoplasma; Histoplasmosis; Humans; Immunocompetence

Histoplasmosis is the most common endemic mycosis among people living with advanced HIV infection.. Describe general aspects and challenges of this disease and its association with HIV.. Review of literature.. Articles found using different combinations of terms including "disseminated histoplasmosis" and AIDS/HIV or immunosuppression in PubMed, Scopus, WHO Global health library, and Scielo database.. We look for information on epidemiology, pathogenesis, diagnosis, and treatment of histoplasmosis in AIDS patients.. Histoplasmosis is caused by. Histoplasmosis remains a neglected disease. Few studies about the disease and expensive treatments make it difficult to reduce the morbidity and mortality of this condition. Public health services and physicians must be aware of histoplasmosis' burden among the HIV-positive population.

Topics: AIDS-Related Opportunistic Infections; Amphotericin B; Histoplasma; Histoplasmosis; HIV Infections; Humans

Cases of empyema associated with

Topics: Amphotericin B; Empyema, Pleural; Female; Histoplasma; Histoplasmosis; Humans; Injections, Intravenous; Middle Aged; Pleural Effusion; Therapeutic Irrigation; Thoracoscopy

Progressive disseminated histoplasmosis remains a major but neglected cause of death among patients with advanced HIV. Recently, aiming to reduce avoidable deaths, the Pan American Health Organization issued the first diagnosis and treatment guidelines for HIV-associated histoplasmosis. But what proportion of progressive disseminated histoplasmosis in HIV-infected patients is severe is currently not known. Because this proportion influences treatment needs, we aimed to estimate this in a cohort of 416 patients in French Guiana.. We used the definition in the recent PAHO/WHO guidelines for severity. We used regression modelling to predict the impact of CD4 count on the proportion of severe cases. In a territory where treatment cost is not a limiting factor and where histoplasmosis is well known, we assumed that clinicians' initial treatment reflected their perception about the severity of the case and therefore, the needs for different treatments.. Using these definitions, since the beginning, there were 274 (65.9%) severe/moderately severe cases and 142 (34.1%) mild cases. In practice 186 cases were treated with deoxycholate or liposomal amphotericin B (44.7%) and 230 (55.3%) cases treated with itraconazole as first line treatment. The Kappa concordance measure between the guideline definition and the actual treatment given was 0.22. There was a 9% risk difference for death within 30 days of antifungal treatment initiation between severe/moderately severe and mild cases. Over threequarters (77%) of early deaths were attributed to severe/moderately severe cases.. This is the only rigorous estimate of the proportion of severe/moderately severe cases of progressive disseminated histoplasmosis in symptomatic HIV patients on the largest published cohort. These numbers may help defend budget needs for rapid diagnostic tests and liposomal amphotericin B.

Topics: Amphotericin B; Antifungal Agents; Histoplasma; Histoplasmosis; HIV Infections; Humans; Itraconazole

Topics: Aged, 80 and over; Amphotericin B; Antifungal Agents; Histoplasma; Histoplasmosis; Humans; Itraconazole; Male

Topics: Adolescent; Amphotericin B; Anti-Inflammatory Agents; Antifungal Agents; Doxorubicin; Etoposide; Histoplasmosis; Humans; Immunocompetence; Lymphohistiocytosis, Hemophagocytic; Male; Mass Spectrometry; Methylprednisolone; Treatment Outcome

Topics: Adult; AIDS-Related Opportunistic Infections; Amphotericin B; Antifungal Agents; Cameroon; Female; Histoplasmosis; Humans; Pancytopenia

A 48-year-old male patient living with HIV presented to our hospital with fever and weight loss. On evaluation, he was found to have pancytopenia, deranged liver and kidney function. CD4 count was 13 cells/uL. Bone marrow examination done because of pancytopenia showed yeast forms of histoplasmosis. Although liposomal amphotericin B is preferred for induction, he was treated with deoxycholate amphotericin B despite poor kidney function because of financial constraints. He was treated for 12 days with intravenous amphotericin, during which his clinical condition significantly improved. He was discharged on oral itraconazole.

Topics: Amphotericin B; Antifungal Agents; Deoxycholic Acid; Histoplasmosis; Humans; Kidney; Male; Middle Aged

The therapeutic efficacy of daily amphotericin B infusion is related to its maximum concentration in blood; however, trough levels may be useful in intermittent regimens of this antifungal drug.. : High performance liquid chromatography (HPLC) was used to determine the minimum concentration (Cmin) of amphotericin B in the serum of patients receiving deoxycholate (D-Amph) or liposomal amphotericin B (L-AmB) for the treatment of cryptococcal meningitis (n=28), histoplasmosis (n=8), paracoccidioidomycosis (n=1), and leishmaniasis (n=1).. Daily use of D-Amph 30 to 50 mg or L-AmB 50 mg resulted in a similar Cmin, but a significant increase ocurred with L-AmB 100 mg/day. The geometric mean Cmin tended to decrease with a reduction in the dose and frequency of intermittent L-AmB infusions: 357 ng/mL (100 mg 4 to 5 times/week) > 263 ng/mL (50 mg 4 to 5 times/week) > 227 ng/mL (50 mg 1 to 3 times/week). The impact on Cmin was variable in patients whose dose or therapeutic scheme was changed, especially when administered the intermittent infusion of amphotericin B. The mean Cmin for each L-AmB schedule of intermittent therapy was equal or higher than the minimum inhibitory concentration of amphotericin B against Cryptococcus isolates from 10/12 patients. The Cmin of amphotericin B in patients with cryptococcal meningitis was comparable between those that survived or died.. By evaluating the Cmin of amphotericin B, we demonstrated the therapeutic potential of its intermittent use including in the consolidation phase of neurocryptococcosis treatment, despite the great variability in serum levels among patients.

Topics: Amphotericin B; Antifungal Agents; Chromatography, High Pressure Liquid; Deoxycholic Acid; Histoplasmosis; Humans; Leishmaniasis; Meningitis, Cryptococcal; Paracoccidioidomycosis

Histoplasmosis is a rare infectious condition with mainly pulmonary involvement. Disseminated histoplasmosis may occur in immunocompromised condition. It can present in different ways but jaundice and ascites is very uncommon.. A 8- year old girl visited to department of pediatric gastroenterology & nutrition, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh. Child presented with fever, jaundice and abdominal distension for 2 ½ months. There was no history of contact with tuberculosis patient and travelling to kala-azar, malaria endemic zone and no history of previous jaundice, blood or blood product transfusion, history of sib death, family history of jaundice or neuropsychiatric disorder, significant weight loss. On general examination she was fretful, febrile, moderately icteric, mildly pale, vitally stable, severely wasted and moderately stunted, skin survey revealed infected scabies, BCG vaccine mark was absent, generalized lymphadenopathy, hepato-splenomegaly and ascites present. After evaluating the physical findings, several investigations was done including lymphnode biopsy, then the case was finally diagnosed as Disseminated histoplasmosis with portal hypertension. Child was treated with injectable Deoxycholate Amphotericin B for 28 days and improved on follow up.. We suggest that children presenting with fever, jaundice, lymphadenopathy and hepatosplenomegaly and portal hypertension, disseminated histoplasmosis can be one differential.

Topics: Amphotericin B; Bangladesh; Child; Female; Fever; Histoplasmosis; Humans; Hypertension, Portal

We describe a case of haemophagocytic lymphohistiocytosis (HLH) secondary to disseminated histoplasmosis, which was treated with chemotherapy in addition to standard antifungal therapy. While HLH in the setting of infections is very well described, its treatment in this setting is controversial, with some physicians treating only the underlying infection, whereas others using immune suppression in addition to antimicrobials. To the best of our knowledge, this is the first report documenting the successful treatment of an adult patient with HLH due to disseminated histoplasmosis using etoposide chemotherapy after initial antifungal therapy failed to show improvement.

Topics: Abdominal Pain; Adult; Amphotericin B; Antifungal Agents; Biopsy; Bone Marrow; Dexamethasone; Diagnosis, Differential; Drug Therapy, Combination; Encephalitis, Viral; Etoposide; Female; Fever; Histoplasma; Histoplasmosis; Humans; Invasive Fungal Infections; Lymphohistiocytosis, Hemophagocytic; Meningitis; Nausea; Treatment Outcome

Histoplasmosis is a rare disease in nonendemic areas. We report a case of a 23-year-old male patient who presented with fever of unknown origin, cytopenias, organomegaly, and allograft dysfunction 4 months after renal transplant with father as donor. Bone marrow examination showed intracellular budding yeast cells, which was confirmed as histoplasmosis by culture of bone marrow biopsy sample. The patient was treated with intravenous liposomal amphotericin and responded well.

Topics: Administration, Intravenous; Amphotericin B; Antifungal Agents; Biomarkers; Fever of Unknown Origin; Histoplasma; Histoplasmosis; Humans; Kidney Transplantation; L-Lactate Dehydrogenase; Male; Predictive Value of Tests; Treatment Outcome; Young Adult

Histoplasmosis is a systemic mycosis caused by the dimorphic fungus Histoplasma capsulatum, with disseminated histoplasmosis (HD) being one of its clinical forms. As a consequence of the HIV-AIDS pandemic, HD has become prevalent not only in regions that are recognized as endemic but also in areas not considered endemic, such as Europe and Asia. Its clinical manifestations are varied and mimic several infectious diseases, mainly tuberculosis. In endemic areas, it is the first manifestation of AIDS in 50 to 70% of patients. The diagnosis of histoplasmosis is difficult and HD can lead to death if not diagnosed early and if proper treatment is not instituted. The present report presents a patient with a recent diagnosis of HIV-AIDS, in treatment for miliary tuberculosis, who was diagnosed with disseminated histoplasmosis because of his dermatological manifestations.

Topics: Acquired Immunodeficiency Syndrome; Amphotericin B; Anti-HIV Agents; Antifungal Agents; Antitubercular Agents; Critical Illness; Dermatomycoses; Histoplasma; Histoplasmosis; Humans; Itraconazole; Male; Tuberculosis, Miliary; Young Adult

Topics: Amphotericin B; Antifungal Agents; Biopsy; Brain; Brain Neoplasms; CD4 Lymphocyte Count; Histoplasma; Histoplasmosis; HIV Infections; Humans; Itraconazole; Magnetic Resonance Imaging; Male; Middle Aged; Polymerase Chain Reaction; Treatment Outcome

Topics: Adolescent; Amphotericin B; Antigens, Fungal; Antiviral Agents; Biopsy; Bone Marrow; Cytomegalovirus; Cytomegalovirus Infections; Female; Fever of Unknown Origin; Graft Rejection; Histoplasma; Histoplasmosis; Humans; Immunosuppressive Agents; Kidney Failure, Chronic; Kidney Transplantation; Lymphohistiocytosis, Hemophagocytic; Mycophenolic Acid; Renal Dialysis; Treatment Outcome; Viral Load

We describe a Venezuelan visitor to Japan who was diagnosed with hemophagocytic lymphohistiocytosis (HLH). The patient was also diagnosed with human immunodeficiency virus (HIV) and Epstein-Barr virus infection by the Western blot and polymerase chain reaction (PCR) tests, respectively. The cause of HLH was considered to be these two infections at first; however, the patient did not recover with antiretroviral/anti-herpes virus therapy. Thereafter, diagnosis of disseminated histoplasmosis was confirmed with an antigen detection test, culture, and PCR test of blood, urine, and bone marrow, and the patient improved gradually after the initiation of liposomal amphotericin B. This case highlights the importance of ruling out endemic mycosis as a cause of HLH even if other probable causes exist in patients from endemic areas.

Topics: Amphotericin B; Antiviral Agents; Epstein-Barr Virus Infections; Female; Herpesvirus 4, Human; Histoplasma; Histoplasmosis; HIV; HIV Infections; Humans; Japan; Lymphohistiocytosis, Hemophagocytic; Middle Aged; Travel; Venezuela

Detailed studies of Addison's disease resulting from disseminated adrenal histoplasmosis (AH) are not available. We describe the presentation and prognosis of AH and cortisol status before and after antifungal therapy.. Single-centre retrospective hospital-based study of 40 consecutive adults with AH [39 males; age (mean ± SD) 53 ± 11 years] was conducted between 2006 and 2018. The median duration of follow-up was 2.5 years (range 0.2-12 years).. AH was diagnosed by bilateral adrenal enlargement on CT scan and presence of Histoplasma by histology and/or culture of biopsied adrenal tissue. All patients received oral itraconazole and, if required, amphotericin B as per guidelines. ACTH-stimulated serum cortisol (normal > 500 nmol/L) was measured in 38 patients at diagnosis and re-tested after one year of antifungal therapy in 21 patients.. Seventy-three per cent of patients had primary adrenal insufficiency (PAI) and one-third had an adrenal crisis at presentation. HIV antibody was negative in all patients. Of the 29 patients who completed antifungal therapy, 25 (86%) were in remission at last follow-up. Overall, 8 (20%) patients died: three had a sudden death, four had severe histoplasmosis and one died due to adrenal crisis. No patient with PAI became eucortisolemic on re-testing after one year of antifungal therapy. Of the eight patients with normal cortisol at diagnosis, two developed adrenal insufficiency on follow-up.. All patients with AH tested negative for HIV antibody. While patients achieved a high rate of clinical remission after antifungal therapy, overall mortality was significant. Cortisol insufficiency did not normalize despite treatment.

Topics: Addison Disease; Adult; Amphotericin B; Antifungal Agents; Female; Follow-Up Studies; Histoplasma; Histoplasmosis; Humans; Hydrocortisone; Itraconazole; Male; Middle Aged; Prognosis; Retrospective Studies

A wide differential diagnosis must be entertained in patients with unusual oral and pharyngeal ulcerations. A mucosal biopsy is essential. We retrospectively reviewed 10 cases from the Infectious Diseases Division at Mayo Clinic Rochester (MN, USA), in which the diagnosis proved to be Histoplasma capsulatum infection. Between 1995 and 2016, 10 patients were diagnosed with oropharyngeal histoplasmosis. Common presenting symptoms included weight loss, weakness and oropharyngeal pain with ulcerations. Despite specialty evaluation at other facilities, diagnostic delay occurred in six patients due to lack of biopsy or fungal staining. Yeast forms consistent with H. capsulatum were identified in the biopsy specimens of all our patients. Treatment included intravenous amphotericin B and prolonged courses of azoles. Oral histoplasmosis occurred in both immunocompetent and immunosuppressed patients, and was a manifestation of disseminated infection. Severe pain involving all areas of the mouth was typical. Diagnostic delay may be avoided by early biopsy using fungal stains.

Topics: Aged; Aged, 80 and over; Amphotericin B; Antifungal Agents; Biopsy; Complement Fixation Tests; Delayed Diagnosis; Female; Histoplasmosis; Humans; Immunocompromised Host; Male; Middle Aged; Oropharynx; Pharyngeal Diseases; Retrospective Studies; Smoking; Tongue; Weight Loss

Topics: Abdominal Pain; Aged; Amphotericin B; Antifungal Agents; Diagnosis, Differential; Diarrhea; Female; Fever; Histoplasma; Histoplasmosis; Humans

Opportunistic infections, while well studied in the AIDS population, continue to have variable and surprising presentations. Here, we present a case of disseminated histoplasmosis with disseminated nontuberculous mycobacterial infection in a 50 year old man with long standing AIDS living in a non-endemic area.. Patient presented with a constellation of symptoms, and imaging of the chest showed a pulmonary mass with cavitation, multiple nodules, and ground glass opacities. Further investigations revealed granulomatous lung nodules and fungemia consistent with Histoplasma capsulatum, and coinfection with disseminated nontuberculous mycobateria in a nonendemic area.. Immunocompromised patients risk co-inhabitation by multiple infectious organisms. Some of these organisms may preside in the host for years prior to reactivation. Clinicians in non endemic areas should therefore be careful to not overlook specific organisms based on a lack of a recent travel history. Physicians in nonendemic areas should become more familiar with the clinical findings and diagnostic approach of infectious such as Histoplasmosis, to ensure earlier recognition and treatment in immunocompromised individuals.

Topics: Acquired Immunodeficiency Syndrome; AIDS-Related Opportunistic Infections; Amphotericin B; Anti-Bacterial Agents; Anti-HIV Agents; Antifungal Agents; Antitubercular Agents; Azithromycin; Bacteremia; California; Emtricitabine; Ethambutol; Fungemia; Heterocyclic Compounds, 3-Ring; Histoplasmosis; Humans; Lung; Male; Middle Aged; Mycobacterium Infections, Nontuberculous; Oxazines; Piperazines; Pyridones; Rifabutin; Tenofovir; Tomography, X-Ray Computed

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

Topics: Adult; Amphotericin B; Antifungal Agents; Fever; Heart Failure; Hemolysis; Hepatomegaly; Histoplasmosis; Humans; Immunocompetence; Itraconazole; Lymphohistiocytosis, Hemophagocytic; Male; Pancytopenia; Splenomegaly

We report an unusual 3-substituted pyridine polyketide, onydecalin A (1), which was obtained along with 2 as a major constituent from the fungus Aioliomyces pyridodomos (order: Onygenales) following a two-month fermentation. Feeding studies demonstrated that the pyridine subunit originates via an unprecedented biosynthetic process in comparison to other polyketide-linked pyridines or derivatives such as pyridones. The slow growth of the fungus led us to perform a one-year fermentation, leading to production of compounds 2-4 as the major constituents. These compounds showed modest but selective inhibition against a variety of transient receptor potential channels, as well as against the human pathogenic fungus Histoplasma capsulatum.

Topics: Ascomycota; Biological Products; Fermentation; Histoplasma; Histoplasmosis; Humans; Molecular Structure; Polyketides; Transient Receptor Potential Channels

Amphotericin is the preferred treatment for pulmonary histoplasmosis during pregnancy. The long half-life of amphotericin supports less than daily administration.. A 28-year-old pregnant woman diagnosed with recurrent pulmonary histoplasmosis was initiated on liposomal amphotericin 250 mg (4 mg/kg) intravenously daily. After 2 weeks, the patient was discharged and successfully received 250 mg thrice weekly at a hospital-associated outpatient infusion centre. After 6 weeks of outpatient treatment, a chest X-ray demonstrated no remaining disease and therapy was discontinued.. Administration of thrice-weekly liposomal amphotericin in a hospital-associated, outpatient infusion centre may be a promising option for stepdown treatment in patients unable to take itraconazole.

Topics: Adult; Amphotericin B; Antifungal Agents; Female; Histoplasmosis; Humans; Lung Diseases; Outpatients

A 46-year-old Dominican man, known to have HIV, presented with constitutional symptoms of two week's duration. The patient was found to have cytopenias, significantly elevated ferritin level and lymphadenopathy. Biopsies and laboratory studies met the criteria for hemophagocytic lymphohistiocytosis (HLH). A concomitant diagnosis of histoplasmosis was confirmed as the trigger for HLH and treatment resulted in clinical improvement and resolution of symptoms.

Topics: Amphotericin B; Antifungal Agents; Antiretroviral Therapy, Highly Active; Histoplasmosis; HIV Seropositivity; Humans; Itraconazole; Lymphohistiocytosis, Hemophagocytic; Male; Middle Aged; Treatment Outcome

Topics: Acquired Immunodeficiency Syndrome; Aged; AIDS-Related Opportunistic Infections; Amphotericin B; Anti-Retroviral Agents; Bone Marrow; Fungemia; Histoplasma; Histoplasmosis; HIV; Humans; Itraconazole; Male; Viral Load

Histoplasmosis is a fungal infection caused by a dimorphic fungus, Histoplasma capsulatum. We report a first case of disseminated histoplasmosis in a 34-year-old woman, infected with human immunodeficiency virus (HIV), originating from Ivory Coast and living in Tunisia for 4 years. She was complaining from fever, chronic diarrhoea and pancytopenia. The Histoplasma capsulatum var. capsulatum was identified by direct microscopic examination of the bone marrow. She was treated by Amphotericin B, relayed by itraconazole. Even though a regression of symptoms and normalization of blood cell count (BCC), the patient died in a respiratory distress related to CMV hypoxemic pneumonia.

Topics: Adult; AIDS-Related Opportunistic Infections; Amphotericin B; Antifungal Agents; Bone Marrow; Communicable Diseases, Imported; Cote d'Ivoire; Fatal Outcome; Female; Histoplasma; Histoplasmosis; HIV Infections; Humans; Itraconazole; Microscopy; Respiratory Distress Syndrome; Tunisia

Epidemiological cut-off values (ECVs) have been used as a tool to detect the acquisition of resistance mechanisms to antifungal drugs. In this context, the objective of this study was to determine the ECVs for classic antifungals against Histoplasma capsulatum var. capsulatum isolates from human immunodeficiency virus (HIV)-infected patients with a diagnosis of disseminated histoplasmosis. First, minimum inhibitory concentrations (MICs) for amphotericin B (AmB), itraconazole (ITR), fluconazole (FLU), voriconazole (VCZ) and caspofungin (CAS) were determined against 138 H. capsulatum isolates in the filamentous form by the broth microdilution method; antifungal ECVs were then calculated. MIC ranges were 0.0078-1 µg/mL for AmB, 0.0005-0.0625 µg/mL for ITR, 2 to ≥256 µg/mL for FLU, 0.0078-1 µg/mL for VCZ and ≤0.0156 to ≥32 µg/mL for CAS. The obtained ECVs were 0.5, 0.0313, 128, 0.5 and 16 µg/mL for AmB, ITR, FLU, VCZ and CAS, respectively. The percentage of wild-type isolates was 96.4% for AmB, 98.6% for ITR and 99.3% for FLU, VCZ and CAS. Although these results do not cover all phylogenetic species of H. capsulatum, they bring important information on strains from Brazil. In addition, the assessed isolates were from HIV-positive patients, which may not reflect the antifungal ECVs against isolates from immunocompetent individuals or from other sources. Finally, this study pioneers the initiative of establishing ECVs for five antifungal agents against H. capsulatum var. capsulatum, providing a criterion for the interpretation of susceptibility results as well as a monitoring strategy for the emergence of antifungal resistance.

Topics: Amphotericin B; Antifungal Agents; Brazil; Caspofungin; Echinocandins; Fluconazole; Histoplasma; Histoplasmosis; HIV; HIV Infections; Humans; Itraconazole; Lipopeptides; Microbial Sensitivity Tests; Retrospective Studies; Voriconazole

Central nervous system (CNS) involvement occurs in 5 to 10% of individuals with disseminated histoplasmosis. Most experience has been derived from small single center case series, or case report literature reviews. Therefore, a larger study of central nervous system (CNS) histoplasmosis is needed in order to guide the approach to diagnosis, and treatment.A convenience sample of 77 patients with histoplasmosis infection of the CNS was evaluated. Data was collected that focused on recognition of infection, diagnostic techniques, and outcomes of treatment.Twenty nine percent of patients were not immunosuppressed. Histoplasma antigen, or anti-Histoplasma antibodies were detected in the cerebrospinal fluid (CSF) in 75% of patients. One year survival was 75% among patients treated initially with amphotericin B, and was highest with liposomal, or deoxycholate formulations. Mortality was higher in immunocompromised patients, and patients 54 years of age, or older. Six percent of patients relapsed, all of whom had the acquired immunodeficiency syndrome (AIDS), and were poorly adherent with treatment.While CNS histoplasmosis occurred most often in immunocompromised individuals, a significant proportion of patients were previously, healthy. The diagnosis can be established by antigen, and antibody testing of the CSF, and serum, and antigen testing of the urine in most patients. Treatment with liposomal amphotericin B (AMB-L) for at least 1 month; followed by itraconazole for at least 1 year, results in survival among the majority of individuals. Patients should be followed for relapse for at least 1 year, after stopping therapy.

Topics: Acquired Immunodeficiency Syndrome; Age Factors; Amphotericin B; Antibodies, Fungal; Antigens, Fungal; Brain; Central Nervous System Fungal Infections; Female; Histoplasmosis; Humans; Immunocompromised Host; Magnetic Resonance Imaging; Male; Middle Aged; Retrospective Studies; Spinal Cord

A 41-year-old man left for Mexico in May 2015. Right pulmonary nodule was detected at a health examination in May 2016, and he subsequently showed headache and slight fever. Contrast-enhanced magnetic resonance imaging of the brain revealed basilar meningitis, so he was admitted to our hospital. We considered imported mycosis due to his travel history to Mexico. We diagnosed histoplasmosis based on the presence of antibodies against Histoplasma in both serum and cerebrospinal fluid. Symptoms almost completely recovered with a liposomal formulation of amphotericin B. Central nervous system histoplasmosis is very rare in Japan. Immunocompetent hosts can develop histoplasmosis, and this pathology is important to consider in patients presenting with basilar meningitis and a positive travel history.

Topics: Adult; Amphotericin B; Antibodies, Fungal; Antifungal Agents; Biomarkers; Brain Stem; Cerebellum; Chronic Disease; Early Diagnosis; Histoplasma; Histoplasmosis; Humans; Immunocompetence; Itraconazole; Magnetic Resonance Imaging; Male; Meningitis, Fungal; Treatment Outcome; Tuberculosis, Pulmonary

A 53-year-old man with Crohn's disease treated with adalimumab was hospitalised with abdominal pain, fatigue, fever and chills. CT scan of the abdomen showed chronic thickening of the terminal ileum and cecum and new-onset ascites. Further studies revealed weakly positive urine and serum histoplasma antigen. Laparoscopy revealed metastatic caking of the omentum and abdominal wall; peritoneal biopsy demonstrated organisms morphologically consistent with

Topics: Abdominal Pain; Adalimumab; Amphotericin B; Anti-Inflammatory Agents; Antifungal Agents; Ascites; Crohn Disease; Histoplasma; Histoplasmosis; Humans; Itraconazole; Laparoscopy; Male; Middle Aged; Peritonitis; Tomography, X-Ray Computed; Treatment Outcome

Histoplasma microconidia when inhaled are presented in antigenic form to T cells, limiting the extent of infection; however, defects in cellular immunity results in disseminated disease. Chronic lymphocytic leukaemia (CLL) is a lymphoproliferative disorder resulting in functionally impaired lymphocytes, predisposing patients to various opportunistic infections. The author reports a recently treated patient with CLL presenting with constitutional symptoms accompanied by hepatosplenomegaly and diffuse adenopathy. Considering the recent diagnosis and treatment of CLL, initial suspicion was relapsed disease. However, considering the immune deficiency associated with CLL and its treatment, infectious aetiologies were strongly considered. Further investigation revealed a case of disseminated histoplasmosis mimicking CLL in this reported patient. Considering appropriate diagnosis and timely therapy, the reported patient had good prognosis despite being diagnosed with disseminated histoplasmosis. This case highlights consideration of disseminated histoplasmosis in patients presenting with diffuse adenopathy along with hepatomegaly and/or splenomegaly in the right clinical setting.

Topics: Aged; Amphotericin B; Antifungal Agents; Farmers; Fever; Hepatomegaly; Histoplasmosis; Humans; Itraconazole; Leukemia, Lymphocytic, Chronic, B-Cell; Male; Opportunistic Infections; Radionuclide Imaging; Splenomegaly; Tomography, X-Ray Computed; Treatment Outcome; Urinalysis; Weight Loss

Disseminated histoplasmosis is a rare fungal infection and most documented cases are in immunocompromised individuals such as those with acquired immunodeficiency syndrome. However, histoplasmosis easily goes unrecognized in immunocompetent populations.. We report a rare case of histoplasmosis that was manifested as persistent fever and abnormal liver function in a 45-year-old immunocompetent female from Jiangsu Province.. Investigations revealed anemia and thrombocytopenia. Giemsa-stained bone marrow aspirate showed yeast-like cells, suggestive of Histoplasma capsulatum. Wright-stained bone marrow aspirate confirmed the diagnosis.. The patient was treated by amphotericin B (amphotericin B liposome) and itraconazole.. Our patient responded well to the treatment.. Emphasizing histoplasmosis as a cause of fever of unknown origin in an immunocompetent patient, this case highlights the need for an index of suspicion and the importance of prompt diagnosis, as any delay of treatment can be life threatening.

Topics: Amphotericin B; Antifungal Agents; Diagnosis, Differential; Female; Histoplasma; Histoplasmosis; Humans; Immunocompetence; Itraconazole; Middle Aged; Tomography, X-Ray Computed

Topics: Amphotericin B; Antifungal Agents; Germany; Histoplasmosis; Humans; Itraconazole; Male; Middle Aged; Tongue Diseases; Treatment Outcome; Ulcer

Histoplasma capsulatum variety capsulatum (H. capsulatum) is a thermally dimorphic fungus that is endemic to the Mississippi River and Ohio River valley regions. Of the hundreds of thousands of patients exposed to this fungus, less than 1% develop a severe illness most commonly manifesting as pulmonary disease. Septic arthritis from hematogenous seeding with H. capsulatum or from direct inoculation has been reported only rarely in the literature. The first case of septic arthritis of the shoulder due to H. capsulatum occurring in an immunocompromised patient, treated successfully with irrigation and debridement, systemic antifungals, and local delivery of amphotericin B with cement beads, is reported here. Importantly, the addition of local amphotericin B delivery by cement beads to conventional treatment likely led to clinical cure in this patient.

Topics: Aged, 80 and over; Amphotericin B; Antifungal Agents; Antirheumatic Agents; Arthritis, Infectious; Female; Histoplasma; Histoplasmosis; Humans; Immunocompromised Host; Methotrexate; Ohio; Treatment Outcome

The small lymphocytic lymphoma is a mature B cell neoplasm with a broad spectrum of clinical presentations. Opportunistic infections that are not related to the treatment, even in advanced stages, have a low incidence rate. There are few case reports in the medical literature of patients who have not received immunosuppressive therapy and present with small lymphocytic lymphoma associated with disseminated histoplasmosis at diagnosis.\ A female 82-year-old patient was admitted due to an intermittent dry cough, asthenia, and adynamia that had persisted for one month. Multiple studies to detect infections and immuno-rheumatic conditions were performed and an extensive cervical, thoracic and peritoneal adenopathic syndrome was diagnosed.\ A flow cytometry and a cervical lymph node biopsy were performed reporting CD19+, CD20dim, CD5+, CD45+, CD23+, CD43neg, and CD10neg phenotypes with restriction in the light kappa chain compatible with a small lymphocytic lymphoma.\ Epithelioid granulomas without necrosis were observed in the lymph node histopathology and special colorations showed no microorganisms. The culture from the lymph node was positive for Histoplasma capsulatum. We initiated treatment with amphotericin B and itraconazole with an adequate response. In the absence of compliance with oncology treatment criteria, the patient was managed on a “watch and wait” basis.\ Opportunistic infections could be the initial clinical manifestation in patients with low-grade lymphoproliferative syndromes. This case report shows that they can develop even in the absence of chemotherapy.

Topics: Aged, 80 and over; Alzheimer Disease; Amphotericin B; Antifungal Agents; Diabetes Mellitus, Type 2; Female; Histoplasma; Histoplasmosis; Humans; Hypertension; Itraconazole; Leukemia, Lymphocytic, Chronic, B-Cell; Lymph Nodes; Opportunistic Infections; Watchful Waiting

Histoplasmosis is an invasive mycosis caused by inhalation of the spores of dimorphic fungi Histoplasma capsulatum. The disease manifests in the lung as acute or chronic pulmonary histoplasmosis and in severe cases gets disseminated in multiple organs like skin, adrenal gland, central nervous system, lymph node, liver, spleen, bone marrow, and gastrointestinal tract. It occurs most commonly in immunodeficient patients like HIV-positive patients and transplant recipients, while immunocompetent hosts are affected rarely. In cases of gastrointestinal histoplasmosis, the samples are collected for culture and biopsy should be sent for histopathological examination for definitive diagnosis. We conducted a retrospective study of colonic biopsies performed in the department of gastroenterology in a tertiary care hospital of north India from January 2014 to December 2015. Five cases of colonic histoplasmosis were diagnosed on histopathology out of which 4 patients were from north India while 1 patient was from Myanmar. The patients presented with various complaints, including loose stools, diarrhea, altered bowel habits, and gastrointestinal bleeding. The prognosis is very good after early and aggressive treatment while the disease is fatal if it remains untreated. In our study, 2 patients died within few days of diagnosis due to delay in the diagnosis, dissemination, and associated complications. Other patients were started on amphotericin B deoxycholate and are under follow-up. An early diagnosis of gastrointestinal histoplasmosis is important as appropriate treatment leads to long-term survival while untreated cases are almost fatal.

Topics: Adult; Aged; Amphotericin B; Antifungal Agents; Biopsy; Colon; Colonoscopy; Deoxycholic Acid; Diarrhea; Drug Combinations; Female; Follow-Up Studies; Gastrointestinal Hemorrhage; Histoplasma; Histoplasmosis; Humans; India; Male; Middle Aged; Prognosis; Retrospective Studies; Time Factors

Topics: Adult; Amphotericin B; Anti-Bacterial Agents; Antifungal Agents; Diagnosis, Differential; Female; Histoplasmosis; HIV Infections; Humans; Itraconazole

A 64-year-old man presented with gradual onset of confusion, ataxia and 25-pound weight loss over 3 months. MRI of the brain revealed two enhancing cerebellar lesions suspicious for metastases. Positron emission tomography-CT showed enhancement of cervical and axillary lymph nodes. Left axillary lymph node biopsy showed no evidence of malignancy but instead showed fungal organisms morphologically consistent with Histoplasma spp. Disseminated histoplasmosis with central nervous system involvement was suspected. Further history revealed that the patient had been having subjective fever for the past several months. He has had mild pancytopenia for about 2 years, which had not been further evaluated. Additionally, he had an oesophagogastroduodenoscopy 3 months prior to admission, which had shown granulomatous gastritis. Subsequently, the diagnosis of disseminated histoplasmosis was confirmed by serological testing and bone marrow biopsy. The patient was started on liposomal amphotericin B. Unfortunately, the patient had a catastrophic stroke and was transitioned to comfort care measures.

Topics: Amphotericin B; Antifungal Agents; Axilla; Central Nervous System; Histoplasmosis; Humans; Lymph Nodes; Male; Middle Aged; Palliative Care; Positron Emission Tomography Computed Tomography; Stroke

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.

Topics: Adult; Amphotericin B; Antifungal Agents; Fatal Outcome; Fever; Histoplasma; Histoplasmosis; HIV Infections; Humans; India; Itraconazole; Lung; Lung Diseases, Fungal; Male; Middle Aged; Treatment Outcome

A 70-year-old man with history of heart transplant performed in 1986, presented with altered mental status. CT scan of brain showed ring-enhancing lesions, raising suspicion for metastatic malignancy. Work-up revealed bilateral adrenal masses, biopsy showed granulomatous changes consistent with histoplasmosis. The possibility of histoplasmosis was less likely as the patient had no prior history of symptomatic disease and had lived in the endemic area 30 years prior to presentation. Brain biopsy confirmed central nervous system involvement. Amphotericin B was initiated for disseminated disease but his hospital course was complicated by renal failure and new liver hypodensities on follow-up imaging. Acute progressive disseminated histoplasmosis can manifest after decades of initial exposure and should always be in differential diagnosis even in non-endemic areas for prompt diagnosis and better clinical outcome.

Topics: Adrenal Gland Diseases; Aged; Amphotericin B; Antifungal Agents; Brain; Delayed Diagnosis; Diagnosis, Differential; Heart Transplantation; Histoplasma; Histoplasmosis; Humans; Magnetic Resonance Imaging; Male; Tomography, X-Ray Computed; Transplant Recipients; Treatment Outcome

In patients with acquired immunodeficiency syndrome (AIDS), advanced immunosuppression is associated with atypical presentation of dermatological conditions. Our patient presented with a single crusted plaque over the lower lip and large tender cervical lymphadenopathy. The enzyme-linked immunosorbent assay for human immunodeficiency virus was found to be positive, and his CD4+ lymphocyte cell count was 4 cells/mm

Topics: Acquired Immunodeficiency Syndrome; Adult; Amphotericin B; Antifungal Agents; Biopsy; CD4 Lymphocyte Count; Deoxycholic Acid; Drug Combinations; Enzyme-Linked Immunosorbent Assay; Histoplasma; Histoplasmosis; Humans; Itraconazole; Lymph Nodes; Lymphoma, Non-Hodgkin; Male; Treatment Outcome

Topics: Adolescent; Amphotericin B; Antifungal Agents; Fever; Graft Rejection; Histoplasma; Histoplasmosis; Humans; Immunosuppression Therapy; Invasive Fungal Infections; Kidney Transplantation; Lymph Nodes; Male; Pancytopenia; Transplant Recipients; Urogenital Abnormalities

Histoplasma capsulatum causes a spectrum of manifestations from asymptomatic to fatal disseminated disease. Disseminated histoplasmosis is mostly seen in endemic areas among immunocompromised patients such as those with AIDS. Here, we present a patient living in a non-endemic area with previously undiagnosed diabetes mellitus, who presented with septic shock and diabetic ketoacidosis (DKA), and was ultimately diagnosed with disseminated histoplasmosis. The patient rapidly recovered on administration of intravenous liposomal amphotericin followed by oral itraconazole. Uncontrolled diabetes may be a risk factor for disseminated or severe histoplasmosis in otherwise immunocompetent patients.

Topics: Adult; Amphotericin B; Antifungal Agents; Delayed Diagnosis; Diabetes Mellitus, Type 2; Diabetic Ketoacidosis; Histoplasma; Histoplasmosis; Humans; Immunocompetence; Male; Tomography, X-Ray Computed; Travel; Treatment Outcome

Topics: AIDS-Related Opportunistic Infections; Amphotericin B; Antifungal Agents; Colonoscopy; Dyspepsia; Endoscopy, Digestive System; Gastrointestinal Diseases; Histoplasma; Histoplasmosis; Humans; Male; Middle Aged; Tomography Scanners, X-Ray Computed; Weight Loss

Histoplasma capsulatum can rarely affect the trachea. We report the case of a 68-year-old woman with rheumatoid arthritis on immunosuppressive therapy who presented with fevers, worsening shortness of breath, nonproductive cough and subjective throat hoarseness and fullness. Chest computed tomography demonstrated no tracheal findings. Bronchoscopy found mucosal irregularity, nodularity and vesicular regions in the proximal trachea extending seven centimeters distal to the vocal cords. Also seen was an edematous, exudative left vocal cord with polyps and an ulcerative lesion. Silver staining and culture and wash of the tracheal biopsy revealed Histoplasma capsulatum. She was treated with oral itraconazole then briefly on intravenous amphotericin for rising Histoplasma urinary antigen levels. She continued treatment 24 months following diagnosis with minimal dyspnea. Histoplasma tracheitis has been proposed as an indicator of disseminated infection. However, our patient did not demonstrate other organ manifestations. Histoplasma tracheitis should be considered in a differential diagnosis of tracheal lesions even in the absence of systemic involvement.

Topics: Administration, Intravenous; Aged; Amphotericin B; Antifungal Agents; Diagnosis, Differential; Female; Histoplasma; Histoplasmosis; Humans; Itraconazole; Trachea; Treatment Outcome

Central nervous system histoplasmosis is a rare opportunistic infection with a heterogeneous clinical presentation. We describe the first case of human immunodeficiency virus-associated cerebral histoplasmosis presenting with hemichorea. The patient recovered after treatment with conventional amphotericin B and itraconazole.

Topics: Adult; AIDS-Related Opportunistic Infections; Amphotericin B; Anti-Infective Agents; Antifungal Agents; Athetosis; Biopsy; Brain; Chorea; Histoplasma; Histoplasmosis; Homosexuality, Male; Humans; Itraconazole; Magnetic Resonance Imaging; Male; Treatment Outcome

Topics: Adolescent; Amphotericin B; Antifungal Agents; Deoxycholic Acid; Dermatomycoses; Drug Combinations; Fever; Histoplasmosis; Humans; Itraconazole; Lung Diseases, Fungal; Male; Nepal; Rural Population

Topics: Aged; Amphotericin B; Antifungal Agents; Edema; Erythema; Female; Forearm; Hand; Histoplasmosis; Humans; Itraconazole; Kansas; Pain; Treatment Outcome

Histoplasmosis, caused by the dimorphic fungus Histoplasma capsulatum, is a disease of protean manifestations and of global distribution. Although increasingly reported in Asia, there are few reports from the Philippines. Here, we describe a case of microbiologically diagnosed histoplasmosis, probably acquired from the Philippines, in a returning traveler who presented with a right foot wound and papular rash. The final diagnosis was disseminated histoplasmosis with cutaneous and bone involvement, both unusual manifestations of the disease.

Topics: Administration, Intravenous; Administration, Oral; Aged; Amphotericin B; Cefepime; Cephalosporins; Dexamethasone; Follow-Up Studies; Histoplasma; Histoplasmosis; Humans; Immunocompromised Host; Magnetic Resonance Imaging; Male; Osteomyelitis; Philippines; Skin Diseases; Thalidomide; Vancomycin

Topics: Adult; AIDS-Related Opportunistic Infections; Amphotericin B; Antifungal Agents; Deoxycholic Acid; Drug Combinations; Female; Histoplasma; Histoplasmosis; HIV Infections; Humans; Treatment Outcome; Uganda

Multiple lytic bone lesions in a child can be a manifestation of various diseases like Langerhans cell histiocytosis, metastatic neuroblastoma, leukemia, hyperparathyroidism, multifocal osteomyelitis and histoplasmosis. Disseminated histoplasmosis caused by Histoplasma capsulatum var. duboisii is well known to present with multiple osteolytic lesions in immunocompromised adults and is mostly restricted to the African subcontinent. Histoplasmosis seen in American and Asian countries is caused by Histoplasma capsulatum var. capsulatum, which presents with pulmonary and systemic manifestations and rarely bone involvement. We report a case of histoplasmosis, caused by H. capsulatum var. capsulatum with extensive lytic bone lesions in a 13 year old immunocompetent boy who presented with prolonged fever, weight loss and multiple boggy swellings. He responded to amphotericin and is currently on Itraconazole. This case is unique for extensive osteolytic lesions with H. capsulatum var. capsulatum infection in an immunocompetent child.

Topics: Adolescent; Amphotericin B; Antifungal Agents; Fever; Histoplasma; Histoplasmosis; Humans; Immunocompetence; Itraconazole; Male; Treatment Outcome

Haemophagocytic lymphohistiocytosis is an uncommon syndrome that results from an uncontrolled activation of macrophages and lymphocytes resulting in the compromise of multiple organs that is potentially fatal without timely treatment. It can be hereditary or a secondary result of infectious processes, neoplasms or autoimmune conditions. We present the case of a patient with HIV/AIDS who developed hemophagocytic lymphohistiocytosis as well as disseminated intravascular coagulation associated with histoplasmosis and who was successfully treated with amphotericin B, steroids and transitory dialytic support.

Topics: Acquired Immunodeficiency Syndrome; Amphotericin B; Disseminated Intravascular Coagulation; Histoplasmosis; Humans; Lymphohistiocytosis, Hemophagocytic

A 59-year-old patient with multiple myeloma on maintenance chemotherapy presented with fever, weight loss, and night sweats. An F-18 fluorodeoxyglucose (FDG) positron emission tomography (PET) computed tomography (CT) showed intra-abdominal lymphadenopathy with a mesenteric mass that led to further workup and diagnosis of histoplamosis. The patient was treated with amphotericin B and subsequently switched to itraconazole. This exemplifies the usefulness of FDG PET CT in diagnosis of infectious complications.

Topics: Amphotericin B; Antifungal Agents; Antineoplastic Agents; beta-Glucans; Colonoscopy; Fever; Fluorodeoxyglucose F18; Gastrointestinal Diseases; Hematopoietic Stem Cell Transplantation; Histoplasma; Histoplasmosis; Humans; Ileum; Intestinal Obstruction; Itraconazole; Lymphadenopathy; Male; Middle Aged; Multiple Myeloma; Positron-Emission Tomography; Radiopharmaceuticals; Tomography, X-Ray Computed; Weight Loss

To compare clinical features, diagnosis and therapeutic effect between pulmonary histoplasmosis and progressive disseminated histoplasmosis.
 Methods: A retrospective analysis for 12 cases of hospitalized patients with histoplasmosis, who was admitted in Xiangya Hospital, Central South University during the time from February 2009 to October 2015, was carried out. Four cases of pulmonary histoplasmosis and 8 cases of progressive disseminated histoplasmosis were included. The differences of clinical features, imaging tests, means for diagnosis and prognosis were analyzed between the two types of histoplasmosis.
 Results: The clinical manifestations of pulmonary histoplasmosis were mild, such as dry cough. However, the main clinical symptoms of progressive disseminated histoplasmosis were severe, including recurrence of high fever, superficial lymph node enlargement over the whole body, hepatosplenomegaly, accompanied by cough, abdominal pain, joint pain, skin changes, etc.Laboratory examination showed pancytopenia, abnormal liver function and abnormal coagulation function. One pulmonary case received the operation of left lower lung lobectomy, 3 cases of pulmonary histoplasmosis and 6 cases of progressive disseminated histoplasmosis patients were given deoxycholate amphotericin B, itraconazole, voriconazole or fluconazole for antifungal therapy. One disseminated case discharged from the hospital without treatment after diagnosis of histoplasmosis, and 1 disseminated case combined with severe pneumonia and active tuberculosis died ultimately.
 Conclusion: As a rare fungal infection, histoplasmosis is easily to be misdiagnosed. The diagnostic criteria depends on etiology through bone marrow smear and tissues biopsy. Liposomeal amphotericin B, deoxycholate amphotericin B and itraconazole are recommended to treat infection for histoplasma capsulatum.. 目的：比较肺型与进展播散型组织胞浆菌病的临床特点、诊断及预后差异。 方法：回顾性分析中南大学湘雅医院2009年2月至2015年10月期间收治的组织胞浆菌病住院患者12例，其中肺型4例，进展播散型8例。从临床表现、影像学、确诊途径及预后等方面分析两者之间的差异性。 结果：肺型组织胞浆菌病临床表现轻微，干咳多见。进展播散型患者全身症状明显，极易出现反复高热、全身浅表淋巴结肿大、肝脾肿大，可合并咳嗽、腹痛、关节痛、皮肤改变等。实验室检查示全血细胞减少、肝功能异常、凝血功能异常等。1例肺型患者给予了左下肺切除术，其余3例肺型及6例进展播散型患者分别给予两性霉素B脱氧胆酸盐、伊曲康唑、伏立康唑或氟康唑抗真菌感染治疗，好转出院，1例播散型确诊后暂未治疗即出院，1例播散型因合并重症肺炎及活动性肺结核治疗无效死亡。结论：组织胞浆菌病临床少见，极易漏诊或误诊，依靠骨髓涂片、病理组织切片特殊染色明确病原学是目前确诊的主要依据，推荐两性霉素B脂质体、两性霉素B脱氧胆酸盐及伊曲康唑抗感染治疗。.

Topics: Abdominal Pain; Amphotericin B; Antifungal Agents; Biopsy; Cough; Death; Deoxycholic Acid; Diagnostic Errors; Drug Combinations; Fever; Hepatomegaly; Histoplasma; Histoplasmosis; Humans; Invasive Fungal Infections; Itraconazole; Lung; Lung Diseases, Fungal; Pneumonia; Recurrence; Retrospective Studies; Splenomegaly; Treatment Outcome; Tuberculosis

Topics: Adolescent; Amphotericin B; Antifungal Agents; Bone Marrow; Diagnosis, Differential; Fever of Unknown Origin; Fungemia; Histoplasma; Histoplasmosis; Humans; Infusions, Intravenous; Kidney Transplantation; Lung Diseases, Interstitial; Lymphohistiocytosis, Hemophagocytic; Male; Pancytopenia; Transplant Recipients

We describe the laboratory-confirmed etiologies of illness among participants in a hospital-based febrile illness cohort study in northern Tanzania who retrospectively met Integrated Management of Adolescent and Adult Illness District Clinician Manual (IMAI) criteria for septic shock, severe respiratory distress without shock, and severe pneumonia, and compare these etiologies against commonly used antimicrobials, including IMAI recommendations for emergency antibacterials (ceftriaxone or ampicillin plus gentamicin) and IMAI first-line recommendations for severe pneumonia (ceftriaxone and a macrolide). Among 423 participants hospitalized with febrile illness, there were 25 septic shock, 37 severe respiratory distress without shock, and 109 severe pneumonia cases. Ceftriaxone had the highest potential utility of all antimicrobials assessed, with responsive etiologies in 12 (48%) septic shock, 5 (14%) severe respiratory distress without shock, and 19 (17%) severe pneumonia illnesses. For each syndrome 17-27% of participants had etiologic diagnoses that would be non-responsive to ceftriaxone, but responsive to other available antimicrobial regimens including amphotericin for cryptococcosis and histoplasmosis; anti-tuberculosis therapy for bacteremic disseminated tuberculosis; or tetracycline therapy for rickettsioses and Q fever. We conclude that although empiric ceftriaxone is appropriate in our setting, etiologies not explicitly addressed in IMAI guidance for these syndromes, such as cryptococcosis, histoplasmosis, and tetracycline-responsive bacterial infections, were common.

Topics: Acute Disease; Adolescent; Adult; Aged; Aged, 80 and over; Amphotericin B; Ampicillin; Anti-Infective Agents; Bacterial Infections; Ceftriaxone; Child; Cohort Studies; Cryptococcosis; Emergencies; Female; Gentamicins; Histoplasmosis; Humans; Infections; Macrolides; Male; Microbial Sensitivity Tests; Middle Aged; Pneumonia, Bacterial; Respiratory Distress Syndrome; Shock, Septic; Tanzania; Tetracycline; Young Adult

To report on a case of Histoplasma capsulatum endogenous endophthalmitis in an immunocompetent patient.. A 30-year-old patient was admitted with floaters and vision impairment of 1 month's duration. He had a history of adrenal insufficiency, together with nasal, septum, and soft palate lesions of 3 months; duration. Culture results from specimens of these lesions were positive for H capsulatum. He was human immunodeficiency virus negative and there was no evidence of immunodepression or history of immunosuppression. Fundus examination revealed multiple fluffy balls with a string of pearls appearance, 2+ vitreous haze, multiple foci of retinochoroiditis inferiorly in the peripheral retina, and a 6-disk area lesion of retinochoroiditis at the superotemporal periphery. Due to poor response to oral itraconazole, a vitrectomy was performed with an intraocular injection of amphotericin B 5 μg/0.1 mL and removal for a vitreous specimen for culture of bacteria and fungi.. Vitreous specimen culture of the yeast at 28°C grew a white filamentous fungus colony, which was again cultured in a brain heart infusion agar medium, where it developed hyaline septate hyphae with microconidia and circular macroconidia with double wall, which was stained with a lactophenol dye at microscopic examination. The macroscopic morphology was consistent with H capsulatum.. Although endogenous H capsulatum endophthalmitis is a rare entity, it should be considered as a possible etiology even in apparently immunocompetent hosts, especially in patients with history of disseminated disease.

Topics: Adult; Amphotericin B; Antifungal Agents; Chorioretinitis; Combined Modality Therapy; Endophthalmitis; Eye Infections, Fungal; Histoplasma; Histoplasmosis; Humans; Immunocompetence; Immunocompromised Host; Injections, Intraocular; Male; Vitrectomy; Vitreous Body

Disseminated histoplasmosis is an invasive fungal infection documented in patients with impaired cellular immunity coming from endemic areas (America, Asia, Africa). We report two cases of disseminated histoplasmosis in AIDS patients paradigmatic of the multifaceted nature of the disease, which may be an expression either of an advanced state of immunosuppression or the immune reconstitution inflammatory syndrome (IRIS).

Topics: Acquired Immunodeficiency Syndrome; Adult; AIDS-Related Opportunistic Infections; Amphotericin B; Antifungal Agents; Brazil; Deoxycholic Acid; Diagnosis, Differential; Drug Combinations; Female; Hepatitis B, Chronic; Hepatitis D, Chronic; Histoplasmosis; Homosexuality, Male; Humans; Immunocompromised Host; Invasive Fungal Infections; Italy; Male; Risk Factors; Thailand; Treatment Outcome; Voriconazole

Topics: Aged; Amphotericin B; Antifungal Agents; Bone Marrow; Cell Transformation, Neoplastic; Histoplasmosis; Humans; Itraconazole; Leukemia, Lymphocytic, Chronic, B-Cell; Liver; Lymph Nodes; Lymphoma, Large B-Cell, Diffuse; Male; Radionuclide Imaging; Spleen; Treatment Outcome

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.

Topics: Adolescent; Amphotericin B; Antifungal Agents; CD4-Positive T-Lymphocytes; Histoplasmosis; Humans; Itraconazole; Lymphocyte Depletion; Male; Skin Diseases; Treatment Outcome

Topics: Adult; AIDS Serodiagnosis; Amphotericin B; Antifungal Agents; Fungemia; Histoplasma; Histoplasmosis; HIV Infections; Humans; Male; Skin

Invasive fungal infections are a major cause of morbidity and mortality among solid organ transplant (SOT) and hematopoietic cell transplant (HCT) recipients, but few data have been reported on the epidemiology of endemic fungal infections in these populations.. Fifteen institutions belonging to the Transplant-Associated Infection Surveillance Network prospectively enrolled SOT and HCT recipients with histoplasmosis, blastomycosis, or coccidioidomycosis occurring between March 2001 and March 2006.. A total of 70 patients (64 SOT recipients and 6 HCT recipients) had infection with an endemic mycosis, including 52 with histoplasmosis, 9 with blastomycosis, and 9 with coccidioidomycosis. The 12-month cumulative incidence rate among SOT recipients for histoplasmosis was 0.102%. Occurrence of infection was bimodal; 28 (40%) infections occurred in the first 6 months post transplantation, and 24 (34%) occurred between 2 and 11 years post transplantation. Three patients were documented to have acquired infection from the donor organ. Seven SOT recipients with histoplasmosis and 3 with coccidioidomycosis died (16%); no HCT recipient died.. This 5-year multicenter prospective surveillance study found that endemic mycoses occur uncommonly in SOT and HCT recipients, and that the period at risk extends for years after transplantation.

Topics: Adolescent; Adult; Aged; Amphotericin B; Antifungal Agents; Blastomycosis; Child; Coccidioidomycosis; Coinfection; Comorbidity; Endemic Diseases; Female; Hematopoietic Stem Cell Transplantation; Histoplasmosis; Humans; Incidence; Itraconazole; Male; Middle Aged; Organ Transplantation; Prospective Studies; Respiratory Tract Infections; Time Factors; United States; Young Adult

In Western French Guiana, there was a dramatic increase in HIV prevalence between 1990 and 2000. The present study describes the causes of fever among HIV patients hospitalized in the medical ward of the only hospital in the western part of French Guiana. A retrospective descriptive study was conducted between 1 January 2008 and 30 June 2010 in the department of medicine of Saint Laurent du Maroni Hospital. The main characteristics of 67 patients having presented with fever in the first 48 hours of hospitalization were described. Among patients with CD4 <200/mm(3)the main febrile opportunistic infection was disseminated histoplasmosis (41.1%). Among patients with CD4 counts <50/mm(3)and fever without focal points 85.7% had disseminated histoplasmosis. Three patients died and all had disseminated histoplasmosis. Disseminated histoplasmosis is the most common febrile opportunistic infection in western French Guiana. Primary prophylaxis with itraconazole among immunocompromised patients seems warranted.

Topics: Adolescent; Adult; Age Distribution; Aged; AIDS-Related Opportunistic Infections; Amphotericin B; CD4 Lymphocyte Count; Coinfection; Female; Fever; French Guiana; Histoplasma; Histoplasmosis; HIV Infections; Hospitalization; Humans; Immunocompromised Host; Itraconazole; Male; Middle Aged; Prevalence; Retrospective Studies; Sex Distribution; Weight Loss; Young Adult

Topics: Adult; Amphotericin B; Anorexia; Antifungal Agents; CD4 Lymphocyte Count; Emergencies; Endemic Diseases; Guyana; Hallucinations; Histoplasma; Histoplasmosis; HIV Infections; Humans; Incidental Findings; Itraconazole; Leukocytes; Male

Histoplasmosis usually occurs in specific endemic areas. Sporadic cases have also been reported in mainland China. Here, we described an indigenous case of disseminated histoplasmosis. Phylogenetic analysis revealed that the Histoplasma capsulatum isolated in our case belongs to the Australian clade. Combined with previous studies, it revealed high genetic diversity among Chinese H. capsulatum isolates.

Topics: Administration, Intravenous; Administration, Oral; Adult; Amphotericin B; Antifungal Agents; Bone Marrow; China; DNA, Fungal; Genetic Variation; Histoplasma; Histoplasmosis; Humans; Itraconazole; Male; Phylogeny; Treatment Outcome

Topics: Abdominal Pain; Amphotericin B; Antibodies, Fungal; Antifungal Agents; Cerebrospinal Fluid; Child; Diagnosis, Differential; Fever of Unknown Origin; Histoplasmosis; Humans; Lung Diseases, Fungal; Male; Nausea

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.

Topics: Amphotericin B; Antifungal Agents; Azoles; Caspofungin; Echinocandins; Histoplasma; Histoplasmosis; Humans; India; Lipopeptides; Lung; Microbial Sensitivity Tests; Molecular Sequence Data; Mycelium; Yeasts

The frequency of histoplasmosis among solid organ transplant (SOT) recipients appears to be low where there are only a few case series, mostly among renal and liver transplant recipients. Herein we report a case of a 44-year-old woman who underwent a living-related renal transplant 18 years prior to evaluation, developed a nodule after followed by ulceration upon her posterior right leg and a second one upon her left leg 3 months and 2 months before her hospitalisation, respectively. The biopsy of lesion revealed the presence of Histoplasma spp. Bone marrow aspiration was performed and also revealed the same organism. She had initially received itraconazole without improvement of lesions, while a new lesion appeared on her left arm. Healing of all lesions could be observed after 40 days of liposomal amphotericin B when she was submitted to skin grafts on the legs and a surgical treatment on the arms, and the myelosuppression improved simultaneously. Histoplasmosis seems to be very uncommon among patients who underwent to organ solid transplantation. Most cases occur within 12-18 months after transplantation, although unusual cases have been presented many years post-transplant. There are cases reported in the literature, occurring from 84 days to 18 years after organ transplantation, but without cutaneous involvement. Our patient developed lesions on limbs and myelosuppression after 18 years of chronic immunosuppression medication. This case suggests that besides cutaneous histoplasmosis is an uncommon infection following iatrogenic immunosuppression and even rarer over a long period after the transplantation. Clinicians who care SOT recipient patients must bear in mind histoplasmosis infection as differential diagnosis in any case of cutaneous injury with prolonged fever and try to use as many tools as possible to make the diagnosis, once this disease presents a good prognosis if it is diagnosed and treated promptly.

Topics: Adult; Allografts; Amphotericin B; Antifungal Agents; Bone Marrow; Bone Marrow Diseases; Dermatomycoses; Female; Histoplasma; Histoplasmosis; Humans; Immunocompromised Host; Kidney Transplantation; Skin Transplantation; Skin Ulcer; Transplant Recipients; Treatment Outcome

Infective endocarditis is an uncommon manifestation of infection with Histoplasma capsulatum. The diagnosis is frequently missed, and outcomes historically have been poor. We present 14 cases of Histoplasma endocarditis seen in the last decade at medical centers throughout the United States. All patients were men, and 10 of the 14 had an infected prosthetic aortic valve. One patient had an infected left atrial myxoma. Symptoms were present a median of 7 weeks before the diagnosis was established. Blood cultures yielded H. capsulatum in only 6 (43%) patients. Histoplasma antigen was present in urine and/or serum in all but 3 of the patients and provided the first clue to the diagnosis of histoplasmosis for several patients. Antibody testing was positive for H. capsulatum in 6 of 8 patients in whom the test was performed. Eleven patients underwent surgery for valve replacement or myxoma removal. Large, friable vegetations were noted at surgery in most patients, confirming the preoperative transesophageal echocardiography findings. Histopathologic examination of valve tissue and the myxoma revealed granulomatous inflammation and large numbers of organisms in most specimens. Four of the excised valves and the atrial myxoma showed a mixture of both yeast and hyphal forms on histopathology. A lipid formulation of amphotericin B, administered for a median of 29 days, was the initial therapy in 11 of the 14 patients. This was followed by oral itraconazole therapy, in all but 2 patients. The length of itraconazole suppressive therapy ranged from 11 months to lifelong administration. Three patients (21%) died within 3 months of the date of diagnosis. All 3 deaths were in patients who had received either no or minimal (1 day and 1 week) amphotericin B.

Topics: Aged; Aged, 80 and over; Amphotericin B; Antifungal Agents; Antigens, Fungal; Aortic Valve; Echocardiography, Transesophageal; Endocarditis; Heart Atria; Heart Valve Prosthesis Implantation; Histoplasma; Histoplasmosis; Humans; Itraconazole; Male; Medical Records, Problem-Oriented; Middle Aged; Myxoma; Prosthesis-Related Infections; Treatment Outcome; United States

Histoplasmosis caused by Histoplasma capsulatum var. duboisii is a rare disease outside central and western Africa. In Europe, all cases are imported. We report a case of an African histoplasmosis with isolated pulmonary involvement in a non-immunocompromised patient that occurred 40 years after his stay in a disease-endemic area. The patient was given itraconazole. (18)F-fluoro-2-deoxy-d-glucose positron emission tomography-computed tomography was used to assess evolution during treatment. The outcome for the patient was favorable.

Topics: Africa; Amphotericin B; Endemic Diseases; Histoplasma; Histoplasmosis; Humans; Itraconazole; Male; Middle Aged; Portugal; Positron-Emission Tomography; Travel; Treatment Outcome

Topics: Adult; Amphotericin B; Antifungal Agents; Blood Specimen Collection; CD4 Lymphocyte Count; Diagnosis, Differential; Erythrocytes, Abnormal; Fungemia; Histoplasma; Histoplasmosis; HIV Infections; Humans; Itraconazole; Male; Viral Load

Topics: Abdominal Pain; Acquired Immunodeficiency Syndrome; Adult; Amphotericin B; Anti-HIV Agents; Histoplasma; Histoplasmosis; Humans; Ileal Diseases; Ileocecal Valve; Infusions, Intravenous; Intestinal Fistula; Itraconazole; Male; Opportunistic Infections; Rare Diseases; Risk Assessment; Treatment Outcome

The authors report a clinical case of an isolated oral histoplasmosis in a hemodialysis patient that presented with fever of unknown origin and had an unremarkable physical examination. During the investigation, a Gallium scan showed uptake in the oral cavity and soon after the oral cavity examination revealed a granulomatous lesion on the tooth 26. Histopathologic findings were compatible with histoplasmosis. The treatment regimen included liposomal amphotericin B followed by itraconazole consolidation therapy, and side effects did not occur. Both clinical evolution and outcome were favorable. Oral histoplasmosis in a non-immunosuppressed patient is extremely rare.

Topics: Amphotericin B; Antifungal Agents; Fever of Unknown Origin; Gingiva; Histocytochemistry; Histoplasmosis; Humans; Itraconazole; Male; Portugal; Renal Dialysis

Topics: Amphotericin B; Antibodies, Fungal; Antifungal Agents; Brain Damage, Chronic; Brain Edema; Child; Delayed Diagnosis; Deoxycholic Acid; Diagnostic Errors; Drug Combinations; Histoplasma; Histoplasmosis; Humans; Hydrocephalus; Immunocompetence; Itraconazole; Liposomes; Male; Meningitis; Meningitis, Viral; Prognosis; Stroke, Lacunar; Tuberculosis, Meningeal; Ventriculoperitoneal Shunt

Topics: Amphotericin B; Antifungal Agents; Cellulitis; Diabetes Mellitus, Type 2; Female; Hand Dermatoses; Histoplasma; Histoplasmosis; Humans; Hypothyroidism; Immunocompromised Host; Immunosuppressive Agents; Itraconazole; Middle Aged; Panniculitis; Pemphigus

Histoplasmosis is an infection caused by the dimorphic fungus Histoplasma capsulatum and primarily presents with pulmonary symptoms. Immunocompromised individuals are at high risk for contracting disseminated histoplasmosis, which can be fatal if left untreated.. We present a case involving a 50-year-old woman with acquired immunodeficiency syndrome with an ulcerated vulvar lesion concerning for carcinoma. Extensive workup revealed disseminated histoplasmosis without pulmonary manifestations. She was treated with an extended course of an antifungal agent. Her vulvar lesion resolved.. Vulvar histoplasmosis is a rare etiology of vulvar pathology but one that should be considered in immunocompromised patients.

Topics: AIDS-Related Opportunistic Infections; Amphotericin B; Antifungal Agents; Female; Histoplasma; Histoplasmosis; Humans; Middle Aged; Ulcer; Vulvar Diseases

Isolated laryngeal histoplasmosis is a very rare entity. It has variable clinical presentations that might mimic both benign and malignant lesions, and is usually associated with pulmonary and other disseminated forms of histoplasmosis. Herein, we report a case of primary laryngeal histoplasmosis without the involvement of other systems in a 70-year-old Chinese man, who previously worked as a miner. He presented with a history of hoarseness for two months, with no other associated symptoms. Direct laryngoscopy revealed irregularity of the posterior one-third of both vocal folds. Histopathological examination revealed the presence of Histoplasma capsulatumon periodic acidSchiff and Grocott's methenamine silver staining. The lesion resolved after one month of oral itraconazole treatment. However, the patient had to complete six months of antifungal treatment to prevent recurrence.

Topics: Aged; Amphotericin B; Antifungal Agents; Histoplasma; Histoplasmosis; Humans; Laryngitis; Laryngoscopy; Larynx; Male; Occupational Diseases; Occupational Exposure

Topics: AIDS-Related Opportunistic Infections; Amphotericin B; Anti-HIV Agents; Antifungal Agents; Biopsy; Dermatomycoses; Histoplasma; Histoplasmosis; HIV Infections; Humans; Male; Middle Aged; Skin Ulcer; Treatment Outcome

Histoplasmosis is an endemic fungal infection that causes no symptoms or minor self-limited illnesses in most cases. Severe forms are commonly reported in patients with immunodeficiency disorders; histoplasmosis is considered to be an opportunistic infection in patients with AIDS. We report a case of disseminated histoplasmosis in a patient with no induced active suppression of the immune response. The infection was fulminant, and antifungal treatment was delayed because of a misdiagnosis of tuberculosis.

Topics: Adult; Amphotericin B; Antifungal Agents; Antitubercular Agents; Brazil; Bronchoalveolar Lavage Fluid; Delayed Diagnosis; Diagnostic Errors; Disseminated Intravascular Coagulation; Fatal Outcome; French Guiana; Histoplasma; Histoplasmosis; HIV Seronegativity; Humans; Immunocompetence; Lung Diseases, Fungal; Male; Mining; Occupational Diseases; Tuberculosis, Miliary

Histoplasmosis has been sporadically reported from India. Though asymptomatic adrenal involvement has been described in patients with disseminated histoplasmosis; isolated adrenal involvement with adrenal insufficiency (AI) as the presenting manifestation of the disease is rare.. We describe 5 immunocompetent men (mean age 55.6 yrs) from a nonendemic area with adrenal histoplasmosis presenting with constitutional symptoms. Three patients had AI at presentation with bilateral adrenal involvement and the other two developed AI during the course of the illness and had unilateral adrenal mass . All the patients had histopathological/cytologically proven adrenal histoplasmosis. 18FDG-PET done in 3 patients helped in delineating the extent of the disease. Adrenalectomy was done in 2 patients who presented with unilateral adrenal mass. All these patients received Amphotericin B and/or itraconazole treatment which led to symptomatic improvement but AI persisted in all at the end of the follow up of 6 to 18 months.. The diagnosis of adrenal histoplasmosis should be considered in patients presenting with constitutional symptoms and unilateral or bilateral adrenal mass/es with or without AI.

Topics: Adrenal Gland Diseases; Adrenal Insufficiency; Adult; Aged; Amphotericin B; Antifungal Agents; Histoplasmosis; Humans; Immunocompetence; Itraconazole; Male; Middle Aged

Histoplasmosis of the central nervous system (CNS) is seen in 10% to 20% of patients with disseminated histoplasmosis and/or in association with immunocompromised patients. Meningitis, arachnoiditis, and hydrocephalus are the most common clinical manifestations of CNS histoplasmosis. Patients with CNS histoplasmosis present similarly to other infectious etiologies, and confirmatory diagnosis is important in the management of these patients. However, diagnosis of CNS histoplasmosis can be difficult, and sometimes performing a parenchymal biopsy is necessary to confirm the diagnosis.. We describe the case of a 41-year-old man with HIV/AIDS who presented with the signs, symptoms, and radiologic evidence of basal meningitis and hydrocephalus. Cerebrospinal fluid (CSF) analysis from multiple lumbar punctures was negative. The patient underwent a neuroendoscopic procedure with diagnostic and therapeutic goals. Internal CSF diversion (endoscopic third ventriculostomy) and biopsy of the floor of the third ventricle and subarachnoid space were performed; surgical biopsies identified noncaseating granulomas, and ventricular CSF was positive for Histoplasmosis antibodies. The patient was treated with liposomal amphotericin B and itraconazole. The patient had resolution of his symptoms immediately after surgery, and 1-month follow-up computed tomography of the head demonstrated resolution of the hydrocephalus. At the last follow-up 12 months postoperatively, the patient has not required insertion of a ventriculoperitoneal shunt.. Clinicians should maintain a high index of suspicion for fungal basal meningitis in patients with AIDS and hydrocephalus. With nondiagnostic lumbar CSF sampling, neuroendoscopy can be considered as an alternative for diagnosis and treatment of basal meningitis and hydrocephalus.

Topics: Adult; Amphotericin B; Antibodies, Fungal; Antifungal Agents; Arachnoiditis; Biopsy; Central Nervous System Fungal Infections; Cerebral Ventricles; Histoplasmosis; HIV Infections; Humans; Hydrocephalus; Itraconazole; Male; Neuroendoscopy; Neurologic Examination; Neurosurgical Procedures; Paresis; Spinal Puncture; Subarachnoid Space; Tomography, X-Ray Computed; Ventriculostomy

A 19-year-old HIV-positive man was admitted with fever of unknown origin and poor general condition. Antiretroviral therapy had been stopped by the patient eight months prior to admission.. Laboratory tests revealed pancytopenia, high viral load and low count of T-helper cells (13/µl). Computer tomography of the thorax showed small patchy infiltrations. Extensive examinations (microbiology, laboratory tests, multiple investigations) revealed no pathogen. Liver biopsy proved disseminated histoplasmosis.. Liposomal amphotericin B was started and switched to oral itraconazole after 14 days with itraconazole. With this treatment the patient condition improved and fever stopped. T-helper cells increased and the patient was discharged.. Disseminated histoplasmosis as an AIDS-defining opportunistic infection is uncommon (particularly as the patient had not been abroad in the last four years) and can be a life-threatening complication. Diagnosis must be confirmed by invasive methods especially in patients with compromised immune status and rapid clinical progression.

Topics: AIDS-Related Opportunistic Infections; Amphotericin B; Anti-Bacterial Agents; Anti-HIV Agents; Antifungal Agents; Antiretroviral Therapy, Highly Active; Biopsy; Bronchoscopy; Diagnosis, Differential; Drug Therapy, Combination; Histoplasmosis; Humans; Infusions, Intravenous; Liver; Male; Tomography, X-Ray Computed; Young Adult

This report describes clinical manifestations of histoplasmosis in 6-month-old dizygotic twins, one of whom developed disseminated histoplasmosis of infancy while his sibling remained well, but developed serologic evidence of histoplasmosis. The report also documents histoplasma antigen concentrations in serum and urine before, during and after completing antifungal therapy.

Topics: Amphotericin B; Antifungal Agents; Antigens, Fungal; Histoplasmosis; Humans; Infant; Itraconazole; Male; Twins, Dizygotic

This study contains a descriptive analysis of histoplasmosis in AIDS patients between 2006 and 2010 in the state of Ceará, Brazil. Additionally, the in vitro susceptibility of Histoplasma capsulatum isolates obtained during this period was assessed. We report 208 cases of patients with histoplasmosis and AIDS, describing the epidemiological, clinical, laboratory and therapeutic aspects. The in vitro antifungal susceptibility test was carried out by the microdilution method, according to Clinical and Laboratory Standards Institute, with H. capsulatum in the filamentous and yeast phases, against the antifungals amphotericin B, fluconazole, itraconazole, voriconazole and caspofungin. In 38.9% of the cases, histoplasmosis was the first indicator of AIDS and in 85.8% of the patients the CD4 cell count was lower than 100 cells/mm(3). The lactate dehydrogenase levels were high in all the patients evaluated, with impairment of hepatic and renal function and evolution to death in 42.3% of the cases. The in vitro susceptibility profile demonstrated there was no antifungal resistance among the isolates evaluated. There was a significant increase in the number of histoplasmosis cases in HIV-positive patients during the period surveyed in the state of Ceará, northeastern Brazil, but no antifungal resistance among the recovered isolates of H. capsulatum.

Topics: Adult; AIDS-Related Opportunistic Infections; Amphotericin B; Antifungal Agents; Brazil; Caspofungin; CD4 Lymphocyte Count; Echinocandins; Female; Fluconazole; Histoplasma; Histoplasmosis; Humans; Itraconazole; L-Lactate Dehydrogenase; Lipopeptides; Male; Microbial Sensitivity Tests; Pyrimidines; Triazoles; Voriconazole

Histoplasma capsulatum is an opportunistic dimorphic fungus responsible for most often self-limiting or flu-like infections but potentially lethal in immunocompromised hosts. Histoplasmosis is rare in Europe. We reported a case of disseminated histoplasmosis in an African HIV patient with a leprosy-like primary cutaneous presentation and involvement of lungs, brain, limphnodes and eye. The therapy with liposomial B amphotericin and itraconazole led to a prompt resolution of the symptoms.

Topics: Adult; AIDS-Related Opportunistic Infections; Amphotericin B; Antifungal Agents; Antiretroviral Therapy, Highly Active; Dermatomycoses; Diagnosis, Differential; Drug Therapy, Combination; Ghana; Histoplasma; Histoplasmosis; HIV Seropositivity; Humans; Immunocompromised Host; Italy; Itraconazole; Leprosy; Male; Skin; Treatment Outcome

Sjögren's syndrome is an autoimmune disease characterized by decreased exocrine gland secretions; patients may also present several hematological abnormalities, like lymphopenia. We describe the case of a 28 year old man who complained of headache a month of duration, with fever and vomiting in the last 48 hours. He also presented skin lesions on trunk and face, without neck stiffness. The diagnosis of duration infection was confirmed by culture from the skin biopsy and spinal fluid specimens; in addition, the presence of lymphopenia, positive anti Ro-SSA antibodies, poor concentration of the tracer in scintigraphy and lymphocytic infiltration in salivary glands confirmed the diagnosis of Sjögren's syndrome. the patient was successfully treated with liposomal amphotericin and itraconazole. We report this case to emphasize that opportunistic infections, such as disseminated histoplasmosis, may be an uncommon clinical presentation of Sjögren's syndrome.

Topics: Adult; Amphotericin B; Antifungal Agents; Histoplasma; Histoplasmosis; Humans; Itraconazole; Lymphopenia; Male; Sjogren's Syndrome

Abstract. Coinfection with tuberculosis in some countries occurs in 8-15% of human immunodeficiency virus (HIV) -infected patients who have histoplasmosis. This coinfection interferes with prompt diagnosis, and treatment is difficult because of drug interactions. We retrospectively reviewed the cases of 14 HIV-infected patients who had concomitant tuberculosis and histoplasmosis. The most frequent clinical manifestations were weight loss (85.7%), asthenia (78.5%), and fever (64.2%). The diagnosis of histoplasmosis was made primarily by histopathology (71.4%), and the diagnosis of tuberculosis was made by means of direct microscopic examination (71.4%). Death occurred in two patients, and relapse of both infections occurred in one patient. Moxifloxacin was substituted for rifampicin in six patients, with good outcomes noted for both infections. The clinical presentation does not readily identify acquired immunodeficiency syndrome (AIDS) patients who have tuberculosis and histoplasmosis. The use of a fluoroquinolone as an alternative agent in place of rifampicin for tuberculosis allows effective therapy with itraconazole for histoplasmosis.

Topics: Acquired Immunodeficiency Syndrome; Adult; Amphotericin B; Antifungal Agents; Coinfection; Deoxycholic Acid; Drug Combinations; Female; Histoplasmosis; Humans; Itraconazole; Male; Middle Aged; Retrospective Studies; Risk Factors; Tuberculosis

Topics: Amphotericin B; Anti-Bacterial Agents; Histoplasma; Histoplasmosis; Humans; Male; Middle Aged; Pancytopenia; Prognosis

Pneumonia with pleuritis is a rare presentation of histoplasmosis infection. We present a 12-year old previously healthy boy in whom histoplasmosis presented with pleuritis, confirmed by detection of antigen in empyema fluid.

Topics: Amphotericin B; Anti-Bacterial Agents; Antifungal Agents; Antigens, Fungal; Bronchoalveolar Lavage Fluid; Child; Debridement; Glycoproteins; Histoplasmosis; Humans; Itraconazole; Male; Pleurisy; Pleuropneumonia; Tomography, X-Ray Computed

We hereby report a short case of 71-year-old gentleman who developed ST segment elevation myocardial infarction shortly after starting the infusion of liposomal amphotericin B for disseminated histoplasmosis. We also discuss the novel pathogenesis of specific liposomal component of amphotericin B that contributed to the acute cardiopulmonary compromise in our patient leading to subsequent myocardial infarction.

Topics: Aged; Amphotericin B; Antifungal Agents; Histoplasmosis; Humans; Hypotension; Male; Myocardial Infarction

Topics: Adult; Amphotericin B; Antifungal Agents; Dermatomycoses; Histoplasma; Histoplasmosis; HIV Infections; Humans; Immunocompromised Host; Male; Shock, Septic; Silver Staining

A 34-year-old, HIV-positive man living in Texas presented with a 2-week history of fever, malaise, myalgias, oral ulcers, and papules on his chest, back, face, and extremities, including the palms. Initially secondary syphilis was suspected. However, RPR was negative. Histopathologic examination revealed a lymphocytic infiltrate with numerous intra-histiocytic fungal organisms. GMS and PAS stains were positive, consistent with the diagnosis of histoplasmosis. We report a case of disseminated histoplasmosis clinically mimicking secondary syphilis.

Topics: Adult; AIDS-Related Opportunistic Infections; Amphotericin B; Antifungal Agents; Biopsy; Cryptococcosis; Diagnosis, Differential; Endemic Diseases; Hepatomegaly; Histoplasmosis; Humans; Itraconazole; Male; Syphilis; Texas

To describe ocular involvement and response to treatment in a patient with human immunodeficiency virus (HIV) infection with severe progressive disseminated histoplasmosis (PDH).. We report a 35-year-old HIV-infected patient seen in our clinics over a period of 4 years. During antiretroviral treatment (ART), the HIV load became undetectable at 3 months; however, CD4 T-cell count increased slowly and rose to 100 cells/microl. Histoplasma capsulatum was cultured from skin pustules, cerebrospinal fluid (CF) and aqueous humour.. The patient developed central nervous system (CNS) involvement 2 months and panuveitis in both eyes 4 months after the initiation of ART. With intravenous liposomal amphotericin B followed by oral voricanozole, the chorioretinal lesions of the right eye (RE) became inactivated and magnetic resonance imaging (MRI) lesions of CNS disappeared. Relapse of the inflammation in the anterior segment of the left eye (LE) resulted in a total closure of the chamber angle and severe glaucoma. Despite medical therapy, two cyclophotocoagulations, total vitrectomy and repeated intravitreal amphotericin B injections, LE became blind. Histoplasma capsulatum was cultured from the aqueous humour after antifungal therapy of 16 months' duration.. PDH with intraocular and CNS manifestations was probably manifested by an enhanced immune response against a previous subclinical disseminated infection. It seems difficult to eradicate H. capsulatum from the anterior segment of the eye in an immunocompromised patient.

Topics: Adult; AIDS-Related Opportunistic Infections; Amphotericin B; Anti-Retroviral Agents; Aqueous Humor; CD4 Lymphocyte Count; Central Nervous System Fungal Infections; Cerebrospinal Fluid; Dermatomycoses; Drug Therapy, Combination; Eye Infections, Fungal; Female; Glaucoma, Angle-Closure; Histoplasma; Histoplasmosis; HIV-1; Humans; Magnetic Resonance Imaging; Panuveitis; Skin; Viral Load

Human immunodeficiency virus (HIV) infection can cause a broad spectrum of clinical manifestations, ranging from an asymptomatic carrier state to severe immunodeficiency. The most common renal lesion, HIV-associated nephropathy (HIVAN), is a sclerosing glomerulopathy. However, potentially reversible causes of renal disease in HIV-infected patients should also be considered. We describe two cases of patients with acquired immune-deficiency syndrome (AIDS) who presented with rapidly progressive renal failure but were found to have reversible etiologies. The first case was found to have syphilis and the second, disseminated histoplasmosis; their renal injury resolved after initiation of a third-generation cephalosporin antibiotic and amphotericin B, respectively.

Topics: Acquired Immunodeficiency Syndrome; Adult; AIDS-Associated Nephropathy; Amphotericin B; Biopsy; Ceftriaxone; Histoplasmosis; Humans; Kidney; Male; Neurosyphilis

African histoplasmosis is a rare but not an exceptional condition and recently discovered in Madagascar. We report the fifth Malagasy case involving skin and nodes in an immunocompetent patient. Management of African histoplasmosis encountered many problems because of the availability of amphotericin B and cost of the biochemical tests in order to prevent major side effects in case of failure of oral antimycotic drug.

Topics: Adult; Amphotericin B; Antifungal Agents; Fatal Outcome; Histoplasma; Histoplasmosis; Humans; Immunocompetence; Lymph Nodes; Madagascar; Male; Skin

Topics: Adalimumab; Amphotericin B; Antibodies, Monoclonal; Antibodies, Monoclonal, Humanized; Antifungal Agents; Bone Marrow Examination; Histoplasmosis; Humans; Immunocompromised Host; Immunosuppressive Agents; Lymphohistiocytosis, Hemophagocytic; Male; Still's Disease, Adult-Onset; Tumor Necrosis Factor-alpha; Young Adult

Topics: Acquired Immunodeficiency Syndrome; Adolescent; Amphotericin B; Bone Marrow Cells; Fatal Outcome; Female; Histoplasma; Histoplasmosis; Humans; Leukocytes

A 5-week-old infant presented with a fever, and was diagnosed with congenital human immunodeficiency virus and histoplasmosis. Both infections were likely transmitted vertically. The child was effectively treated with antifungal medications and highly active antiretroviral therapy. This represents the first case of delayed presentation of vertically transmitted histoplasmosis, and the first case in a nonendemic area.

Topics: Amphotericin B; Antifungal Agents; Female; Guatemala; Histoplasma; Histoplasmosis; HIV Infections; Humans; Infant, Newborn; Infant, Newborn, Diseases; Infectious Disease Transmission, Vertical; Itraconazole; Mothers

Histoplasmosis caused by Histoplasma capsulatum is found worldwide. Japan is known to be non-endemic area. Progressive disseminated histoplasmosis (PDH) is a severe form of histoplasmosis. We report a case of PDH in a 54-year-old male who was not immunocompromised. His last travel history to an endemic region was 2 years before onset. He was diagnosed as histoplasmosis by 18S rRNA-PCR from serum and ascites and immunodiffusion test. We treated him with parental liposomal amphotericin B for 2 weeks then changed to oral itraconazole, which was continued for 6 months. Rigorous work up, including HIV status, lymphocyte counts, and adrenal function did not reveal any evidence of immunosuppression of the patient. Our case suggests that PDH can occur in immunocompetent patients as previously described, and must be included in the differential diagnoses if presentation is consistent. In addition, the skills of travel history taking are emphasized.

Topics: Amphotericin B; Antifungal Agents; Histoplasma; Histoplasmosis; Humans; Immunocompetence; Itraconazole; Japan; Male; Middle Aged; Polymerase Chain Reaction; RNA, Ribosomal, 18S; Travel

Topics: Amphotericin B; Antifungal Agents; Central Nervous System Fungal Infections; Diagnostic Errors; Epiglottis; Female; Granuloma; Histoplasmosis; Humans; Middle Aged; Recurrence; Spinal Cord; Tuberculosis, Meningeal

Histoplasmosis is a systemic fungal disease, also known as Darling's disease, caused by the dimorphic fungus Histoplasma capsulatum. It is usually self-limiting or localized in immunecompetent individuals whereas in patients with acquired immune deficiency syndrome (AIDS), it occurs in the disseminated form in 95% of cases. Although histoplasmosis predominates in the Americas (United States and Latin America, including Brazil) as an important infection among AIDS patients, it is not common in Bangladesh. In contrast, tuberculosis is extremely common in Bangladesh, with an estimated prevalence of 387 per 100,000 people. Here, a confirmed case of disseminated histoplasmosis is reported in Bangladesh in a known HIV-positive patient, which was initially suspected to be extrapulmonary tuberculosis.

Topics: Adult; AIDS-Related Opportunistic Infections; Amphotericin B; Antifungal Agents; Bangladesh; Biopsy; Diagnosis, Differential; Disease Progression; Histoplasma; Histoplasmosis; Humans; Lymph Nodes; Lymphadenitis; Male

Renal allograft recipients are prone to opportunistic infections, rarely multiple coexisting infections, due to the immunocompromised state. To the best of our knowledge, no case of a co-existing polyoma virus nephropathy and pulmonary histoplasmosis in a renal allograft recipient has been reported so far in the available literature. A 55-year-old male renal allograft recipient underwent graft biopsy for asymptomatic graft dysfunction. The graft biopsy showed features of polyoma virus nephropathy. Soon after, he developed fever with pulmonary nodules. Fine-needle aspiration from lung nodules showed intracellular yeast forms of histoplasma. The patient responded well to amphotericin B with subsidence of fever. The co-existence of renal allograft-limited infection like polyoma virus and systemic fungal infection such as histoplasmosis should be kept in mind in a transplant recipient with graft dysfunction and non-specific systemic symptoms. Prompt recognition of these infections permits the clinician to institute appropriate therapeutic modification and improved survival.

Topics: Amphotericin B; Histoplasmosis; Humans; Kidney Transplantation; Lung Diseases, Fungal; Male; Middle Aged; Opportunistic Infections; Polyomavirus Infections

Topics: Amphotericin B; Antifungal Agents; Contrast Media; Histoplasmosis; HIV Seronegativity; Humans; Itraconazole; Male; Middle Aged; Tomography, X-Ray Computed

Histoplasmosis caused by Histoplasma capsulatum var. duboisii is an endemic mycosis of sub-Saharan Africa that usually affects the skin, subcutaneous tissue, lymph nodes and bones. We present a case of a 10-year-old immunocompetent girl with severe cutaneous and subcutaneous abscesses affecting the head and upper body. Microscopic examination showed polar budding yeasts and short mycelium compatible with H. capsulatum var. duboisii. Cultures were not possible but serology showed antibodies against both H. capsulatum var. duboisii and H. capsulatum var. capsulatum antigens. Presumptive diagnosis of histoplasmosis was done but treatment with itraconazole was inefficacious. After 15 days of treatment with Amphotericin B i/v, improvement was evident and, three months later, the patient was discharged with only residual lesions. Seven months later, no relapses were observed.

Topics: Abscess; Amphotericin B; Antibodies, Fungal; Antifungal Agents; Chad; Child; Dermatomycoses; Female; Histoplasma; Histoplasmosis; Humans; Itraconazole

Histoplasma polysaccharide antigen testing is used routinely to diagnose histoplasmosis. At least 3 antigen tests are commercially available. Controversy exists about the relative accuracy of these tests. We report 2 patients with AIDS and culture-confirmed Histoplasma capsulatum meningitis from whom discrepant Histoplasma polysaccharide antigen results were obtained from different laboratories and discuss the potential clinical implications of these results.

Topics: Acquired Immunodeficiency Syndrome; Adult; Amphotericin B; Antifungal Agents; Antigens, Fungal; Diagnostic Errors; Histoplasma; Histoplasmosis; Humans; Immunoenzyme Techniques; Laboratories; Male; Meningitis, Fungal; Polysaccharides; Reproducibility of Results; Sensitivity and Specificity

Disseminated cutaneous histoplasmosis is an opportunistic infection in patients with acquired immunodeficiency syndrome. We report a series of 23 cases (21 men, two women; median age 29 years) with disseminated cutaneous histoplasmosis seen at two hospital centres. Most of the patients (21/23) were classified as stage C3. The most common dermatological findings were papules, crusting plaques, nodules and ulcers, mainly located on the face and chest. Of the 23 cases, 15 (65%) had pulmonary involvement. Amphotericin B and itraconazole were the main drugs used for treatment. Treatment response was variable: four of the patients were cured, six improved and remain stable, nine patients died, and four patients were lost to follow-up.

Topics: Adult; AIDS-Related Opportunistic Infections; Amphotericin B; Antifungal Agents; Female; Histoplasmosis; HIV-1; Humans; Itraconazole; Male; Retrospective Studies; Treatment Outcome; Young Adult

Histoplasma capsulatum infection involving the larynx is a rare manifestation, especially in immunocompetent individuals and a high index of suspicion is needed to establish the diagnosis correctly. We report a case of a 50-year-old Brazilian man who presented with progressive hoarseness and throat pain for 4 months. Laryngoscopy showed a supraglottic vegetant lesion, and the biopsies chronic granulomatous inflammation without any specific agent. A second laryngoscopy with biopsies was performed and after 17 days of incubation in specific medium, H. capsulatum was isolated. The patient was successfully treated with amphotericin B.

Topics: Amphotericin B; Antifungal Agents; Biopsy; Brazil; Histocytochemistry; Histoplasma; Histoplasmosis; Humans; Laryngeal Diseases; Laryngoscopy; Larynx; Male; Middle Aged

Histoplasmosis is endemic to the midwestern and east central states in the United States near the Mississippi and the Ohio River valleys. Ninety-nine percent of patients exposed to histoplasmosis develop only subclinical infection. Liver involvement as a part of disseminated histoplasmosis is well known; however, isolated hepatic histoplasmosis without any other stigmata of dissemination is extremely rare and the literature is limited to only two case reports. We present a rare case of isolated granulomatous hepatitis due to histoplasmosis in a 35-year-old female with dermatomyositis receiving low-dose prednisone and methotrexate. There was no evidence of fungal dissemination elsewhere. High clinical suspicion is critical for early diagnosis and treatment.

Topics: Adult; Amphotericin B; Antifungal Agents; Female; Granuloma; Hepatitis; Histoplasmosis; Humans; Liver

Topics: Aged; Amphotericin B; Antibodies, Monoclonal; Antirheumatic Agents; Arthritis, Rheumatoid; Colonic Diseases; Colonoscopy; Female; Follow-Up Studies; Fungemia; Histoplasmosis; Humans; Immunocompromised Host; Infliximab; Risk Assessment; Ulcer

Topics: Amphotericin B; Antifungal Agents; Fever; Histoplasma; Histoplasmosis; Humans; Jaundice; Male; Middle Aged

Topics: Adult; AIDS-Related Opportunistic Infections; Amphotericin B; Antifungal Agents; Biopsy; Bone Marrow; Bone Marrow Examination; Disease Progression; Histoplasma; Histoplasmosis; Humans; Male

Topics: Amphotericin B; Antifungal Agents; Blood; Female; Fever; Hepatomegaly; Histoplasma; Histoplasmosis; Humans; Infant; Macrophages; Pancytopenia; Splenomegaly; Urine

Histoplasmosis, a granulomatous disease caused by Histoplasma capsulatum, is endemic in Venezuela. We conducted the current study to appraise retrospectively the demographic data, clinical features, diagnostic methods, and treatment of patients with histoplasmosis from January 2000 to December 2005. We reviewed the medical records of outpatient cases with a diagnosis of histoplasmosis and considered clinical samples processed at our laboratory. We collected demographic, epidemiologic, and clinical data from each case as available, including results of any mycologic examinations performed. Treatment and outcome data were available for some patients. We assessed 158 cases of histoplasmosis: 103 (65.2%) patients came from the Caracas metropolitan area; 53 were associated with acquired immunodeficiency syndrome (AIDS), 14 with tuberculosis, and 8 with paracoccidioidomycosis. Six pediatric patients were malnourished. Epidemiologic data suggested histoplasmosis in most cases. Patients received treatment with itraconazole and/or amphotericin B. Our results may reflect changes in the epidemiology occurring in Venezuela, perhaps due to environmental changes and the presence of AIDS. Several mycologic exams are necessary to ensure a proper diagnosis. More reliable data and statistics on this infection are necessary to monitor outbreaks closely and to establish if there is an epidemic pattern.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Amphotericin B; Anti-Bacterial Agents; Child; Child, Preschool; Female; Histoplasmosis; Humans; Infant; Infant, Newborn; Itraconazole; Male; Middle Aged; Retrospective Studies; Socioeconomic Factors; Treatment Outcome; Venezuela

Meningitis is a common evolution in progressive disseminated histoplasmosis in children, and is asymptomatic in many cases. In leukemia, the impaired of the T cells function can predispose to the disseminated form. The attributed mortality rate in this case is 20%-40% and the relapse rate is as high as 50%; therefore, prolonged treatment may be emphasized. We have described a child with acute myeloid leukemia (AML), that developed skin lesions and asymptomatic chronic meningitis, with a good evolution after prolonged treatment with amphotericin B deoxycholate followed by fluconazole.

Topics: Acute Disease; Adolescent; Amphotericin B; Antifungal Agents; Chronic Disease; Deoxycholic Acid; Drug Combinations; Drug Therapy, Combination; Fluconazole; Histoplasmosis; Humans; Immunocompromised Host; Leukemia, Myeloid; Male; Meningitis, Fungal; Treatment Outcome

Soft-tissue masses are rarely associated with Histoplasma capsulatum infection. We describe a heart transplant patient who presented with a large right-sided chest wall mass as a manifestation of disseminated histoplasmosis. A successful clinical outcome was achieved upon recognition of the fungal pathogen.

Topics: Aged; Amphotericin B; Antifungal Agents; Biopsy; Debridement; Diagnosis, Differential; Drug Administration Schedule; Drug Therapy, Combination; Graft Rejection; Heart Transplantation; Histoplasma; Histoplasmosis; Humans; Immunosuppressive Agents; Itraconazole; Male; Mycophenolic Acid; Soft Tissue Infections; Tacrolimus; Thoracic Wall; Tomography, X-Ray Computed; Transplantation Conditioning

The following case illustrates an ileal perforation and reactive hemophagocytic syndrome (RHS) resulting from disseminated histoplasmosis in a patient with Human Immunodeficiency Virus (HIV) from Puerto Rico. Although the diagnosis was established by histopathologic findings and a positive bone marrow culture, Histoplasma capsulatum-specific real-time Polymerase Chain Reaction (PCR) allowed to confirm the diagnosis from formalin-fixed, paraffin-embedded tissue. Interestingly, the Histoplasma antigens in both serum and urine samples were falsely negative. Amphotericin B lipid complex (Abelcet), followed by oral itraconazole, led to a successful response and resolution of symptoms. A short review of the clinical signs and symptoms, diagnostic tests, and therapeutic options for disseminated histoplasmosis is done, with emphasis on the role of Histoplasma-specific real-time PCR as a molecular diagnostic tool and the efficacy of treatment with one of the lipid formulations of amphotericin B.

Topics: Adult; AIDS-Related Opportunistic Infections; Amphotericin B; Antifungal Agents; Drug Combinations; Histoplasma; Histoplasmosis; HIV Infections; HIV-1; Humans; Ileum; Intestinal Perforation; Lymphohistiocytosis, Hemophagocytic; Male; Phosphatidylcholines; Phosphatidylglycerols; Puerto Rico; Treatment Outcome

We report the first indigenous case of disseminated histoplasmosis in Taiwan diagnosed by histopathology of bone marrow, microbiologic morphology, and PCR assay of the isolated fungus. This case suggests that histoplasmosis should be 1 of the differential diagnoses of opportunistic infections in immunocompromised patients in Taiwan.

Topics: Aged; Amphotericin B; Antifungal Agents; Diagnosis, Differential; Histoplasmosis; Humans; Itraconazole; Male; Taiwan

Topics: Adult; AIDS-Related Opportunistic Infections; Amphotericin B; Antifungal Agents; Cryptococcosis; Deoxycholic Acid; Drug Combinations; Fungemia; Hepatitis B, Chronic; Hepatomegaly; Herpes Zoster; Histoplasmosis; Humans; Male; Splenomegaly; Toxoplasmosis; Ultrasonography; Uremia

A 61-yr-old liver transplant recipient presented with abdominal cramping and nonbloody diarrhea resulting in orthostasis. Multiple ulcerations throughout the colon were seen during endoscopy, and biopsies from the ulcer edges revealed histoplasmosis. Treatment with a course of itraconazole improved the diarrhea. The patient later presented with pericarditis and symptomatic pleural effusions, the latter of which was confirmed to be a result of disseminated histoplasmosis. Treatment with amphotericin B led to resolution. Histoplasmosis should be considered in liver transplant patients with diarrhea and large ulcers in the colon. The presence of disseminated histoplasmosis should be ruled out once colonic histoplasmosis has been diagnosed.

Topics: Amphotericin B; Antifungal Agents; Cholangitis, Sclerosing; Histoplasmosis; Humans; Itraconazole; Liver Transplantation; Male; Middle Aged; Pericarditis; Pleural Effusion; Postoperative Complications; Reoperation; Treatment Outcome

Topics: Adult; AIDS-Related Opportunistic Infections; Amphotericin B; Antiretroviral Therapy, Highly Active; Dermatomycoses; Histoplasmosis; HIV Seropositivity; Humans; Male

Topics: Amphotericin B; Antifungal Agents; Brain Diseases; Brain Neoplasms; Diagnosis, Differential; Diffusion Magnetic Resonance Imaging; Histoplasmosis; Humans; Male; Middle Aged; Pons; Radiography

Topics: Amphotericin B; Antifungal Agents; Child; Fatal Outcome; Female; Fever; Histoplasmosis; Humans

A 58 year old male, chronic smoker, with diabetes mellitus (Type II), residing in Madhya Pradesh presented with dysphagia, hoarseness, odynophagia and significant weight loss. Microlaryngoscopy showed reddish ulcerated area involving valleculae, and pharyngo-epiglottic fold. Histopathological examination showed foamy macrophages containing Histoplasma capsulatum. Patient initially responded to Azoles, relapsed three months after stopping the treatment and presented with oral lesions. Biopsy showed H. capsulatum, histologically as well as on culture. The mycelial phase converted to yeast phase on B.H.I.A. at 37 degrees C confirming the isolate as H. capsulatum. The patient responded well to amphotericin B.

Topics: Amphotericin B; Antifungal Agents; Disease Progression; Histoplasma; Histoplasmosis; Humans; Laryngeal Diseases; Laryngoscopy; Larynx; Male; Middle Aged; Mouth Diseases; Recurrence

Topics: Adult; AIDS-Related Opportunistic Infections; Amphotericin B; Anti-HIV Agents; Antifungal Agents; Biopsy; Female; Histoplasma; Histoplasmosis; HIV Infections; HIV Protease Inhibitors; Humans; Itraconazole; Lopinavir; Pyrimidinones; Skin; Treatment Outcome

Topics: Adrenal Cortex Hormones; Adult; Amphotericin B; Antifungal Agents; CD4 Lymphocyte Count; Histoplasma; Histoplasmosis; Humans; Magnetic Resonance Imaging; Male; Muscle Weakness; Nails; Neurologic Examination; Onychomycosis; Spinal Cord; Spinal Cord Diseases

Topics: Abscess; Adrenal Gland Diseases; Amphotericin B; Histoplasmosis; Humans; Immunocompetence; Middle Aged; Tomography, X-Ray Computed

Topics: Abdominal Pain; Adrenal Cortex Hormones; Adult; Amphotericin B; Antibodies, Monoclonal; Antifungal Agents; Biopsy; Colon; Colonoscopy; Crohn Disease; Diagnosis, Differential; Diagnostic Errors; Diarrhea; Hematologic Tests; Histoplasma; Histoplasmosis; Humans; Infliximab; Male; Necrosis

Among bone lesions of African histoplasmosis, those affecting the jaw are relatively rare and concern, with other facial involvements, particularly infants and adolescent patients with an usual uncompromised immunologic status. As clinical and radiologic features are not specific, the differential diagnosis to other mandibular diseases is difficult. We report on a case of African histoplasmosis that involved the right mandibula of a 17-year-old Congolese boy with a persistent and fungiform cutaneous ulceration. As mycologic tests had not been carried out initially, the disease was histologically diagnosed on the basis of the presence of numerous intra-cytoplasmic large yeasts in a granulomatous lesion containing giant cells. As it is impossible to confront the histologic diagnosis with mycologic tests in such a situation, the problems of the differential diagnosis to other deep fungus infections and to some yeast-like foreign body-granulomas encountered at the microscopical level underline the importance of culturing organisms from lesions to confirm the histologic diagnosis. It is worth considering this pathology at least for three reasons: it usually mimicks a malignant jaw tumor; it may constitute a migrant pathology; and prognosis is commonly favorable with amphotericin B treatment.

Topics: Adolescent; Africa; Amphotericin B; Antifungal Agents; Diagnosis, Differential; Histoplasma; Histoplasmosis; Humans; Injections, Intravenous; Jaw Neoplasms; Male; Maxilla; Maxillary Diseases; Skin Ulcer

Topics: Aged; Amphotericin B; Antifungal Agents; Biopsy; Bone Marrow; Diagnosis, Differential; Fatigue; Fever; Histoplasmosis; Humans; Male; Pancytopenia; Weight Loss

With the advent of potent immunosuppressive therapies used in solid organ transplantation, patients are more susceptible to a variety of infectious organisms. Infections may result from atypical pathogens and present in an unusual manner. We describe a case of progressive disseminated histoplasmosis presenting as cellulitis in a renal transplant recipient and review this disease.

Topics: Adult; Amphotericin B; Cellulitis; Disease Progression; Female; Graft Rejection; Histoplasma; Histoplasmosis; Humans; Kidney Transplantation; Living Donors; Postoperative Complications; Treatment Outcome

Although disseminated histoplasmosis is recognized as a common opportunistic infection in HIV-infected persons living in endemic areas, it is not widely reported in Southeast Asia, and has not been reported in Cambodia. It remains unanswered whether this is secondary to a low disease prevalence, or whether the disease, which is associated with a nonspecific clinical presentation, is under diagnosed. In addition to a review of the literature regarding histoplasmosis in Southeast Asia, we provide a description of two HIV-1 infected patients with documented disseminated histoplasmosis complicating other opportunistic infections in Phnom Penh, Cambodia. These two cases highlight the need for both a high clinical suspicion, and reliable laboratory testing, in a setting where there is likely to be more than one infection complicating the patient's clinical course.

Topics: Adult; AIDS-Related Opportunistic Infections; Amphotericin B; Antifungal Agents; Cambodia; Female; Fluconazole; Histoplasmosis; Humans; Male

To understand the presentation and current management of histoplasmosis in a pediatric oncology center. Study design Retrospective review of clinical features of patients with histoplasmosis at a tertiary-care cancer center in an endemic area.. Between 1988 and 2001, 57 patients with cancer had 61 episodes of acute histoplasmosis. Of these, 76% were male, and 64% had acute lymphocytic leukemia (ALL). Most were not neutropenic and had nonspecific febrile illnesses. The most rapid and specific tests for histoplasmosis in patients with cancer were histopathologic examination of lung biopsy specimens in patients with localized pulmonary infection and Histoplasma sp. antigen detection in the urine of patients with disseminated histoplasmosis (DH). The mean times to diagnosis were 20.6+/-15.2 days (pulmonary) and 18.6+/-8.2 days (disseminated) after the onset of symptoms. Most patients were treated with amphotericin B (AmB) followed by azole drugs for a mean of 8.5+/-3.1 weeks (pulmonary) and 10.4+/-7.9 weeks (disseminated). No patient died of histoplasmosis, but cancer therapy often was modified because of the infection. Most received unnecessary antibacterial drugs.. Most readily available diagnostic tests for histoplasmosis lack sensitivity in these patients. Delay in diagnosis of histoplasmosis complicates care. No deaths were attributed to histoplasmosis; outcomes after treatment are good.

Topics: Acute Disease; Adolescent; Adult; Amphotericin B; Antifungal Agents; Child; Female; Histoplasmosis; Humans; Lung Diseases, Fungal; Male; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Retrospective Studies

Topics: Amphotericin B; Antifungal Agents; Chemistry, Pharmaceutical; Drug Combinations; Fluconazole; Histoplasmosis; Humans; Itraconazole; Male

Topics: Acute Disease; Administration, Oral; Aged; Amphotericin B; Anti-Inflammatory Agents; Antifungal Agents; Follow-Up Studies; Histoplasmosis; Humans; Itraconazole; Lung Diseases, Fungal; Male; Prednisone; Radiography, Thoracic; Time Factors; Tomography, Emission-Computed; Tomography, X-Ray Computed

Whether maintenance antifungal prophylaxis against histoplasmosis should be continued life-long in patients with immune restoration after highly active antiretroviral therapy (HAART) remains unclear. We report a case of disseminated histoplasmosis involving the skin, lung, gastrointestinal tract, mesentery, and retroperitoneum in a 33-year-old man with acquired immunodeficiency syndrome. His symptoms improved after use of amphotericin B and itraconazole in addition to ileostomy to relieve the intestinal obstruction. After the start of HAART, he was able to discontinue itraconazole as maintenance therapy without relapse for 24 months.

Topics: Adult; AIDS-Related Opportunistic Infections; Amphotericin B; Antifungal Agents; Antiretroviral Therapy, Highly Active; Histoplasmosis; Humans; Itraconazole; Male

To investigate the epidemiologic features of disseminated histoplasmosis (PDH) in Hubei province.. Bone marrow smears of 12 patients diagnosed as Kala-azer in Hubei province including 4 patients in Jingsan, 2 patients in Shashi and each 1 in Yichang, Jinmen, Zhongxiang, Luotian, Xianning and Guanghua respectively were re-examed under microscope. Peripheral blood and bone marrow smears of several patients were detected. After inoculated the bone marrow, peripheral blood, liver and spleen tissue of patients in MLI, the single colony was trans-inoculated in BHIB, SDA and CMA and incubated at 25 degrees C and 35 degrees C. Bone marrow, peripheral blood and bacterial fluid of yeast-phase Histoplasma capsulatum (H.cap) were injected into the abdominal cavity of Kunming mice and nude mice. When symptoms and signs developed, the spleen tissue was separated, then observed under microscope and cultured. Mycelium-phase and Yeast-phase H.cap were inoculated in urase and gelatin medium, then incubated at 25 degrees C and 35 degrees C. Histoplasmin was injected subcutaneously into patients, and then followed for 48 - 72 hours. Amphotericin B was selected to treat the PDH patients.. Moriform cell cluster and sausage-shaped cell were not observed in mononuclear-macrophages in the bone marrow smears from 12 patients. Leishman-Donovan body was found only in one patient. There wasn't kinetoplast in the cellular plasm of spores in 11 patients and no transeptae was found. The reaction of H.cap to urease was positive and H.cap did not liquefy the gelatin. It appeared to be mycelium-phase at 25 degrees C but no penicillus and catenulate conidia was found. The characteristic denticle macroconidia was observed but produced red coloring matter. It also appeared to be yeast-phase at 35 degrees C. Yeast-phase spores were observed under microscope. No sausage-shaped spore and transeptae were identified. H.cap could be acquired in the spleen tissue in Kunming mice and nude mice. Bacterium forms, characteristics under microscope and biochemical reaction of mycelium-phase and yeast-phase H.cap were different from some other kinds of dimorphic fungi such as Penicillium marneffei and Histoplasm duboisii etc.. There were scattered epidemics of PDH in Hubei province. The detection rate of PDH was higher in the southeast area then in the northwest area. The golden standards of clinic diagnosis were mycological culture and inoculation to animals. Amphotericin B was necommended as the first choice for treatment.

Topics: Adolescent; Adult; Amphotericin B; Animals; Antifungal Agents; China; Female; Histoplasma; Histoplasmin; Histoplasmosis; Humans; Male; Mice; Mice, Nude; Middle Aged; Skin Tests

Since 1987, the US Centers for Disease Control and Prevention has considered disseminated histoplasmosis an acquired immunodeficiency syndrome (AIDS)-defining illness. Cutaneous manifestations of disseminated disease are diverse and often present as a nondescript rash with systemic complaints. Diagnosis is best established by histopathologic examination with appropriate stains for fungal organisms. Skin lesions often resolve within weeks of initiating treatment. We detail a case of cutaneous histoplasmosis and review its epidemiology, common presentations, diagnosis, and treatment options.

Topics: Adult; AIDS-Related Opportunistic Infections; Amphotericin B; Antifungal Agents; Diagnosis, Differential; Histoplasmosis; Humans; Itraconazole; Male; Skin Diseases

Topics: AIDS-Related Opportunistic Infections; Amphotericin B; Antifungal Agents; Chemical and Drug Induced Liver Injury; Histoplasmosis; Humans; Liposomes; Safety

We report 10 cases of histoplasmosis with oral manifestations seen in a teaching hospital in Brazil.. This is a retrospective study of the sociodemographic, clinicopathologic, and treatment data of these cases.. Overall, 8 of 10 cases were seropositive for human immunodeficiency virus (HIV), whereas 2 were negative. The predominant oral manifestations found in HIV-seropositive patients were ulcers, oral pain, and odynophagia; both of the HIV-seronegative patients were symptom-free. HIV infection was suspected in 7 cases because of the presence of oral lesions of histoplasmosis. Asthenia, fever, weight loss, lymphadenopathy, and hepatosplenomegaly were found only in HIV-seropositive patients. Radiographs in 3 out of 10 patients suggested pulmonary involvement. Amphotericin B was the antifungal therapy chosen, and clinical remission of oral lesions occurred in an average of 30 days (accumulated doses: 500-1500 mg). Itraconazole was very effective as a follow-up treatment in terms of prevention of recurrence.. Histoplasmosis only rarely affects HIV-seronegative patients; however, the possibility of hidden immunodepression should be considered when oral manifestations of histoplasmosis are present.

Topics: Adult; AIDS-Related Opportunistic Infections; Amphotericin B; Antifungal Agents; Brazil; Female; Histoplasmosis; HIV Seropositivity; Humans; Itraconazole; Male; Middle Aged; Mouth Diseases; Retrospective Studies

Topics: Adult; Amphotericin B; Antifungal Agents; Female; Histoplasmosis; Humans; Multiple Organ Failure; Shock, Septic; Switzerland

Topics: Acquired Immunodeficiency Syndrome; Adolescent; AIDS-Related Opportunistic Infections; Amphotericin B; Anti-HIV Agents; Antifungal Agents; Brain Diseases; Female; Histoplasma; Histoplasmosis; HIV-1; Humans; Itraconazole; Transfusion Reaction

The outcome of central nervous system (CNS) histoplasmosis is often unfavorable. Although fluconazole plays an integral role in treatment of fungal meningitis, its role in the treatment of histoplasmosis is hampered by reduced activity and potential development of resistance. A murine model of CNS histoplasmosis was used to evaluate the hypothesis that a combination of amphotericin B and fluconazole therapy would be superior to amphotericin B monotherapy. Groups of B6C3F(1) mice were infected by injection of Histoplasma capsulatum into the subarachnoid space. The addition of fluconazole hindered the antifungal effect of amphotericin B, as determined by measurement of fungal burden, suggesting antagonism in the brain. Fluconazole was less effective as a single agent than was amphotericin B, despite the greater penetration of fluconazole into brain tissues. The hypothesis that amphotericin B-fluconazole combination therapy would be superior to amphotericin B monotherapy for treatment of CNS histoplasmosis was not supported by this study.

Topics: Amphotericin B; Animals; Antifungal Agents; Brain; Central Nervous System Fungal Infections; Disease Models, Animal; Drug Therapy, Combination; Female; Fluconazole; Histoplasmosis; Mice; Spleen

The number of cases of systemic histoplasmosis has increased substantially in recent years, and improved therapy is needed. We examined the efficacy of immunomodulation with interferon (IFN)-gamma alone or in combination with a suboptimal regimen of amphotericin B for the treatment of primary systemic murine histoplasmosis. In the first study, BALB/c mice were infected with Histoplasma capsulatum G217B and treated with 10(5) U of IFN given every other day either preinfection and postinfection or only postinfection, alone or in combination with amphotericin B. IFN alone given subcutaneously (s.c.) postinfection prolonged survival over untreated controls (P < 0.01), whereas intravenous (i.v.) administration was ineffective. All combination regimens and amphotericin B alone significantly prolonged survival (P < 0.0001). The combination regimens of amphotericin B and IFN i.v. (pre- and postinfection) or IFN s.c. (postinfection) reduced the fungal burden in the liver and spleen; the latter regimen had superior efficacy in the spleen (P < 0.05) to either amphotericin B or IFN alone. After infection with a low-challenge inoculum, IFN given s.c. (pre- and postinfection) alone caused a significant reduction in fungal burden in the spleen (P < 0.001). In an acutely lethal model, combination regimens of IFN s.c. or i.v. and amphotericin B again prolonged survival (P < 0.01-0.001), with amphotericin B plus IFN given s.c. (pre- and postinfection) superior to all regimens (P < 0.05-0.01). This regimen also showed enhanced efficacy in causing the reduction of fungal burden in the spleen (P < 0.05). These results indicate that IFN in combination with AmB shows enhanced efficacy in the treatment of systemic histoplasmosis and support the potential utility of IFN as an adjunctive therapy.

Topics: Administration, Cutaneous; Amphotericin B; Animals; Antifungal Agents; Carrier Proteins; CASP8 and FADD-Like Apoptosis Regulating Protein; Disease Models, Animal; Drug Therapy, Combination; Histoplasma; Histoplasmosis; Interferon-gamma; Intracellular Signaling Peptides and Proteins; Liver; Mice; Mice, Inbred BALB C; Spleen

Topics: Acquired Immunodeficiency Syndrome; Adult; AIDS-Related Opportunistic Infections; Amphotericin B; Antifungal Agents; Dermatomycoses; Histoplasma; Histoplasmosis; Humans; Immunocompromised Host; Injections, Intravenous; Itraconazole; Male; Recurrence

AIDS epidemics and intercontinental travels in endemic areas have increased the incidence of endemic mycoses (histoplasmosis, coccidioidomycosis, blastomycosis, penicilliosis). Environmental dimorphic fungi, through an aerial contamination cause them. Frequent in the HIV patients living in endemic areas, they represent an AIDS definition criterion. Most of primary infections are asymptomatic, they may also present as influenza or pneumonia, that will spontaneously recover. A secondary dissemination may especially occur among immunocompromised hosts involving most often the skin, central nervous system and bones. Lastly, a chronic pulmonary presentation may also occur. Direct examination and histology, cultures and serologies establish diagnosis. In all cases of disseminated or chronic infections, a long-term treatment is necessary, using amphotericin B and azoles. Life-time secondary prophylaxis is recommended in AIDS patients.

Topics: Adult; AIDS-Related Opportunistic Infections; Amphotericin B; Antifungal Agents; Blastomycosis; Coccidioidomycosis; Diagnosis, Differential; Fluconazole; Histoplasmosis; Humans; Itraconazole; Ketoconazole; Travel

Topics: Amphotericin B; Antifungal Agents; Candidiasis; Cryptococcosis; Fluconazole; Flucytosine; Histoplasmosis; Humans; Immunosuppression Therapy; Mycology; Mycoses; Neutropenia; Prognosis; Risk Factors; Travel

A 33-year-old Hispanic woman with newly diagnosed human immunodeficiency virus (HIV) infection, a CD4 T-lymphocyte count of 2, viral load of 730,000 copies/mL, candidal esophagitis, seizure disorder, a history of bacterial pneumonia, and recent weight loss was admitted with tonic clonic seizure. On admission, her vital signs were: pulse of 88, respiration rate of 18, temperature of 37.7 degrees C, and blood pressure of 126/76. Her only medication was phenytoin. On examination, the patient was found to have multiple umbilicated papules on her face, as well as painful, erythematous, large, punched-out ulcers on the nose, face, trunk, and extremities of 3 months' duration (Fig. 1). The borders of the ulcers were irregular, raised, boggy, and undermined, while the base contained hemorrhagic exudate partially covered with necrotic eschar. The largest ulcer on the left mandible was 4 cm in diameter. The oral cavity was clear. Because of her subtherapeutic phenytoin level, the medication dose was adjusted, and she was empirically treated with Unasyn for presumptive bacterial infection. Chest radiograph and head computed tomography (CT) scan were within normal limits. Sputum for acid-fast bacilli (AFB) smear was negative. Serologic studies, including Histoplasma antibodies, toxoplasmosis immunoglobulin M (IgM), rapid plasma reagin (RPR), hepatitis C virus (HCV), and hepatitis B virus (HBV) antibodies were all negative. Examination of the cerebrospinal fluid was within normal limits without the presence of cryptococcal antigen. Blood and cerebrospinal cultures for bacteria, mycobacteria, and fungi were all negative. Viral culture from one of the lesions was also negative. The analysis of her complete blood count showed: white blood count, 2300/microl; hemoglobin, 8.5 g/dL; hematocrit, 25.7%; and platelets, 114,000/microl. Two days after admission, the dermatology service was asked to evaluate the patient. Although the umbilicated papules on the patient's face resembled lesions of molluscum contagiosum, other infectious processes considered in the differential diagnosis included histoplasmosis, cryptococcosis, and Penicillium marnefei. In addition, the morphology of the ulcers, particularly that on the left mandible, resembled lesions of pyoderma gangrenosum. A skin biopsy was performed on an ulcer on the chest. Histopathologic examination revealed granulomatous dermatitis with multiple budding yeast forms, predominantly within histiocytes, with few organisms resid

Topics: Adult; Amphotericin B; Antifungal Agents; Biopsy; Dermatomycoses; Female; Histoplasma; Histoplasmosis; HIV Infections; Humans; Pyoderma Gangrenosum

Topics: Adult; AIDS-Related Opportunistic Infections; Amphotericin B; Antifungal Agents; Dermatomycoses; Diagnosis, Differential; Facial Dermatoses; Histoplasma; Histoplasmosis; Humans; Itraconazole; Male

The development of a rash in response to trimethoprim-sulfamethoxazole (TMP-SMX) administration is a frequent adverse reaction in people with the acquired immunodeficiency syndrome (AIDS). In contrast, there are no published reports in the English language literature describing TMP-SMX induced delirium in an AIDS patient. This report describes the development of frank delirium in a person with AIDS receiving TMP-SMX. The episode resolved completely within 72 h of withdrawal of the drug.

Topics: Acute Disease; AIDS-Related Opportunistic Infections; Amphotericin B; Anti-Infective Agents; Delirium; Drug Therapy, Combination; Histoplasmosis; Humans; Male; Middle Aged; Pneumonia, Pneumocystis; Trimethoprim, Sulfamethoxazole Drug Combination

Nikkomycin Z was tested both in vitro and in vivo for efficacy against Histoplasma capsulatum. Twenty clinical isolates were tested for susceptibility to nikkomycin Z in comparison to amphotericin B and itraconazole. The median MIC was 8 microg/ml with a range of 4 to 64 microg/ml for nikkomycin Z, 0.56 microg/ml with a range of 0.5 to 1.0 microg/ml for amphotericin B, and < or =0.019 microg/ml for itraconazole. Primary studies were carried out by using a clinical isolate of H. capsulatum for which the MIC of nikkomycin Z was greater than or equal to 64 microg/ml. In survival experiments, mice treated with amphotericin B at 2.0 mg/kg/dose every other day (QOD) itraconazole at 75 mg/kg/dose twice daily (BID), and nikkomycin Z at 100 mg/kg/dose BID survived to day 14, while 70% of mice receiving nikkomycin Z at 20 mg/kg/dose BID and none of the mice receiving nikkomycin Z at 5 mg/kg/dose BID survived to day 14. All vehicle control mice died by day 12. Fungal burden was assessed on survivors. Mice treated with nikkomycin Z at 20 and 100 mg/kg/dose BID had significantly higher CFUs per gram of organ weight in quantitative cultures and higher levels of Histoplasma antigen in lung and spleen homogenates than mice treated with amphotericin B at 2.0 mg/kg/dose QOD or itraconazole at 75 mg/kg/dose BID. Studies also were carried out with a clinical isolate for which the MIC of nikkomycin Z was 4 microg/ml. All mice treated with amphotericin B at 2.0 mg/kg/dose QOD; itraconazole at 75 mg/kg/dose BID; and nikkomycin Z at 100, 20, and 5 mg/kg/dose BID survived until the end of the study at day 17 postinfection, while 30% of the untreated vehicle control mice survived. Fungal burden assessed on survivors showed similar levels of Histoplasma antigen in lung and spleen homogenates of mice treated with amphotericin B at 2.0 mg/kg/dose QOD; itraconazole at 75 mg/kg/dose BID; and nikkomycin Z at 100, 20, and 5 mg/kg/dose BID. The three surviving vehicle control mice had significantly higher antigen levels in lung and spleen than other groups (P<0.05). The efficacy of nikkomycin Z at preventing mortality and reducing fungal burden correlates with in vitro susceptibility.

Topics: Aminoglycosides; Amphotericin B; Animals; Anti-Bacterial Agents; Antifungal Agents; Cells, Cultured; Disease Models, Animal; Histoplasmosis; Itraconazole; Mice

Topics: Acute Disease; Amphotericin B; Anemia, Macrocytic; Bone Marrow; Child; Choroiditis; Female; Fever; Histoplasmosis; Humans; Treatment Outcome

Twenty clinical isolates of Histoplasma capsulatum were tested for their in vitro susceptibilities to caspofungin in comparison to those to amphotericin B by following National Committee for Clinical Laboratory Standards guidelines for yeasts. The mean MICs were 16.6 microgram/ml (range, 8 to 32 microgram/ml) for caspofungin and 0.56 microgram/ml (range, 0.5 to 1.0 microgram/ml) for amphotericin B. Survival experiments used a 10(5) dose in a pulmonary challenge model with B6C3F(1) mice. All mice that received amphotericin B at 2 mg/kg of body weight every other day (q.o.d.), 30% of mice that received caspofungin at 8 mg/kg/day, and 20% of mice that received caspofungin at 4 mg/kg/day survived to day 15, while mice that received caspofungin at 2 mg/kg/day and all control mice that received the vehicle died by day 14. Amphotericin B at 2 mg/kg q.o.d. markedly reduced the fungal burden in the lungs and spleens, as measured by Histoplasma antigen detection techniques and quantitative cultures, for each comparison. Caspofungin at 10 mg/kg twice a day (b.i.d.) did not reduce the fungal burden, as measured by antigen detection techniques, but slightly reduced the levels of fungi in both the lungs and spleens, as determined by quantitative cultures. Caspofungin at 5 mg/kg b.i.d. did not affect fungal burden. Overall, caspofungin had only a slight effect on survival or fungal burden.

Topics: Amphotericin B; Animals; Anti-Bacterial Agents; Antifungal Agents; Caspofungin; Disease Models, Animal; Echinocandins; Histoplasma; Histoplasmosis; Humans; Lipopeptides; Mice; Microbial Sensitivity Tests; Peptides; Peptides, Cyclic; Treatment Outcome

To investigate the efficacy of combined treatment with fluconazole (Flu) and amphotericin B (AmB) for Histoplasma capsulatum meningitis, MICs were determined for 10 clinical isolates, following National Committee for Clinical Laboratory Standards guidelines. Weak synergy was observed for 6 of the 10 isolates. For the in vivo models, mice either were sham treated or were given Flu (75 mg/kg/day), AmB (2 mg/kg every other day), itraconazole (Itra; 75 mg/kg/day), AmB+Flu, or AmB+Itra. Following infection with 5x105 yeasts, Flu antagonized AmB's reduction of fungal burden without reducing its effect on survival. When in vivo antagonism was reproduced following infection with 1x104 yeasts, a higher fungal burden was observed in the lungs. Itra had no effect on AmB's activity and was more effective than Flu for clearance of fungal burden. These findings caution against use of AmB+Flu for treatment of histoplasmosis, but studies of the effect of treatment on the fungal burden in the brain are needed to assess combination therapy for meningitis.

Topics: Amphotericin B; Animals; Drug Interactions; Drug Therapy, Combination; Female; Fluconazole; Histoplasmosis; Itraconazole; Mice; Microbial Sensitivity Tests

AmBisome is a liposomal formulation of amphotericin B that has broad-spectrum antifungal activity and greatly reduced toxicity compared to the parent drug. In this study, amphotericin B deoxycholate (Fungizone) (1 mg/kg) and AmBisome (1 to 20 mg/kg) were tested as single-dose prophylactic agents in both immunocompetent and immunosuppressed C57BL/6 mice challenged with either Candida albicans or Histoplasma capsulatum. Prophylactic efficacy was based on survival and fungal burden in the target organ (kidneys or spleen). At 9 to 10 days after histoplasma challenge, 80 to 90% of both immunocompetent and immunosuppressed mice in the control and Fungizone groups had died. All AmBisome-treated mice survived, although in the AmBisome groups given 1 mg/kg, the mice became moribund by day 10 to 12. No spleen CFU were detected in the histoplasma-challenged mice given 10 or 20 mg of AmBisome per kg. By 23 to 24 days after histoplasma challenge, fungal growth and/or death had occurred in all immunosuppressed mice except for four mice receiving 20 mg of AmBisome per kg. There were still no detectable fungi in the spleens of immunocompetent mice given 10 or 20 mg of AmBisome per kg. In the C. albicans experiment at 7 days postchallenge, all animals in both untreated and treated groups were alive with culture-positive kidneys. The kidney fungal burdens in AmBisome groups given 5 to 20 mg/kg were at least 1 log unit lower than those in the Fungizone group and significantly lower than those in the untreated control group (P < 0.05). There was a trend toward decreasing fungal growth in the kidneys as the dose of AmBisome was increased. In conclusion, these results show that a single high dose of AmBisome (5 to 20 mg/kg) had prophylactic efficacy in immunocompetent and immunosuppressed murine H. capsulatum and C. albicans models.

Topics: Amphotericin B; Animals; Antibiotic Prophylaxis; Antifungal Agents; Candida albicans; Candidiasis; Disease Models, Animal; Female; Histoplasma; Histoplasmosis; Immunocompetence; Immunocompromised Host; Kidney; Mice; Mice, Inbred C57BL; Spleen; Stem Cells

A murine model of intratracheally induced histoplasmosis in immunocompromised B6C3F(1) mice was used to evaluate a new triazole antifungal agent, posaconazole. This compound was previously shown to be comparable to amphotericin B and superior to itraconazole for the treatment of histoplasmosis in immunocompetent mice. The current study used mice that were depleted of T lymphocytes by intraperitoneal injection of anti-CD4 and anti-CD8 monoclonal antibodies beginning 2 days before infection and continuing at 5-day intervals until completion of the study. Groups of B6C3F(1) mice that were depleted of CD4 and CD8 T cells were infected with an inoculum of 10(4) Histoplasma capsulatum yeasts. All mice receiving posaconazole at 1 or 0.1 mg/kg of body weight/day, amphotericin B at 2 mg/kg every other day (qod), or itraconazole at 75 mg/kg/day survived to day 29. Only 60% of mice receiving itraconazole at 10 mg/kg/day and none receiving amphotericin B at 0.2 mg/kg qod survived to that date. Fungal burdens were determined at day 14 of infection, 1 day after discontinuation of therapy. Quantitative colony counts and Histoplasma antigen levels in lung and spleen tissues declined following treatment with amphotericin B at 2 mg/kg qod, posaconazole at 5 and 1 mg/kg/day, and itraconazole at 75 mg/kg/day but not in mice treated with amphotericin B at 0.2 mg/kg qod or itraconazole at 10 mg/kg/day. Posaconazole at 0.1 mg/kg/day reduced fungal colony counts and antigen levels in spleens but not in lungs. This study shows posaconazole activity for the treatment of histoplasmosis in immunosuppressed animals.

Topics: Amphotericin B; Animals; Antifungal Agents; CD4-Positive T-Lymphocytes; CD8-Positive T-Lymphocytes; Histoplasma; Histoplasmosis; Immunocompromised Host; Immunosuppression Therapy; Itraconazole; Lung; Mice; Mice, Inbred Strains; Spleen; Survival Analysis; Time Factors; Triazoles

Several endogenous cytokines, including granulocyte-macrophage colony-stimulating factor (GM-CSF), are necessary for eliminating Histoplasma capsulatum from tissues. In this study, we explored the efficacy of recombinant murine GM-CSF in the treatment of pulmonary histoplasmosis. This cytokine significantly reduced fungal burden in a dose-dependent manner. Pretreatment did not consistently produce a better result than treatment started after infection. The biological effectiveness of GM-CSF was not associated with modulation of lung cytokine production or alteration in lung inflammation, but it directly activated a nonadherent lung cell population to exert anti-Histoplasma activity. GM-CSF improved survival of T-cell-depleted mice exposed to H. capsulatum. When combined with a suboptimal amount of amphotericin B, GM-CSF enhanced survival of normal or T-cell-depleted mice given a lethal challenge. These results suggest that this cytokine may be useful as an adjunctive treatment for histoplasmosis.

Topics: Amphotericin B; Animals; Cytokines; Dose-Response Relationship, Drug; Drug Interactions; Flow Cytometry; Granulocyte-Macrophage Colony-Stimulating Factor; Histoplasma; Histoplasmosis; Immunocompetence; Immunocompromised Host; Leukocytes; Lung; Male; Mice; Mice, Inbred C57BL; Recombinant Proteins

Histoplasma capsulatum (HC) infection is rare in India. We document a case of unilateral adrenal histoplasmosis in a 56 year male. The patient presented with hepatosplenomegaly, unilateral adrenal mass and significant weight loss. Since FNAC of adrenal mass was inconclusive, he underwent splenectomy, adrenalectomy and liver biopsy, histology of these specimens revealed HC only in adrenal mass. Subsequently, histoplasmin test was also performed which was also found to be positive. He responded well to parenteral amphotericin B and is under regular follow-up with no complaints now.

Topics: Adrenal Gland Diseases; Amphotericin B; Antifungal Agents; Diagnosis, Differential; Hepatomegaly; Histoplasmin; Histoplasmosis; Humans; India; Male; Middle Aged; Splenomegaly; Weight Loss

Topics: Adult; AIDS-Related Opportunistic Infections; Amphotericin B; Antifungal Agents; Histoplasmosis; Humans; Itraconazole; Male

A murine model of intratracheally induced histoplasmosis was used to evaluate a new triazole antifungal agent, Schering (SCH) 56592, for treatment of histoplasmosis. MICs were determined for SCH 56592, amphotericin B, and itraconazole by testing yeast-phase isolates from 20 patients by a macrobroth dilution method. The MICs at which 90% of the isolates are inhibited were for 0.019 microgram/ml for SCH 56592, 0.5 microgram/ml for amphotericin B, and < or = 0.019 microgram/ml for itraconazole. Survival studies were done on groups of 10 B6C3F1 mice with a lethal inoculum of 10(5). All mice receiving 5, 1, or 0.25 mg of SCH 56592 per kg of body weight per day, 2.5 mg of amphotericin B per kg every other day (qod), or 75 mg of itraconazole per kg per day survived to day 29. Only 44% of mice receiving 5 mg of itraconazole/kg/day survived to day 29. Fungal burden studies done in similar groups of mice with a sublethal inoculum of 10(4) showed a reduction in CFUs and Histoplasma antigen levels in lung and spleen tissue in animals treated with 2 mg of amphotericin B/kg qod, 1 mg of SCH 56592/kg/day, and 75 mg of itraconazole/kg/day, but not in those treated with lower doses of the study drugs (0.2 mg of amphotericin B/kg qod, 0.1 mg of SCH 56592/kg/day, or 10 mg of itraconazole/kg/day). Serum drug concentrations were measured 3 and 24 h after the last dose in mice (groups of five to seven mice), each treated for 7 days with SCH 56592 (10 and 1 mg/kg/day) and itraconazole (75 and 10 mg/kg/day). Mean levels measured by bioassay were as follows: SCH 56592, 10 mg/kg/day (2.15 micrograms/ml at 3 h and 0.35 microgram/ml at 24 h); SCH 56592, 1 mg/kg/day (0.54 microgram/ml at 3 h and none detected at 24 h); itraconazole, 75 mg/kg/day (22.53 micrograms/ml at 3 h and none detected at 24 h); itraconazole, 10 mg/kg/day (1.33 micrograms/ml at 3 h and none detected at 24 h). Confirmatory results were obtained by high-pressure liquid chromatography assay. These studies show SCH 56592 to be a promising candidate for studies of treatment of histoplasmosis in humans.

Topics: Amphotericin B; Animals; Antifungal Agents; Disease Models, Animal; Histoplasma; Histoplasmosis; Immunocompetence; Itraconazole; Mice; Microbial Sensitivity Tests; Triazoles

Histoplasmosis is an important systemic fungal infection, particularly among immunocompromised individuals, who may develop a progressive disseminated form which is often fatal if it is untreated. In such patients, the detection of antibody responses for both diagnosis and follow-up may be of limited use, whereas the detection of Histoplasma capsulatum var. capsulatum antigens may provide a more practical approach. We have recently described an inhibition enzyme-linked immunosorbent assay (ELISA) for the detection in patients' sera of a 69- to 70-kDa H. capsulatum var. capsulatum-specific antigen which appears to be useful in diagnosis. To investigate its potential for the follow-up of histoplasmosis patients during treatment, antigen titers in the sera of 16 patients presenting with different clinical forms of histoplasmosis were monitored at regular intervals for up to 80 weeks. Sera from four of five patients with the acute form of the disease showed rapid falls in antigenemia, becoming antigen negative by week 14 (range, weeks 10 to 16). Sera from four patients with disseminated histoplasmosis showed falls in antigen levels; three of them became antigen negative by week 32; the fourth patient became negative by week 48. In contrast, antigen titers in four of six AIDS patients with the disseminated form of the disease remained positive throughout follow-up. Sera from only one patient who presented with the chronic form of the disease were analyzed, and this individual's serum became antigen negative by week 9. The inhibition ELISA is shown to be of particular use in the monitoring of non-AIDS patients with the acute and disseminated forms of the disease and may complement existing means of follow-up.

Topics: Adolescent; Adult; AIDS-Related Opportunistic Infections; Amphotericin B; Antifungal Agents; Antigens, Fungal; Child; Child, Preschool; Enzyme-Linked Immunosorbent Assay; Female; Follow-Up Studies; Fungemia; Histoplasma; Histoplasmosis; Humans; Infant; Itraconazole; Male; Sensitivity and Specificity; Time Factors

A 51 year old patient who worked in Africa for eight years, presented twelve years later a progressive ataxia associated with headaches. Neuroimaging studies done after a partial complex seizure demonstrated multiple supra and sub-tentorial cortical ring enhancing lesions. Histoplasma capsulatum histoplasmosis was found on histological examination of brain biopsy and confirmed by isolation of the fungus. Medical treatment with intravenous amphotericin B followed by oral itraconazole (400 mg per day) improved both clinical and radiological status. This observation of cerebral histoplasmosis is rather unusual for a seronegative HIV patient in a non endemic area.

Topics: Amphotericin B; Antifungal Agents; Biopsy; Brain; Disease Progression; Histoplasmosis; HIV Seronegativity; Humans; Magnetic Resonance Imaging; Male; Middle Aged

Sordarins are new antifungals which inhibit fungal protein synthesis by blocking elongation factor 2. Three compounds were evaluated in a murine model of histoplasmosis. Immune-competent mice were infected intravenously with 10(6) to 10(8) CFU of Histoplasma capsulatum yeast cells. Mice were treated either orally with sordarins or fluconazole from day 2 through 8 after infection or intraperitoneally with amphotericin B during the same period. Protection was measured by increased rates of survival for 30 days after infection or reduction of lung or kidney tissue counts 9 days after infection. All three of the antifungal drugs tested were protective compared with controls. Sordarins were effective at doses as low as 2 mg/kg of body weight/day. This novel class of drugs compared favorably with amphotericin B and fluconazole for the treatment of histoplasmosis.

Topics: Amphotericin B; Animals; Antifungal Agents; Fluconazole; Histoplasma; Histoplasmosis; Indenes; Kidney; Lung; Male; Mice; Mice, Inbred ICR

A 36-year-old HIV-infected male patient presented with relapsing fever episodes to 39 degrees C, night sweats and weight loss. Computerized tomography of the abdomen showed enlarged multiple lymph nodes. After surgical resection of multiple lymph nodes, disseminated infection with Histoplasma capsulatum was diagnosed. Amphotericin B desoxycholate was initiated for 24 days. Fourteen days after therapy was discontinued, the patient suffered similar symptoms again. Subsequent treatment with liposomal amphotericin B led to rapid improvement within 3 days. Upon discharge, maintenance therapy with 600-mg itraconazole capsules was initiated and decreased to 400-mg 14-days later. Itraconazole therapy was continued until the patient died more than 2 years later because of complications of the underlying disease. At autopsy there were no signs of histoplasmosis.

Topics: Adult; AIDS-Related Opportunistic Infections; Amphotericin B; Antifungal Agents; Histoplasma; Histoplasmosis; Humans; Liposomes; Male; Recurrence; Treatment Outcome

Topics: Adult; Amphotericin B; Antifungal Agents; Bone Marrow; Female; Histoplasmosis; Humans; Lung Diseases

Histoplasmosis has been little reported among HIV-infected children. We report a case of a 4-year old boy with AIDS who presented with disseminated histoplasmosis diagnosed by lung biopsy. The patient had a good clinical response to amphotericin B followed by itraconazole oral solution.

Topics: Acquired Immunodeficiency Syndrome; Administration, Oral; Amphotericin B; Antifungal Agents; Biopsy; Child, Preschool; Histoplasmosis; Humans; Itraconazole; Lung; Male; Radiography

We present a case of synovitis of the wrist due to histoplasmosis, diagnosed only after extensive surgery and culturing. Treatment with amphotericin B in combination with radical surgery was effective in curing the disease. This manifestation was probably an exacerbation of a latent chronic infection with Histoplasma capsulatum, although it was unclear why the exacerbation occurred. Synovitis resistant to treatment should be assessed with great care, especially in view of the growing number of immunocompromised patients. Close collaboration between surgeon, rheumatologist, pathologist and microbiologist is paramount in such cases.

Topics: Aged; Amphotericin B; Antifungal Agents; Carpal Bones; Combined Modality Therapy; Follow-Up Studies; Histoplasmosis; Humans; Male; Osteomyelitis; Radiography; Synovitis; Treatment Outcome; Wrist Joint

Three cases of chronic pulmonary histoplasmosis affecting aged patients with chronic obstructive pulmonary disease are reported. They had a history of recurrent episodes of respiratory infection and presented radiological lung lesions inducing a misdiagnosis of chronic pulmonary tuberculosis of the adults. The diagnosis of histoplasmosis, suggested by the immunodiffusion test and the detection of yeastlike cells in smeared and stained sputum, was confirmed by the isolation and identification of Histoplasma capsulatum var. capsulatum in selective media. The treatment was carried out with amphothericin B and ketoconazole or itraconazole. Clinical, radiologic, mycologic and serologic improvement was obtained in all the patients. However, relapses occurred within a period of 1 to 18 months after the interruption of the treatment. Mycological diagnosis and the difficulties observed in the treatment were discussed. In addition data on the epidemiology of histoplasmosis in the state of Rio de Janeiro, Brazil, were presented.

Topics: Aged; Amphotericin B; Antifungal Agents; Brazil; Fatal Outcome; Female; Histoplasma; Histoplasmosis; Humans; Immunodiffusion; Itraconazole; Ketoconazole; Lung Diseases, Fungal; Lung Diseases, Obstructive; Male; Middle Aged; Radiography, Thoracic; Recurrence; Sputum

Disseminated histoplasmosis usually occurs in immunocompromised patients who reside in Histoplasma capsulatum-endemic regions. It has also been described in immunocompetent infants after exposure to a large inoculum of the pathogen resulting in case fatality rates of 40 to 50%.. From 1983 through 1996 all infants with documented disseminated histoplasmosis were treated with amphotericin B followed by daily ketoconazole for 3 months. Immunologic workups were performed at the time of diagnosis and at 4 to 6 weeks of therapy. Surviving patients were followed for at least 1 year. Time to resolution of signs and symptoms was recorded, as were complications.. We managed 40 patients with disseminated histoplasmosis. The age in months at diagnosis was 15.3+/-10.2 (mean +/- SD), and 24 were male. All patients were from endemic regions and they presented with fever, spleen and/or liver enlargement and hematologic abnormalities. Diagnosis was made by histology and culture of bone marrow, spleen, lymph node, bronchoalveolar or liver samples. Twenty patients presented with T cell deficiency that resolved at 4 to 6 weeks of therapy in all of the retested patients, and 10 of 12 tested patients had hyperglobulinemia that resolved. Thirty-five (88%) patients were cured by treatment; 4 died and 1 relapsed.. Disseminated histoplasmosis should be considered in infants from endemic areas who present with fever, hepatosplenomegaly and hematologic abnormalities. These patients develop transient hyperglobulinemia and T cell deficiency that resolve with treatment. Treatment with amphotericin B followed by an oral azole for 3 months is effective in most patients.

Topics: Amphotericin B; Antifungal Agents; Costa Rica; Endemic Diseases; Female; Histoplasmosis; Humans; Infant; Ketoconazole; Male; Survival Analysis

Topics: Adult; AIDS-Related Opportunistic Infections; Amphotericin B; Antifungal Agents; Histoplasmosis; Humans; Male; Pneumocystis

We describe a 2 year-old non-immunocompromised girl with disseminated histoplasmosis who presented with a 2-month history of fever and bloody diarrhoea. On presentation, she was severely wasted and anaemic. There were gross hepatosplenomegaly and multiple lymphadenopathy. A septic screen was negative. A subsequent stool culture isolated Salmonella enteriditis. Serial Widal-Weil Felix (WWF) titres showed serological response after 2 weeks of Ceftriaxone. However, she continued to have spiking fever, bloody diarrhoea and weight loss. She developed pancytopaenia and disseminated intravascular coagulation. A bone marrow aspirate and trephine, and lymph node biopsy showed the presence of Histoplasma capsulatum, confirmed by Gomori-Methenamine Silver staining. She responded to intravenous amphotericin B followed by fluconazole (intravenous then oral) for 6 months after discharge. Human Immunodeficiency Virus screening tests were negative. Complement and immunoglobulin levels were normal. T and B enumeration tests showed gross leucopaenia with very low T cell function with defective phagocytic function. A repeat T and B cell enumeration test and phagocytic function tests done 3 months later were normal.

Topics: Amphotericin B; Anti-Bacterial Agents; Antifungal Agents; Bone Marrow; Child, Preschool; Disseminated Intravascular Coagulation; Female; Fluconazole; Histoplasma; Histoplasmosis; Humans; Immune System; Pancytopenia

A rare case of severe disseminated histoplasmosis in a 7-year-old boy with apparently normal immune function is described. Current recommendations for diagnostic investigations, monitoring and the treatment of this disease with amphotericin B and itraconazole are reviewed.

Topics: Amphotericin B; Anti-Bacterial Agents; Antifungal Agents; Child; Histoplasma; Histoplasmosis; Humans; Immunocompetence; Itraconazole; Ketoconazole; Male; Vancomycin

Topics: Adult; Amphotericin B; Antifungal Agents; Cholangitis, Sclerosing; Female; Histoplasmosis; Humans; Immunocompromised Host; Liver Transplantation; Opportunistic Infections

Histoplasma infections in Europe are rare, and acute disseminated histoplasmosis has been observed only in immunocompromised persons. An unusual case of autochthonous disseminated histoplasmosis in a 22-year-old Spanish man who had been treated with azathioprine and prednisone for 4 weeks before admission is reported. The development of an acute form of the disease may represent an endogenous reactivation of a latent infection as a complication of immunosuppression resulting from the use of these drugs. This case illustrates the potential risk of this opportunistic fungal infection in patients receiving azathioprine therapy, an association that has been rarely described before.

Topics: Adult; Amphotericin B; Antifungal Agents; Azathioprine; Bone Marrow Cells; Drug Carriers; Drug Therapy, Combination; Histoplasma; Histoplasmosis; Humans; Immunosuppression Therapy; Immunosuppressive Agents; Liposomes; Lymph Nodes; Male; Opportunistic Infections; Prednisone

A 39-year-old woman with systemic lupus erythematosus suffered a prolonged neurological illness associated with very low levels of glucose in her cerebrospinal fluid (CSF). Six months later, and after numerous CSF investigations, Histoplasma capsulatum was cultured. To our knowledge, this is the first report of cerebral histoplasmosis in Australia in a patient who is not HIV positive.

Topics: Adult; Amphotericin B; Antifungal Agents; Blood Glucose; Brain; Drug Therapy, Combination; Female; Histoplasmosis; Humans; Itraconazole; Lupus Erythematosus, Systemic; Magnetic Resonance Imaging; Meningitis, Fungal; Neurologic Examination; Opportunistic Infections

Histoplasmosis is an important cause of morbidity and death in HIV-infected patients. Significant developments concerning the diagnosis, treatment, follow-up, and prophylaxis of histoplasmosis are discussed. Itraconazole is highly effective at both inducing and maintaining remission in mild to moderate cases of disseminated histoplasmosis. In cases of moderate to severe disease, amphotericin B remains the therapy of choice. A table presents comparative results of treating mild to moderate disseminated histoplasmosis with the drugs itraconazole versus fluconazole. Currently, no resistance of Histoplasmosis capsulatum to itraconazole has emerged from prolonged therapy. Maintenance therapy for life is recommended for patients with CD4 counts less than 100; however, feasibility studies are evaluating the possibility of its discontinuance. While no prophylaxis recommendations currently exist, patients with CD4 counts less than 100 who are exposed to histoplasmosis are recommended to begin oral itraconazole (200 mg daily).

Topics: AIDS-Related Opportunistic Infections; Amphotericin B; Antifungal Agents; Central Nervous System Diseases; Clinical Trials as Topic; Dosage Forms; Fluconazole; Histoplasmosis; Itraconazole; Ketoconazole; Remission Induction

Infection with Histoplasma capsulatum results in a subclinical infection in immunocompetent hosts due to an effective cellular immune response. By contrast, immunodeficient individuals can have a severe disseminated and potentially fatal disease. In a previous study, it was demonstrated that normal mice infected intravenously with H. capsulatum and treated with interleukin-12 (IL-12) at the time of infection were protected from a fatal outcome. In this study, we examined the immunomodulatory effects of IL-12 on disseminated histoplasmosis in immunodeficient SCID mice. SCID mice infected with H. capsulatum and treated with IL-12 showed an increase in survival and a reduction in the colony counts of H. capsulatum in internal organs at 14 days after infection. The protective effect of IL-12 was abrogated if animals were also treated with a neutralizing antibody to gamma interferon (IFN-gamma). IL-12 treatment also resulted in an increase in mRNA expression and protein production for IFN-gamma, tumor necrosis factor alpha (TNF-alpha), and nitric oxide from spleen cells. When IL-12 was combined with amphotericin B (AmB) treatment, there was a significant increase in survival compared with either modality alone. Moreover, combined treatment resulted in an increase in both IFN-gamma and TNF-alpha production, as well as in a substantial reduction in H. capsulatum burden at 35 and 90 days postinfection. This study demonstrates that IL-12 modulates the protective immune response to histoplasmosis in SCID mice and also suggests that IL-12 in combination with AmB may be useful as a treatment for H. capsulatum in immunodeficient hosts.

Topics: Amphotericin B; Animals; Cytokines; Female; Histoplasmosis; Interferon-gamma; Interleukin-12; Mice; Mice, SCID; RNA, Messenger; Tumor Necrosis Factor-alpha

A previously healthy and asymptomatic 7-year-old white boy presented with a history of two episodes of hemoptysis productive of bright red blood in the 5 days preceding admission. After admission he developed massive hemoptysis that, on bronchoscopy, was noted to be emanating from the right lower lobe. An emergency right lower lobe resection was done. Pathological examination revealed hilar adenopathy and peripheral lesions with caseating granulomas containing yeast, morphologically consistent with Histoplasma capsulatum.

Topics: Amphotericin B; Antifungal Agents; Bronchoscopy; Child; Drug Therapy, Combination; Hemoptysis; Histoplasmosis; Humans; Itraconazole; Lung; Lung Diseases, Fungal; Male; Pneumonectomy; Recurrence

Topics: Adult; AIDS-Related Opportunistic Infections; Amphotericin B; Antifungal Agents; Drug Therapy, Combination; Fatal Outcome; Histoplasmosis; Humans; Italy; Itraconazole; Male

A case of an Italian AIDS patient who developed both meningitis and cerebral mass lesion as a final relapse of disseminated histoplasmosis is reported. Central nervous system (CNS) involvement occurred while the patient was receiving both amphotericin B and itraconazole as maintenance therapy, thus indicating the difficulty of eradicating histoplasmosis in patients with AIDS.

Topics: Adult; AIDS-Related Opportunistic Infections; Amphotericin B; Antifungal Agents; Fatal Outcome; Histoplasma; Histoplasmosis; Humans; Italy; Itraconazole; Male; Meningitis

Topics: Amphotericin B; Anorexia; Antifungal Agents; Aspergillosis; Blastomycosis; Candidiasis; Coccidioidomycosis; Cryptococcosis; Cytochrome P-450 CYP3A; Cytochrome P-450 Enzyme Inhibitors; Dose-Response Relationship, Drug; Drug Interactions; Fluconazole; Flucytosine; Gynecomastia; Histoplasmosis; Humans; Itraconazole; Ketoconazole; Kidney Diseases; Liposomes; Male; Mixed Function Oxygenases; Mucormycosis; Nausea; Paracoccidioidomycosis; Sporotrichosis; Teratogens

Topics: AIDS-Related Opportunistic Infections; Amphotericin B; Antifungal Agents; Histoplasmosis; Humans; Hypothermia; Male

Histoplasma capsulatum is a dimorphic pathogenic fungus endemic to the Mississippi and Ohio river valleys. In the immunocompetent it causes a self-limited disease, but in the immunocompromised may lead to disseminated disease (disseminated histoplasmosis (DH)). It is one of the opportunistic infections which defines the acquired immunodeficiency syndrome (AIDS) and is rarely encountered outside endemic regions.. Clinical, laboratory, and histologic information concerning seven patients with DH and AIDS in South Florida was recorded.. We report seven cases of DH with mucocutaneous lesions in patients infected with the human immunodeficiency virus (HIV). All patients had markedly depressed CD4 counts of less than 40 cells/mm3, and only two had traveled to endemic areas. Two out of the seven patients were diagnosed with HIV/AIDS at the time DH was identified. All of our patients had mucocutaneous lesions at the time of diagnosis, which clinically presented as a generalized papular eruption, ulcers, and erythematous scaly plaques.. Even in non-endemic regions, HIV-positive patients presenting with fever, chills, weight loss, hepatosplenomegaly, anemia, cough, lymphadenopathy, and mucocutaneous lesions should have an early skin biopsy specimen taken for mycologic tissue culture and histopathologic evaluation for disseminated fungal infections.

Topics: Adult; AIDS-Related Opportunistic Infections; Amphotericin B; Antifungal Agents; Biopsy; Dermatomycoses; Florida; Histoplasma; Histoplasmosis; Humans; Male; Middle Aged; Skin

Topics: Adolescent; Adult; AIDS-Related Opportunistic Infections; Amphotericin B; Antifungal Agents; Delivery of Health Care; Drug Therapy; Guatemala; Histoplasmosis; HIV Infections; HIV-1; Humans; Itraconazole; Male; Retrospective Studies; Risk Factors

Topics: Adult; Amphotericin B; Antifungal Agents; Fungemia; Histoplasma; Histoplasmosis; Humans; Itraconazole; Liver Transplantation; Male

Necrotizing myofascial fungal infections of the upper extremity is a rare event even in immunocompromised hosts. We report the course of a renal transplant patient who developed extensive necrotizing myofascial infection of an upper extremity secondary to Histoplasma capsulatum. Initial, functional, upper limb salvage was achieved after aggressive surgical debridement and high doses of amphotericin B. The patient ultimately succumbed to systemic fungal sepsis. The etiology and treatment of these infections are discussed.

Topics: Amphotericin B; Combined Modality Therapy; Debridement; Fasciitis; Fatal Outcome; Forearm; Histoplasmosis; Humans; Kidney Transplantation; Male; Middle Aged; Myositis; Necrosis; Opportunistic Infections; Postoperative Complications

Histoplasmosis, an opportunistic fungal infection endemic in the Ohio and Mississippi river valleys, is caused by a dimorphic fungus Histoplasma capsulatum. Most infections are asymptomatic or self-limited febrile illness. Immunosuppressed renal transplant recipients are susceptible to a disseminated disease. We report 5 cases of disseminated histoplasmosis seen in our institute over a period of 25 years amongst 1074 renal transplant recipients. The duration of immunosuppression prior to the diagnosis of infection ranged from 84 days to 14 years. All patients had pulmonary involvement. Three patients received an antilymphocyte preparation and 1 patent received intravenous pulse steroids in the 3 months prior to the onset of infection. Histopathologic examination of the involved organ(s) provided rapid diagnostic information allowing early treatment with amphotericin B. All infections resolved with no relapses to date. In conclusion immunosuppressed patients are more prone to disseminated histoplasmosis. Early recognition and prompt treatment with amphotericin B resolved the infection without relapse.

Topics: Adult; Amphotericin B; Antifungal Agents; Antilymphocyte Serum; Disease Susceptibility; Female; Glucocorticoids; Histoplasma; Histoplasmosis; Humans; Immunosuppression Therapy; Itraconazole; Kidney Transplantation; Lung Diseases, Fungal; Male; Middle Aged; Ohio; Opportunistic Infections; Transplantation, Homologous

A patient with chronic disseminated histoplasmosis was followed after successful treatment with amphotericin B for 10 years until his death from chronic obstructive airways disease. Necropsy showed that Histoplasma organisms could still be identified in the adrenal and pancreatic abscesses, though none appeared viable on electron microscopy. Excision of such abscesses should be considered in view of their potential as a reservoir of organisms.

Topics: Aged; Amphotericin B; Antifungal Agents; Follow-Up Studies; Histoplasmosis; Humans; Male; Time Factors

Topics: Adult; AIDS-Related Opportunistic Infections; Amphotericin B; Histoplasma; Histoplasmosis; Humans; Hypothermia, Induced; Injections, Intravenous; Male

Topics: Aged; Amphotericin B; Anti-Bacterial Agents; Biopsy; Cholestasis; Diagnosis, Differential; Fatal Outcome; Granuloma; Histoplasmosis; Humans; Liver; Liver Diseases; Male

A 35-year-old man from Central America with a history of AIDS and numerous opportunistic infections presented with progressive neutropenia and thrombocytopenia despite having been stable for a period of 6 months. Cessation of antiviral medications did not stop his neutropenia, nor did use of folinic acid, G-CSF, or erythropoietin. The failure of these measures required repeated blood transfusions. Although the physical examination was relatively unremarkable, hematology and blood chemistries indicated that the patient needed urgent hospitalization due to fever and neutropenia. Neutropenia within HIV infection can be confusing, since it may be a result of the infection itself, an adverse effect of drug therapy, or from an opportunistic infection or malignancy. If the cause is not evident, it is wise to seek the etiology first rather than immediately use bone marrow stimulants, such as G-CSF. In this case, an infectious disease specialist made a diagnosis of disseminated histoplasmosis, after which the patient was treated with amphotericin B and released on itraconazole maintenance therapy.

Topics: Acquired Immunodeficiency Syndrome; Adult; Amphotericin B; Antifungal Agents; Erythropoietin; Fever; Granulocyte Colony-Stimulating Factor; Histoplasmosis; Humans; Male; Mucous Membrane; Neutropenia

Liposomal amphotericin B (AmBisome) was compared with amphotericin B deoxycholate for the treatment of disseminated murine histoplasmosis. Liposomal amphotericin B was well tolerated and, milligram for milligram, was as potent as amphotericin B deoxycholate.

Topics: Amphotericin B; Animals; Antifungal Agents; Colony Count, Microbial; Drug Carriers; Histoplasmosis; Immunosuppression Therapy; Kidney; Liposomes; Mice; Mice, Inbred BALB C; Spleen

Topics: Adult; Amphotericin B; Creatinine; Drug Carriers; Female; Histoplasmosis; Humans; Kidney; Liposomes

Histoplasmosis is a fungal infection caused by the organism Histoplasma capsulatum. Disseminated disease usually occurs in immunosuppressed patients or in patients with chronic illnesses. Although relatively uncommon, histoplasmosis has been reported in patients with AIDS, and oral lesions have been noted on multiple sites and in various clinical presentations. We present two HIV-positive cases with oral lesions as the initial signs of histoplasmosis. Both patients responded well to IV amphotericin B but later suffered recurrences despite being maintained on systemic antifungal therapy.

Topics: Adult; AIDS-Related Opportunistic Infections; Amphotericin B; Histoplasmosis; HIV Infections; Humans; Ketoconazole; Male; Mouth Diseases

Topics: Aged; Amphotericin B; Chronic Disease; Diagnosis, Differential; Female; Histoplasmosis; Humans; Ketoconazole; Maxillary Diseases; Mouth Diseases; Mouth Neoplasms; Ulcer

Histoplasma capsulatum histoplasmosis occurs frequently in endemic areas and with the AIDS outbreak, it appears as an opportunistic fungus involved in disseminated disease. We report the clinical, biological and treatment features of seven cases diagnosed in the CISIH of the Eastern part of Paris. Clinically, four patients were suffering from pulmonary symptoms, in three cases digestive disorders and in three cutaneous lesions. In all cases, the mycologic diagnosis was necessary. Amphotericin B and itraconazole were used as treatment for five patients (two died before the diagnosis was completed). Among these five subjects, four died (death was attributed to histoplasmosis in only one case). These observations emphasize the importance of this infection in HIV-infected patients coming from endemic areas.

Topics: Acquired Immunodeficiency Syndrome; AIDS-Related Opportunistic Infections; Amphotericin B; Female; Histoplasmosis; Humans; Itraconazole; Male; Recurrence; Retrospective Studies

At bronchoscopic examination extensive areas of fibrinous slough covering bronchial mucosal inflammation and ulceration were seen in a case of progressive diffuse bronchopulmonary histoplasmosis. Rigid bronchoscopy was needed to obtain sufficient biopsy material for specific histological diagnosis.

Topics: Amphotericin B; Biopsy; Bronchoscopy; Histoplasmosis; Humans; Ketoconazole; Lung Diseases, Fungal; Male; Middle Aged; Prednisolone; Respiratory Insufficiency

Within the upper aerodigestive tract, histoplasmosis often mimics carcinoma, making prompt and accurate diagnosis imperative. More severe and potentially lethal infections with Histoplasma capsulatum are now being seen as the numbers of patients at the extremes of age, as well as those with compromised immune systems, increase. We reviewed the cases of 115 hospitalized patients with disseminated histoplasmosis. Of these, 9 patients were identified with otolaryngologic manifestations: 4 were infected with human immunodeficiency virus (HIV), 1 was diabetic, and 3 were renal transplant patients. Sites of involvement included the larynx (in 2 cases) and the oral cavity and oral pharynx (in 7 cases). Eight of the 9 patients had a positive biopsy result; the other, a positive culture. Treatment with amphotericin B was generally effective, while the use of newer azole anti-fungal agents were less effective. As the number of immunocompromised patients continues to increase in modern clinical practice, histoplasmosis will undoubtedly be encountered more frequently in the head and neck area.

Topics: Amphotericin B; Histoplasmosis; HIV Infections; Humans; Itraconazole; Laryngeal Diseases; Laryngeal Neoplasms; Laryngoscopy; Male; Middle Aged; Retrospective Studies; Stomatognathic Diseases; Treatment Outcome

A 54-year-old man with dermatomyositis initially responsive to corticosteroids and methotrexate developed severe myalgias, increasing weakness, and fevers. Laboratory studies were suggestive of disseminated histoplasmosis, and muscle biopsy revealed myositis, fasciitis, and yeast in the perimysial connective tissue. Histoplasma capsulatum was cultured from skeletal muscle. Despite antifungal therapy, necrotizing fasciitis progressed to gluteal abscess formation. Disseminated histoplasmosis may present atypically in immunocompromised hosts as fasciitis and myositis. Patients with dermatomyositis could be particularly vulnerable to soft tissue invasion by fungi due to their underlying microangiopathy.

Topics: Abscess; Amphotericin B; Buttocks; Dermatomyositis; Diagnosis, Differential; Fasciitis; Histoplasmosis; Humans; Immunosuppression Therapy; Itraconazole; Magnetic Resonance Imaging; Male; Middle Aged; Muscles; Myositis

Disseminated infection with Histoplasma capsulatum frequently involves the nervous system, but the CNS process is generally not clinically apparent. We report an unusual case of a renal transplant recipient with long-standing immunosuppression who presented with clinical evidence of mass lesions in both his cerebral cortex and his spinal cord. Findings of CSF examination were normal, but stereotaxic biopsies of his cortical lesions demonstrated yeast forms and cultures of biopsy specimens yielded H. capsulatum. Clinical defects referable to both the cortical and spinal lesions decreased in severity after the patient received antifungal therapy. Our case illustrates that disseminated histoplasmosis can present in myriad ways and that widespread disease in the CNS can be occult in immunocompromised patients.

Topics: Aged; Amphotericin B; Anorexia; Brain Diseases; Follow-Up Studies; Histoplasmosis; Humans; Immunocompromised Host; Kidney Transplantation; Magnetic Resonance Imaging; Male; Postoperative Complications; Spinal Cord Diseases; Weight Loss

The authors report one case of disseminated African's histoplasmosis with numerous bones in Togolese immunocompetent child. The left tibia and fibula, the collarbones and the acromion were the bones mostly affected. The chronic fistulate lesion of the left leg associated with skin lesion allowed to evoke the diagnosis, this being confirmed by histological examination. The authors review the different diagnosis which will be discussed considering the radiographic appearance of african's histoplasmosis.

Topics: Acromion; Amphotericin B; Antifungal Agents; Child; Clavicle; Histoplasmosis; Humans; Immunocompetence; Ketoconazole; Osteomyelitis; Radiography; Ribs; Tibia; Togo

BRL 49594A (BRL) is a water soluble analogue of amphotericin B which has been developed as a polyene with efficacy similar to amphotericin B but with much reduced toxicity. BRL was prepared in 5% glucose, and was used to treat mice experimentally infected with Aspergillus fumigatus, Cryptococcus neoformans, or Histoplasma capsulatum. In the models in which BRL and amphotericin B were compared, BRL was well tolerated but was less effective than a similar regimen of amphotericin B. However, the ability to give much larger doses of BRL than tolerated with amphotericin B suggest that this drug could be an alternative to amphotericin B.

Topics: Amphotericin B; Animals; Anti-Infective Agents; Antifungal Agents; Aspergillosis; Aspergillus fumigatus; Cryptococcosis; Cryptococcus neoformans; Histoplasmosis; Lung; Male; Mice; Mice, Inbred BALB C; Mice, Inbred ICR; Microbial Sensitivity Tests; Mycoses; Rats; Rats, Sprague-Dawley

An overview of the following fungal infections: thrush, vaginal candidiasis, cryptococcal meningitis, histoplasmosis, and blastomycosis is provided. The symptoms and treatment options of each infection are discussed. New information concerning the use of fluconazole in reducing the frequency of cryptococcal meningitis, esophageal candidiasis, and superficial fungal infections is included. The use of preventive treatment for fungal infections is cautioned due to the possibility of resistance to treatment.

Topics: AIDS-Related Opportunistic Infections; Amphotericin B; Antifungal Agents; Blastomycosis; Candidiasis, Oral; Candidiasis, Vulvovaginal; Clotrimazole; Fluconazole; Histoplasmosis; Humans; Itraconazole; Meningitis, Cryptococcal; Mycoses

Progressive disseminated histoplasmosis is often fatal without treatment and requires rapid and accurate laboratory diagnosis. Radioimmunoassay for Histoplasma capsulatum var. capsulatum antigen has been established as a sensitive and accurate diagnostic technique for disseminated histoplasmosis in adults; this study examines the radioimmunoassay in children. The clinical and laboratory records of 26 patients 18 years old or younger in whom H. capsulatum antigen was detected in urine by radioimmunoassay and at least one other positive corroborative standard test were evaluated. Twenty-two (85%) had disseminated disease, and 4 (15%) had self-limited pulmonary disease. Positive corroborative tests included serologic tests in 17 of 22 (77%) patients tested, tissue stains in 5 of 9 (56%) and fungal cultures in 16 of 24 (67%). Patients with disseminated histoplasmosis had a greater degree of antigenuria than those with self-limited infection. In 20 patients with progressive disease treated with amphotericin B, antigen levels declined, and the decrease in antigenuria correlated with clinical improvement. The radioimmunoassay for H. capsulatum antigen in urine is an important test in the diagnosis of disseminated histoplasmosis and is useful for assessing the efficacy of treatment. The presence of urinary antigen is strong evidence for progressive disease that requires treatment.

Topics: Adolescent; Amphotericin B; Antigens, Fungal; Child; Child, Preschool; Complement Fixation Tests; Histoplasma; Histoplasmosis; Humans; Infant; Radioimmunoassay; Retrospective Studies; Serologic Tests

Topics: Amphotericin B; Child; Common Bile Duct Diseases; Constriction, Pathologic; Female; Histoplasmosis; Humans; Lymphadenitis

Two hemophiliacs infected with human immunodeficiency virus (HIV) presented with hematochezia secondary to gastrointestinal involvement with Histoplasmosis capsulatum. In one patient who was already receiving fluconazole, the diagnosis was obscured. Both patients responded to amphotericin B followed by intraconazole, with no recurrence of bleeding.

Topics: Acquired Immunodeficiency Syndrome; Amphotericin B; Diagnosis, Differential; Fluconazole; Gastrointestinal Diseases; Gastrointestinal Hemorrhage; Hemophilia A; Histoplasmosis; Humans; Male; Middle Aged

A 44-year-old man was admitted with symptoms compatible with Addison crisis. Abdominal computer tomography revealed extensive bilateral adrenal abscesses. Histoplasma capsulatum was cultured from a needle aspirate. The patient was HIV-seronegative and had no underlying malignancy. He may have acquired the infection during several stays in endemic areas in the United States, South America and Asia. The case was also remarkable for moderate brain atrophy, thrombosis of the portal and splenic veins and liver cirrhosis caused by alpha-1-antitrypsin deficiency (phenotype MZ). The patient recovered fully under substitution of adrenal hormones and antifungal treatment. He received intravenous amphotericin B (75 mg q24h) for 10 days, followed subsequently by oral treatment with itraconazole (400 mg q24h) over several months. Radiologic follow-up 9 and 18 months later showed a pronounced decrease of the inflammatory adrenal lesions.

Topics: Abscess; Acute Disease; Addison Disease; Adrenal Gland Diseases; Adult; alpha 1-Antitrypsin Deficiency; Amphotericin B; Histoplasmosis; Humans; Itraconazole; Liver Cirrhosis; Male; Tomography, X-Ray Computed

A 55-year-old homosexual Indonesian (last stay in Indonesia 2 years previously), known to be HIV positive since 1986, developed desquamating, in part ulcerating, skin eruption over the face and shoulder region. On admission his temperature was 38.2 degrees C, erythrocyte sedimentation rate 72/95 mm, white cell count 3.100/microliters, and the CD4 cell count 30/microliters. Examination of lung, oesophagus, stomach, duodenum and colon for possible opportunistic infections was negative. Fundoscopy revealed an infiltrate in the right eye with destruction of the vitreous. Skin biopsy suggested histoplasmosis, confirmed by culturing H. capsulatum varietas capsulatum. It is likely that this was the reactivation of a latent, previously symptom-free infection, in this case the first opportunistic infection in the presence of AIDS. For 30 days he received infusions of amphotericin B (initially 0.1 mg/kg daily, after the 5th day 0.5 mg/kg), resulting in rapid healing of the skin lesions. Subsequently he has received (for 6 months so far) itraconazole, 400 mg daily, without further complications.

Topics: AIDS-Related Opportunistic Infections; Amphotericin B; Biopsy; Dermatomycoses; Diagnosis, Differential; Drug Therapy, Combination; Histoplasma; Histoplasmosis; Humans; Itraconazole; Male; Middle Aged; Skin

A 40-year-old man with aortic stenosis and disseminated histoplasmosis did not respond to treatment with itraconazole. Though there was no haemodynamic deterioration, valvar regurgitation, or embolic phenomena a presumptive diagnosis of infective endocarditis was made. This was confirmed at aortic valve replacement. Antifungal treatment was continued for 18 months after valve replacement and serological tests for Histoplasma became progressively more negative during a three year follow up.

Topics: Adult; Amphotericin B; Aortic Valve; Aortic Valve Stenosis; Combined Modality Therapy; Deglutition Disorders; Endocarditis; Follow-Up Studies; Heart Valve Prosthesis; Histoplasmosis; Humans; Itraconazole; Male; Weight Loss

The objective of this study is to identify prognostic factors affecting mortality in surgical patients with culture-proved fungemia and to examine how amphotericin B affects mortality after controlling for these factors.. The study is based on a retrospective logistic regression analysis of general surgical patients with blood cultures positive for fungi. We analyzed the patients' ages; whether they received triple antibiotics, had diabetes, had malignant neoplasia, received steroids, had concomitant bacteremia, or took antibiotics for greater than 7 days; and total dose of amphotericin B.. The study was carried out at a university-based county hospital.. Analysis of microbiology records for blood cultures that were positive for fungi from November 1987 to January 1992 revealed 63 general surgical patients. Patients with burns and those undergoing organ transplantation were excluded. Forty charts were complete and available for review.. Death was the outcome variable studied.. Stepwise logistic regression analysis of death revealed age to be a risk factor for mortality. Treatment with at least 210 mg of amphotericin B was associated with relative risk of death of 0.055.. Amphotericin B is effective even at low doses at decreasing the mortality in surgical patients with fungemia. On the other hand, increasing age is associated with an increased risk of mortality. Found not to be associated were concomitant bacteremia, concurrent triple antibiotic therapy, malignant neoplasia, and steroid use.

Topics: Age Factors; Aged; Amphotericin B; Aspergillosis; Candidiasis; Female; Fungemia; Histoplasmosis; Humans; Logistic Models; Male; Middle Aged; Postoperative Complications; Prognosis; Regression Analysis; Retrospective Studies; Risk Factors; Survival Analysis

This 49-year-old man with the acquired immunodeficiency syndrome (AIDS) was admitted to the hospital because of fever, weight loss and respiratory symptoms. The radiograph of the chest showed diffuse fine nodular opacities. Histology of lung and lymph node revealed a necrotising granulomatosis and yeasts suggesting histoplasmosis. It's identity was confirmed by positive cultures for Histoplasma capsulatum in blood, urine, lung specimen and lymph node. There was a successful induction treatment and a maintenance therapy with amphotericin B. We discuss disseminated histoplasmosis in the immunodeficiency syndrome.

Topics: AIDS-Related Opportunistic Infections; Amphotericin B; Biopsy; Histoplasma; Histoplasmosis; Humans; Lung Diseases, Fungal; Male; Middle Aged; Radiography

The manifestations of histoplasmosis in 20 patients with the acquired immunodeficiency syndrome are presented. In this series, patients were treated with either itraconazole or fluconazole. Twelve patients received treatment with itraconazole at 400 mg/day, including two patients who had not responded to treatment with fluconazole at 100 mg/day. Of the responses, seven were classified as remissions (mean treatment duration of 24 months), two as improvements, and three as failures. Ten patients received fluconazole. Of the responses, three were classified as remissions (mean treatment duration of 12 months), one as improvement, and six as failures. Of the 10 patients treated with fluconazole, five received doses of 100 mg/day, and five were given doses of 400 or 800 mg/day. The differences in outcome among the five patients receiving the lower dose of fluconazole (one remission, one improvement, and three failures) and the five patients given the higher doses of fluconazole (two remissions and three failures) were negligible. One other patient showed signs of histoplasmosis while receiving fluconazole at 50 mg/day for treatment of thrush. Three failures (two treated with itraconazole and one with fluconazole) followed lapses in azole therapy because of associated conditions. Azole therapy was well tolerated. The treatment responses in this pilot series appear promising in comparison with those reported in the literature with amphotericin B or ketoconazole.

Topics: Acquired Immunodeficiency Syndrome; Adult; Aged; Amphotericin B; Antifungal Agents; Fluconazole; Histoplasmosis; Humans; Itraconazole; Ketoconazole; Middle Aged; Retrospective Studies; Treatment Outcome

The incidence and prevalence of histoplasmosis in Southeast Asia has not been extensively described. The first microbiologically documented case of disseminated histoplasmosis with cutaneous papulonodules in a 56-year-old woman from the Philippines is reported. She presented with fever and generalized papulonodular lesions in various stages, which evolved into vesicles with central necrosis that resembled molluscum contagiosum with an indurated erythematous halo. Biopsies revealed a granulomatous mass of lymphohistiocytic and epithelioid cells with intracellular budding yeast cells and dark nuclei. Cultures were positive for Histoplasma capsulatum. The patient was treated with amphotericin B (3 g) and 5-fluorocytosine (50 mg/kg/day), followed by ketoconazole (400 mg/day). Her clinical course was complicated by intractable hemolytic anemia that was initially treated with corticosteroids. A splenectomy was subsequently performed. Pneumonia and a brain abscess caused by Nocardia asteroides were secondary complications. Nine months after her admission, repeat testing was diagnostic for systemic lupus erythematosus. This patient serves to re-emphasize that cutaneous lesions in an immunocompromised patient must be evaluated by biopsy and culture analysis. Disseminated histoplasmosis in the immunocompromised host may present with unusual cutaneous lesions, and must be considered even in a nonendemic area.

Topics: Amphotericin B; Dermatomycoses; Female; Histoplasma; Histoplasmosis; Humans; Immunocompromised Host; Ketoconazole; Lupus Erythematosus, Systemic; Middle Aged; Neutrophils; Philippines; Prednisone

We treated 20 patients thought to have mediastinal fibrosis secondary to Histoplasma capsulatum. All but 1 were symptomatic. The most common symptoms were dyspnea (8), hemoptysis (6), postobstructive pneumonia (5), and superior vena caval obstruction (2). Nine patients had severe stenosis of the trachea, carina, or main bronchus. Special stains identified Histoplasma capsulatum in surgical specimens in 9 patients. Surgical procedures were done for 18 of 20 patients (resection of subcarinal mass, 6; right middle and lower lobectomy, 5; carinal pneumonectomy, 4; esophagoplasty, 4; sleeve resection, 3 (with right main bronchus in 1, right lower and middle lobectomy in 1, and carina in 1); right upper lobectomy, 1; middle lobectomy, 1; and bronchoplasty of left main bronchus, 1. There were 4 deaths, 3 after complications of carinal pneumonectomy and 1 in a patient with tracheobronchial obstruction that could not be dilated. Two patients were treated with amphotericin and 4 with ketoconazole. Sclerosing mediastinitis secondary to histoplasmosis presents tremendous surgical challenges because of the intense fibrosis encountered. Bronchoplastic procedures are possible in spite of the intense fibrosis. High mortality rates after carinal resection may be encountered. The exact role of antifungal therapy is as yet undefined.

Topics: Adolescent; Adult; Amphotericin B; Boston; Combined Modality Therapy; Esophagoplasty; Female; Fibrosis; Follow-Up Studies; Histoplasmosis; Hospital Mortality; Hospitals, General; Humans; Ketoconazole; Male; Mediastinal Diseases; Middle Aged; Pneumonectomy; Radiography; Steroids

A renal transplant patient presented with ileal perforation due to histoplasmosis 3 years after transplantation. Mesenteric lymph nodes and lungs were also affected by the disease. She was successfully treated with amphotericin B followed by ketoconazole.

Topics: Adult; Amphotericin B; Diagnosis, Differential; Female; Histoplasmosis; Humans; Ileal Diseases; Intestinal Perforation; Ketoconazole; Kidney Transplantation

The purpose of this study was to establish the effect of induction and maintenance treatment with amphotericin B on levels of Histoplasma capsulatum var. capsulatum polysaccharide antigen (HPA) in the urine and blood of patients with acquired immunodeficiency syndrome (AIDS) and disseminated histoplasmosis.. This was a retrospective study of the effect of amphotericin B treatment on levels of HPA in the urine or serum from 70 patients with AIDS and disseminated histoplasmosis. All patients received initial intensive induction treatment with amphotericin B, and a subset continued to receive amphotericin B at less frequent intervals for maintenance therapy to prevent relapse. Treatment regimens varied in intensity and duration and specimens were obtained at irregular intervals. Urine and serum specimens were stored and retested for HPA in the same radioimmunoassay.. HPA levels in serum decreased by at least 2 units during induction therapy in all 19 (100%) patients with initial levels of greater than or equal to 2.6 units and reverted to negative in 40.9% of those with initial levels of greater than or equal to 1.0 unit. HPA in urine decreased by at least 2 units in 84.8% and reverted to negative in 17.3% of patients. During induction treatment, HPA cleared more rapidly from serum than from urine. During maintenance treatment, HPA levels in serum decreased by at least 2 units in 100% and became negative in 66.7%. HPA in urine decreased by at least 2 units in 54.5% and reverted to negative in 20.0%. Rates of clearance of HPA from the serum and urine were similar, 0.01 unit/week compared with -0.04 unit/week, respectively, but less than rates during induction treatment.. Successful therapy of histoplasmosis with amphotericin B is associated with reduction of HPA in body fluids. Periodic measurement of HPA levels offers a method for monitoring the response to therapy and for comparing new treatments for histoplasmosis.

Topics: Acquired Immunodeficiency Syndrome; Amphotericin B; Antigens, Fungal; Histoplasma; Histoplasmosis; Humans; Least-Squares Analysis; Polysaccharides; Retrospective Studies

Topics: Acquired Immunodeficiency Syndrome; Amphotericin B; Drug Administration Schedule; Follow-Up Studies; Histoplasmosis; HIV-1; Humans

The epidemiological, clinical and therapeutical findings are described in a case of recurrent pulmonary histoplasmosis due to Histoplasma capsulatum. The patient, a bulldozer-operator, worked in Africa for a long period in extremely dusty conditions without any protection. Three different episodes of H. capsulatum pneumonia recurred during eighteen months after his return from Africa. A full dose treatment by Amphotericin B failed to eliminate disease recurrence on three occasions. The high concentration of airborne H. capsulatum spores inhaled could have been the main cause of the difficulty obtaining a rapid sterilization of the microorganism by Amphotericin B and disease recurrence. The late start of the treatment or the unexplained ability of some persons to develop repeated infections even with normal immunological parameters could be another explanation for the reported phenomenon.

Topics: Adult; Amphotericin B; Dust; Histoplasmosis; Humans; Ketoconazole; Male; Occupational Diseases; Pneumonia; Recurrence

Low-dose methotrexate sodium therapy used for nonmalignant disease has been associated with a variety of opportunistic infections with pathogens occurring in patients with defective cellular immunity. This article describes the unusual development of disseminated histoplasmosis as a probable complication of immunosuppression resulting from use of methotrexate.. We report the cases of three patients in whom disseminated histoplasmosis developed while receiving low-dose methotrexate therapy for psoriasis. Disease manifestations were unusually severe in two of the three patients. All three cases were disseminated, and two cases resulted in illnesses requiring intensive medical treatment. Each patient responded appropriately to antifungal treatment, although one patient has required long-term suppressive treatment because of persistent Histoplasma antigenuria. These cases illustrate the risk for opportunistic fungal infections in patients receiving low-dose methotrexate therapy for nonmalignant diseases.. Histoplasma should be added to the list of pathogens to be suspected in patients receiving such therapy.

Topics: Acute Disease; Adult; Amphotericin B; Female; Histoplasmosis; Humans; Immunity, Cellular; Male; Methotrexate; Opportunistic Infections; Psoriasis; Time Factors

These patients demonstrate the difficulty in arriving at the diagnosis of disseminated histoplasmosis. The diagnosis in two of the three patients also served as the initial AIDS case-defining opportunistic infection. In each of these patients, the clinical presentations were atypical and in only one patient was a positive exposure history elicited. Recurrent bowel obstruction was the presenting complaint in the first patient and the diagnosis was made only on pathologic exam of the resected small bowel. The second patient's diagnosis was made on biopsy of the colon via colonoscopy. The third patient's diagnosis also eluded an extensive FUO workup; he was diagnosed by bone marrow culture and silver stain of a mediastinal lymph node biopsy, despite serial negative serologic tests for histoplasmosis. The first two patients had significant gastrointestinal disease which is a relatively unusual manifestation for disseminated histoplasmosis. The third patient illustrates the limited diagnostic usefulness of serologic testing in AIDS patients and the continued usefulness of bone marrow analysis in an FUO evaluation. In conclusion, these case presentations demonstrate that disseminated histoplasmosis in patients with HIV infection can present with unusual manifestations, outside of the typical endemic arca, without a positive exposure history or positive serologic test, and may be the initial AIDS case-defining opportunistic infection in these patients. Consequently, a disseminated histoplasmosis should be considered in all AIDS patients with perplexing clinical presentations.

Topics: Acquired Immunodeficiency Syndrome; Adult; Aged; Amphotericin B; Female; Histoplasma; Histoplasmosis; Humans; Ketoconazole; Male; Maryland; Middle Aged; Opportunistic Infections

We have reported what we believe to be the first case of disseminated infection due to a multiply drug resistant strain of Nocardia asteroides in a patient with the acquired immunodeficiency syndrome and concomitant disseminated histoplasmosis. This strain of the organism fits a pattern of susceptibility that is rare among N asteroides isolates in general and has been called the type 5 pattern, described as a resistance to broad spectrum cephalosporins, ciprofloxacin, and all aminoglycosides except amikacin. The recognition of disease due to this group of organisms is especially important in patients with AIDS because sulfonamides, considered the drugs of choice for treatment of N asteroides infection, are associated with a high incidence of adverse effects in these patients.

Topics: Acquired Immunodeficiency Syndrome; Adult; Amphotericin B; Drug Resistance, Microbial; Histoplasmosis; Humans; Ketoconazole; Male; Nocardia asteroides; Nocardia Infections

Topics: Adult; Amphotericin B; Colonic Diseases; Female; Histoplasmosis; Humans; Job Syndrome; Recurrence

Colonic histoplasmosis is a rare entity. There have been four previous reported cases within the population of patients with human immunodeficiency virus (HIV) infection. Because of the increasing incidence of HIV infection within regions where histoplasmosis is endemic, this condition may become more common. Gastrointestinal histoplasmosis has protean clinical manifestations, and symptoms are often nonspecific. Any patient with HIV infection who has unexplained GI symptoms should undergo evaluation for possible histoplasmosis. Aggressive long-term amphotericin B therapy has been effective in HIV patients with histoplasmosis. Resection or diversion of symptomatic colonic strictures caused by histoplasmosis may be necessary in addition to medical therapy.

Topics: Acquired Immunodeficiency Syndrome; Adult; Amphotericin B; Colonic Diseases; Histoplasmosis; Humans; Intestinal Obstruction; Male; Middle Aged

Fungal infection has become increasingly more important in patients undergoing continuous ambulatory peritoneal dialysis. We report here a case of Histoplasma capsulatum infection in such a Hong Kong Chinese patient who presented with fever and peritonitis. Histoplasma capsulatum was isolated from the dialysis fluid and histoplasma antibody was detected in the serum. The patient responded to the combined treatment of fluconazole, 5-flurocytosine and amphotericin B. This is the first reported case of histoplasmosis in Hong Kong.

Topics: Amphotericin B; Fluconazole; Flucytosine; Histoplasma; Histoplasmosis; Humans; Kidney Failure, Chronic; Male; Middle Aged; Peritoneal Dialysis, Continuous Ambulatory

We identified and treated a solid, growing fungal tumor mass in a patient with disseminated histoplasmosis. Although the most commonly reported intraocular lesions from disseminated histoplasmosis are areas of inactive chorioretinal scars or areas of localized subretinal neovascular membrane formation, a focus of active fungal growth needs to be ruled out in all such cases. When a solid tumor mass is identified, the most effective way of preserving vision is with systemic antifungal therapy.

Topics: Amphotericin B; Eye Neoplasms; Histoplasmosis; Humans; Ketoconazole; Male; Middle Aged; Visual Acuity

In a thirty-year-old patient with AIDS the diagnosis of disseminated histoplasmosis was established via biopsy and culture. The patient had grown up in Argentina, where histoplasmosis is endemic. He had not been in an endemic region during the last two years anteceding the manifestation of systemic histoplasmosis. Accordingly, in patients with a progressive immunodeficiency syndrome, reactivation of a former (possibly inapparent) infection with Histoplasma capsulatum must be considered. Therapy with Amphotericin B lead to a remarkable improvement of clinical, laboratory and sonographic findings. Due to the fact that total eradication of H. capsulatum from the infected host cannot be achieved with any known drug regimen, a life-long follow-up therapy was begun. The patient showed no signs of relapse after a follow-up of 7 months.

Topics: Acquired Immunodeficiency Syndrome; Adult; Amphotericin B; Histoplasmosis; Humans; Male

A 65-year-old man with stage I testicular seminoma, treated with surgery and radiation, had fever of unknown origin, adrenal insufficiency, and an isolated perianal ulcer. Tissue diagnosis of disseminated histoplasmosis was established by biopsy of the perianal ulcer, an unusual cutaneous manifestation of the disease. Treatment with amphotericin B resulted in rapid clinical improvement and complete healing of the perianal ulcer.

Topics: Aged; Amphotericin B; Anus Diseases; Histoplasma; Histoplasmosis; Humans; Immune Tolerance; Male; Skin Ulcer

The amphotericin B lipid complex (ABLC), which is composed of amphotericin B and the phospholipids dimyristoyl phosphatidylcholine and dimyristoyl phosphatidylglycerol, was evaluated for its acute toxicity in mice and for its efficacy in mice infected with a variety of fungal pathogens. ABLC was markedly less toxic to mice when it was administered intravenously; it had a 50% lethal dose of greater than 40 mg/kg compared with a 50% lethal dose of 3 mg/kg for Fungizone, the desoxycholate form of amphotericin B. ABLC was efficacious against systemic infections in mice caused by Candida albicans, Candida species other than C. albicans, Cryptococcus neoformans, and Histoplasma capsulatum. ABLC was also efficacious in immunocompromised animals infected with C. albicans, Aspergillus fumigatus, and H. capsulatum. Against some infections, the efficacy of ABLC was comparable to that of Fungizone, while against other infections Fungizone was two- to fourfold more effective than ABLC. Against several infections. Fungizone could not be given at therapeutic levels because of intravenous toxicity. ABLC, with its reduced toxicity, could be administered at drug levels capable of giving a therapeutic response. ABLC should be of value in the treatment of severe fungal infections in humans.

Topics: Amphotericin B; Animals; Aspergillosis; Candidiasis; Cryptococcosis; Dimyristoylphosphatidylcholine; Excipients; Female; Histoplasmosis; Liposomes; Mice; Mycoses; Phosphatidylglycerols

Topics: Adult; Amphotericin B; Biopsy; Diagnosis, Differential; Histoplasmosis; Humans; Liver; Lung; Lung Diseases, Fungal; Male; Methods; Radiography

Three patients with generalized histoplasmosis and the acquired immunodeficiency syndrome (AIDS) are described. Symptoms of generalized histoplasmosis in patients with AIDS are not specific and concomitant opportunistic infections frequently occur. Two patients suffered from an infection by Mycobacterium tuberculosis, one patient had Pneumocystis carinii pneumonia, and one had cerebral toxoplasmosis. One patient had serological results positive for Histoplasma capsulatum. Two of the three patients showed rapid clinical improvement on amphotericin B but this was temporary and all patients died within 5 months.

Topics: Adult; Amphotericin B; Female; Histoplasmosis; HIV Infections; Humans; Male; Middle Aged

The history of 29-year-old male from Surinam with antibodies to HIV-1 and long-lasting fever, lymphadenopathy, pain in the right upper abdomen and a granulomatous hepatitis is described. The patient suffered from disseminated histoplasmosis, a fungal disease rare in The Netherlands, which is the indicator disease for the diagnosis of AIDS (CDC-IVCI). It is stressed that in seropositive patients coming from endemic areas, including Surinam, the possibility of this disease should be considered.

Topics: Acquired Immunodeficiency Syndrome; Adult; Amphotericin B; Drug Therapy, Combination; Histoplasma; Histoplasmosis; Humans; Male; Zidovudine

Fungal infections have become one of the major causes of death among immunocompromised patients, particularly patients with AIDS. Accurate and quick diagnosis is difficult; therefore, empirical therapy is often necessary. This scenario is complicated by the fact that most antifungal agents are toxic at the doses used or relatively ineffective against deep-seated mycoses. Because the population of AIDS patients is increasing, physicians will be faced more often with the management of systemic fungal infections. Despite the current bleak prognosis for these patients, several new antigen detection tests are being developed and triazole agents are proving to be effective and less toxic than their predecessors. Many cases of systemic mycoses do result in mortality, but appropriate treatment can both prolong life and improve its quality.

Topics: Acquired Immunodeficiency Syndrome; Amphotericin B; Antifungal Agents; Azoles; Candidiasis; Cryptococcosis; Flucytosine; Histoplasmosis; Humans; Meningitis; Mycoses

A 2-year-old Trakehner filly with pulmonary histoplasmosis is presented. Clinical signs included weight loss, intermittent fever, dyspnea and depression. Diagnosis was based on thoracic radiography, transtracheal wash cytology and lung aspirate cytology. A 5-week regimen of Amphotercin-B administered intravenously resulted in clinical recovery and return of the animal to normal activity. A brief review of histoplasmosis in man and animal is included.

Topics: Amphotericin B; Animals; Biopsy, Needle; Female; Histoplasma; Histoplasmosis; Horse Diseases; Horses; Lung; Lung Diseases, Fungal

The antifungal activities of amphotericin B and two triazoles, Sch 39304 and fluconazole, were tested against Histoplasma capsulatum. In this study Sch 39304 compared favorably with amphotericin B in treating histoplasmosis in normal and leukopenic mice, whereas fluconazole was much less active. The differences in the efficacies of the triazoles appeared to be due to differences in their pharmacokinetics and the dosage schedule that was used. For amphotericin B there was a good correlation between in vitro and in vivo efficacy, but this was not true of the triazole derivatives. These results further demonstrate that, with the methods used in this study, in vitro susceptibility testing of triazoles may not be predictive of in vivo activity against isolates of H. capsulatum.

Topics: Amphotericin B; Animals; Antifungal Agents; Female; Fluconazole; Histoplasma; Histoplasmosis; Leukopenia; Mice; Microbial Sensitivity Tests; Triazoles

Disseminated histoplasmosis was diagnosed in 36 (4%) of 980 patients with AIDS seen at Parkland Memorial Hospital in Dallas, Texas before September 30, 1989. Diagnostic sensitivity of blood culture plus examination of peripheral smear was 88%; sensitivity of bone marrow aspiration and blood culture was 80%. Median CD4 lymphocyte count at diagnosis was 33/cu mm. Median actuarial survival from the date histoplasmosis was diagnosed was 188 days. Thirteen (36%) of the 36 patients died before adequate antifungal therapy could be administered, while 13 survived long enough to receive 1,500 mg of amphotericin B; actuarial survival of the latter group from the date 1,500 mg of amphotericin B had been infused was 47% at 1 year. The substantial early mortality of AIDS-associated disseminated histoplasmosis and the modestly encouraging survival of those who were diagnosed in time to receive adequate therapy raise the issues of surveillance, prophylaxis, and empiric therapy for this infection in selected HIV-positive patients.

Topics: Acquired Immunodeficiency Syndrome; Actuarial Analysis; Adult; Amphotericin B; Cryptococcosis; Evaluation Studies as Topic; Female; Histoplasma; Histoplasmosis; Humans; Ketoconazole; Male; Middle Aged; Retrospective Studies; Texas; Time Factors

Disseminated histoplasmosis is an increasingly important opportunistic infection in patients with the acquired immunodeficiency syndrome (AIDS). We report the first case of histoplasmosis as a cause of pleural effusion in a patient with AIDS. Recognition of the typical intracellular yeast on a Wright-Giemsa stained smear of the pleural fluid cells allowed prompt initiation of amphotericin B.

Topics: Acquired Immunodeficiency Syndrome; Adult; Amphotericin B; Histoplasma; Histoplasmosis; Humans; Male; Opportunistic Infections; Pleural Effusion

A comparative study between itraconazole, ketoconazole and amphotericin B in the treatment of experimental histoplasmosis in hamsters was carried out. Seventy five animals were inoculated intracardiacally with the yeast-phase of Histoplasma capsulatum. They were divided in 5 groups: 1) treated with itraconazole by gavage (g) at a daily dose of 16 mg/kg; 2) treated with ketoconazole by (g) at a daily dose of 80 mg/kg; 3) treated with amphotericin B intraperitoneally (i.p.) at 6 mg/kg every other day; 4) control animals receiving distilled water i.p. and 5) control animals receiving P.E.G. 200 by (g). All the treatments were started one week after the challenge inoculation and they were given for 21 days. The results were evaluated by autopsy of all the animals one week after the end of the treatments. The following determinations were taken into account: microscopic examinations of spleen, liver and lungs and cultures of the spleen with determination of colony forming units/g. All the antifungal drugs used in this study were able to cause negative microscopic examinations of the liver, spleen and lungs; but only amphotericin B produced culture negative results. Itraconazole and ketoconazole presented 66% and 86% of positive cultures respectively, nevertheless the C.F.U. were lower than those obtained in control groups. In these experimental conditions amphotericin B seems to be more active than the azolic compounds and itraconazole is slightly superior to ketoconazole at a lower dose.

Topics: Amphotericin B; Animals; Antifungal Agents; Colony Count, Microbial; Cricetinae; Female; Histoplasma; Histoplasmosis; Itraconazole; Ketoconazole; Liver; Lung; Male; Mesocricetus; Spleen

We present the first case of disseminated histoplasmosis in an AIDS patient in Europe, a 33-year-old Danish homosexual man, and recommend a detailed travel history in HIV-positive patients presenting with fever, weight loss and organomegaly. In Scandinavia disseminated histoplasmosis is rare but should be kept in mind as the disease is a major opportunistic infection in patients with AIDS. Treatment with amphotericin B followed by fluconazole was effective.

Topics: Acquired Immunodeficiency Syndrome; Adult; Amphotericin B; Denmark; Fluconazole; Histiocytes; Histoplasma; Histoplasmosis; Homosexuality; Humans; Immunity, Cellular; Male; Microscopy, Electron

This report is a description of two Ohio cases of acquired immunodeficiency syndrome (AIDS) and disseminated histoplasmosis, with discussion of diagnosis and treatment of this combination. The patient in case 1 developed disseminated histoplasmosis as the first significant symptomatic medical condition of his life. The patient in case 2 presented with severe pharyngitis, but without signs or symptoms specific to the lungs. Amphotericin B alone does not eradicate histoplasmosis in an AIDS patient. The best therapy at present is a full course of amphotericin B followed by a lifetime regimen of ketoconazole to prevent relapse. Family physicians in the District of Columbia, Texas, Maryland, Louisiana, Missouri, Illinois, Arizona, and Puerto Rico should be particularly vigilant in looking for the combination of these two diseases.

Topics: Acquired Immunodeficiency Syndrome; Adult; Amphotericin B; Histoplasmosis; Humans; Ketoconazole; Male; Middle Aged

The clinical and histopathological features and the therapeutic response of a pustular eruption occurring in a homosexual man with Acquired Immune Deficiency Syndrome (AIDS) is reported. The rare cutaneous presentation consisted of mostly circumscribed, tender, tense pustules, associated with erythema, confined to the face and neck. Biopsy of these lesions revealed intracellular round to oval bodies surrounded by a clear space, consistent with Histoplasma capsulatum. Prompt resolution was observed after initiation of amphotericin B therapy. Clinicians are alerted to the occurrence of exotic presentations of this entity and emphasis is given to the need for skin biopsy and culture to avoid delay in diagnosis and failure to initiate appropriate therapy.

Topics: Acquired Immunodeficiency Syndrome; Adult; Amphotericin B; Histoplasmosis; Humans; Male; Opportunistic Infections

Topics: Acquired Immunodeficiency Syndrome; Adult; Amphotericin B; Histoplasmosis; Humans; Injections, Intravenous; Male; Skin; Substance-Related Disorders

Progressive disseminated histoplasmosis (PDH) has now been described in acquired immunodeficiency syndrome (AIDS) patients from areas both endemic and nonendemic for histoplasmosis. We review the clinical presentation, diagnosis, and therapy of PDH in patients with AIDS by comparing 64 patients from our series collected retrospectively from Houston and the surrounding area with the case summaries of 61 patients reported in the medical literature. PDH occurred as the first manifestation of AIDS half of the time. Fever, weight loss, enlargement of the liver, spleen, or lymph nodes, and anemia were the most common clinical symptoms and signs. Pulmonary symptoms were less common. The chest roentgenogram showed diffuse interstitial infiltrates in slightly more than half of the patients. Bone marrow biopsy and culture, examination and culture of pulmonary tissue and secretions, and blood culture were the most common initial means of establishing a diagnosis. Ketoconazole alone was ineffective in the majority of cases. Patients treated with amphotericin B (AMB) in a dose of at least 30 mg/kg experienced a significantly longer period of follow-up than those treated with less AMB. However, relapses were observed in four of 16 patients (25%) receiving at least 30 mg/kg of AMB followed by ketoconazole suppression. It appears that long-term suppression with 50 to 100 mg of AMB weekly, after completion of initial therapy, has the best chance of maintaining a satisfactory functional status.

Topics: Acquired Immunodeficiency Syndrome; Amphotericin B; Biopsy; Histoplasma; Histoplasmosis; Humans; Ketoconazole; Lung; Radiography

Disseminated histoplasmosis is a serious and often rapidly progressive, opportunistic infection in patients with acquired immunodeficiency syndrome (AIDS), supporting the importance of rapid diagnostic tests. We investigated Histoplasma capsulatum polysaccharide antigen (HPA) detection, a promising new method for rapid diagnosis of histoplasmosis.. Sixty-one cases of disseminated histoplasmosis in patients with AIDS form the basis of this report. Control cases were patients with AIDS who had other opportunistic infections and whose cultures were negative for H. capsulatum. A slightly modified radioimmunoassay procedure was used to measure the levels of HPA in urine and blood specimens.. High levels of HPA were detected in the urine of 59 of 61 (96.7%) and the blood of 37 of 47 (78.7%) patients with AIDS complicated by disseminated histoplasmosis. Treatment with amphotericin B reduced levels of HPA in the urine in 19 of 21 (90.5%) and the serum of all 10 patients tested. HPA levels increased in the urine in all eight and in the serum in all five patients with culture-proven relapse.. In conclusion, HPA detection offers a rapid method for diagnosing disseminated histoplasmosis. Additional experience is required to establish the role of this test in monitoring the effects of treatment and in identifying relapse in patients with AIDS.

Topics: Acquired Immunodeficiency Syndrome; Amphotericin B; Antigens, Fungal; Blood; Histoplasma; Histoplasmosis; Humans; Opportunistic Infections; Polysaccharides; Radioimmunoassay; Recurrence

To assess the efficacy and toxicity of long-term maintenance amphotericin B therapy in preventing relapses after treatment in patients with the acquired immunodeficiency syndrome (AIDS) and disseminated histoplasmosis.. Open, nonrandomized pilot study.. Three private, university-affiliated community hospitals.. We studied 22 consecutive patients with disseminated histoplasmosis and human immunodeficiency virus (HIV) infection. Sixteen patients completed the study, 5 patients died before completing the initial intensive phase of treatment, and 1 patient received a different treatment regimen.. Seven patients were treated with an initial intensive course of 1000 mg of amphotericin B, followed by weekly infusions of 50 to 80 mg until a cumulative dose of 2000 mg was attained; biweekly infusions of 50 to 80 mg were then continued indefinitely. Nine patients received an initial amphotericin B course of 2000 mg followed by weekly infusions of 80 mg.. Of the 7 patients in the 1000-mg intensive regimen group, 6 patients have survived without clinical or laboratory evidence of a histoplasmosis relapse, and 1 died of unrelated causes. Of the 9 patients in the 2000-mg intensive regimen group, 7 patients have survived, 1 patient died of a histoplasmosis relapse, and 1 patient died of other causes. Thus, 13 of 14 patients (93%) who did not die of other causes remained relapse-free. The median follow-up period was 14 months (range, 2 to 23 months). No apparent differences in outcome were observed between patients treated with weekly maintenance regimens and those treated with biweekly maintenance regimens. Sixty-three percent of patients developed intravascular device-related complications.. Long-term, intermittent maintenance amphotericin B therapy in HIV-infected patients with disseminated histoplasmosis is well tolerated and is highly effective in suppressing relapses after treatment.

Topics: Acquired Immunodeficiency Syndrome; Adult; Amphotericin B; Catheters, Indwelling; Drug Administration Schedule; Female; Histoplasmosis; Humans; Male; Middle Aged; Opportunistic Infections; Pilot Projects; Recurrence

Ketoconazole appears to be a safe drug in the treatment of chronic cavitary histoplasmosis. Primary failure and relapse have been described, requiring amphotericin B, even after long therapy with ketoconazole. Four typical cases are presented. We caution about such potential failures and stress the importance of close observation of patients begun on therapy with ketoconazole for chronic cavitary histoplasmosis.

Topics: Administration, Oral; Amphotericin B; Histoplasmosis; Humans; Ketoconazole; Lung Diseases, Fungal; Male; Middle Aged; Recurrence; Time Factors

Three cases are reported of patients with the Acquired Immune Deficiency Syndrome (AIDS) and cutaneous histoplasmosis. Their initial presentation was that of a generalised maculopapular rash. Two patients were bisexual males and the third was an unmarried female. The range of opportunistic infections seen in AIDS patients in Trinidad is mentioned and clinicians are alerted to the fact that in areas endemic for Histoplasma capsulatum maculopapular rash in patients with AIDS may suggest disseminated histoplasmosis. The value of skin biopsy is mentioned.

Topics: Acquired Immunodeficiency Syndrome; Adult; Amphotericin B; Biopsy; Dermatomycoses; Enzyme-Linked Immunosorbent Assay; Female; Histoplasmosis; Humans; Ketoconazole; Male; Middle Aged; Staining and Labeling; Trinidad and Tobago

Topics: Adrenal Glands; Aged; Amphotericin B; Biopsy; Histoplasmosis; Humans; Indonesia; Ketoconazole; Male; Netherlands; Tomography, X-Ray Computed

Progressive disseminated histoplasmosis is now diagnosed frequently in patients with the acquired immunodeficiency syndrome (AIDS) living in the central United States. Previous review articles of AIDS have failed to mention this infection. Herein, we describe 48 AIDS patients with progressive disseminated histoplasmosis in an effort to better understand the clinical presentation and diagnosis of the condition in this setting and to assess the efficacy of antifungal chemotherapy.. In the Houston metropolitan area, there were 66 cases of progressive disseminated histoplasmosis among 1,300 confirmed cases of AIDS from January 1983 to July 1987. Of AIDS patients in East Texas with histoplasmosis, 16 patients were available for follow-up by one of us, and the histories of 32 were obtained by examination of hospital charts and physician records.. Fever, weight loss, and splenomegaly were the most common presenting signs and symptoms, occurring in 81, 52, and 31 percent, respectively. One-third of the patients had hematologic abnormalities. Infiltrates on chest roentgenograms were observed in 52 percent. Progressive disseminated histoplasmosis was the initial manifestation of AIDS in almost three-fourths of our patients. Biopsy and culture of the bone marrow established the diagnosis of progressive disseminated histoplasmosis in 69 percent. Clinical or autopsy proof of relapse occurred in three patients despite an initial course of more than 2 g of amphotericin B chemotherapy followed by ketoconazole suppression.. Progressive disseminated histoplasmosis is often the first sign of immunodeficiency in patients with AIDS, and the diagnosis of this condition is most often established by bone marrow biopsy and culture. Because of the permanence of the immunodeficient state in these patients, progressive disseminated histoplasmosis is resistant to treatment.

Topics: Acquired Immunodeficiency Syndrome; Adult; Amphotericin B; Female; Histoplasmosis; Humans; Ketoconazole; Male; Middle Aged

Involvement of the central nervous system (CNS) by Histoplasma capsulatum is a rare event. It is usually not included in the differential diagnosis of CNS lesions in patients with acquired immunodeficiency syndrome (AIDS). Herein are described four patients with AIDS and progressive disseminated histoplasmosis who had CNS involvement. Histoplasmosis in the CNS may produce meningitis, single or multiple brain abscesses, and may present with either a clinical picture of obtundation or a deteriorating space-occupying CNS lesion. Three of the four patients were treated with amphotericin B and had initial clinical response, but ultimately, all experienced a relapse and died from their infection.

Topics: Acquired Immunodeficiency Syndrome; Adult; Amphotericin B; Central Nervous System Diseases; Histoplasmosis; Humans; Male

A widespread maculo-papular cutaneous rash appeared on a HIV-positive young bisexual Cambodian man. He was treated for Mycobacterium tuberculosis and Pneumocystis carinii infections. He had been residing in France for seven years. Histology showed, within the dermis, abundant extracellular and intramacrophagic yeast-like organisms suggestive of histoplasmosis. Cultured specimens produced a growth of colonies after three weeks on Sabouraud 4 p. 100 dextrose agar at 25 degrees C. Numerous macroconidia were found which made the species diagnosis of Histoplasma capsulatum possible. Despite initiation of therapy with amphotericin B the patient died. Cutaneous involvement with or without specific features is uncommon in disseminated histoplasmosis. The specific cutaneous lesions are protean. They rarely are the presenting sign of initial infection. Disseminated histoplasmosis has a poor prognosis in acquired immunodeficiency syndrome: amphotericin B is not curative. Maintenance suppressive therapy with ketoconazole has been recommended following amphotericin B completion, although break-through has been reported.

Topics: Acquired Immunodeficiency Syndrome; Adult; Amphotericin B; Biopsy; Dermatomycoses; Histoplasmosis; Humans; Male; Prognosis

Fluconazole (UK-49,858) was compared with amphotericin B in treating histoplasmosis in female AKR mice immunosuppressed with either cyclophosphamide or cortisone. Both drugs protected animals from a lethal challenge with Histoplasma capsulatum, but neither regimen resulted in cures since viable organisms were cultured from spleens of survivors.

Topics: Amphotericin B; Animals; Antifungal Agents; Cyclophosphamide; Female; Fluconazole; Histoplasmosis; Hydrocortisone; Immunosuppression Therapy; Mice; Mice, Inbred AKR; Triazoles

Topics: Amphotericin B; Animals; Antifungal Agents; Culture Techniques; Fluconazole; Histoplasma; Histoplasmosis; Ketoconazole; Male; Mice; Triazoles

Topics: Amphotericin B; Brain Diseases; Histoplasmosis; Humans; Male; Middle Aged

Topics: Adult; Amphotericin B; Candidiasis; Candidiasis, Chronic Mucocutaneous; Child; Female; Histoplasmosis; Humans; Ketoconazole; Male; Recurrence

A 41-year-old man was admitted for evaluation of hemoptysis, dysphagia, and pleuritic chest pain associated with a mediastinal mass. Esophagography demonstrated a fistula between the mass and the esophagus. Results of histoplasmosis complement fixation serologic testing suggested an active infection. A methenamine silver stain of a lymph node obtained at mediastinoscopy revealed Histoplasmosis capsulatum. The patient was successfully treated with amphotericin B. This is believed to be the first reported case of an esophageal fistula as a complication of mediastinal histoplasmosis successfully treated with amphotericin B.

Topics: Adult; Amphotericin B; Ceftriaxone; Drug Therapy, Combination; Esophageal Fistula; Hemoptysis; Histoplasmosis; Humans; Male; Mediastinal Diseases; Metronidazole

The antifungal activity of UK 49,858, a difluorophenyl bis-triazole derivative, was evaluated in vitro against seven strains of Histoplasma capsulatum and in vivo in AKR and C57BL/6 murine models of histoplasmosis. UK 49,858 had a lower toxicity for AKR and C57BL/6 mice than amphotericin B did. The therapeutic index of UK 49,858 was 4.3 for AKR mice and 7.1 for C57BL/6; with amphotericin B it was 2 for both mouse strains. Given orally, UK 49,858 compared favorably with amphotericin B given intraperitoneally in either AKR or C57BL/6 mice infected with H. capsulatum.

Topics: Amphotericin B; Animals; Fluconazole; Histoplasma; Histoplasmosis; In Vitro Techniques; Mice; Microbial Sensitivity Tests; Triazoles

Disseminated histoplasmosis was diagnosed in a 10-year-old dog suspected of having hepatic carcinoma. Clinical abnormalities included diffuse hepatomegaly, gastrointestinal bleeding, thoracic and abdominal effusion, anemia, leukocytosis, and thrombocytopenia. Histoplasmosis characteristically is a disease of the mononuclear phagocyte system, but in this case was diagnosed by finding Histoplasma capsulatum organisms in neutrophils on the blood smear.

Topics: Adrenal Insufficiency; Amphotericin B; Animals; Dog Diseases; Dogs; Female; Fluorescent Antibody Technique; Histoplasma; Histoplasmosis; Neutrophils

Topics: Amphotericin B; Child; Histoplasmosis; Humans; Ketoconazole; Male

Five patients with disseminated histoplasmosis are reviewed. Four of five had the acquired immune deficiency syndrome (AIDS) and one was receiving steroid therapy. All were immigrants to the United States from Puerto Rico, the Dominican Republic, or South America, and none had a history of travel to regions of the United States where Histoplasma is endemic. Histoplasma complement fixation titers to mycelial antigen were not demonstrable in three of three patients in whom they were measured. Of the four patients with AIDS, Histoplasma capsulatum was isolated from bone marrow aspirates in two patients and from lymph node and liver biopsy specimens in one patient each. One of the bone marrow specimens showed organisms on Gomori-methenamine silver stain. In the other three cases, results of staining were falsely negative and diagnosis awaited culture results weeks later. Amphotericin B therapy resulted in rapid clinical improvement in the three patients that were treated. Intravenous therapy was followed by treatment with oral ketoconazole. Follow-up has not been long enough to determine the ultimate efficacy of ketoconazole. Disseminated histoplasmosis should be considered in all patients from the Caribbean or South America with AIDS or who are receiving immunosuppressive therapy.

Topics: Acquired Immunodeficiency Syndrome; Adult; Amphotericin B; Drug Therapy, Combination; Ethnicity; Female; Histoplasma; Histoplasmosis; Humans; Ketoconazole; Male; Middle Aged

Histoplasmosis is a rare disease in India. We are reporting this disease in a middle-aged non-Caucasian male who has never travelled outside India. Successful treatment was achieved with the nephrotoxic anti-mycotic drug (Amphotericin B), despite a pre-existing renal impairment.

Topics: Adult; Amphotericin B; Histoplasmosis; Humans; India; Male; Oropharynx; Pharyngeal Diseases

A case of septic, histoplasmal monoarthritis of the knee in a leukaemic patient is described. Ketoconazole therapy failed to eliminate the infection, but after histoplasmosis was diagnosed prolonged therapy with amphotericin B was curative.

Topics: Adult; Amphotericin B; Arthritis, Infectious; Histoplasmosis; Humans; Knee Joint; Leukemia, Myeloid, Acute; Male

This report describes the experience with disseminated histoplasmosis in seven of 15 patients with the acquired immune deficiency syndrome (AIDS) diagnosed in Indianapolis since 1981. Three were homosexual, two were intravenous drug addicts, one was the spouse of another patient with AIDS and disseminated histoplasmosis, and the seventh was a hemophiliac. Six had associated infections: candidiasis in three, Pneumocystis carinii pneumonia, recurrent mucocutaneous herpes simplex infection, and disseminated Mycobacterium avium infection in two each, and disseminated infection with an unidentified mycobacterium in one. Clinical diseases suggested sepsis in four. Histoplasma fungemia occurred in five, but the diagnosis was established first by visualization of organisms in blood or bone marrow in three. Results of Histoplasma serologic tests were positive in each. Three died before receiving 50 mg of amphotericin B, three had prompt improvement with amphotericin B, and one was treated with ketoconazole to prevent dissemination. However, two of the three patients treated with amphotericin B had relapses after a 35 mg/kg course, and the third died within a month following therapy. Disseminated histoplasmosis is a major opportunistic infection in patients with AIDS from endemic areas. AIDS should be strongly considered in otherwise healthy persons with disseminated histoplasmosis, especially if risk factors for AIDS are present. Amphotericin B is not curative in these patients.

Topics: Acquired Immunodeficiency Syndrome; Adult; Amphotericin B; Candidiasis; Female; Herpes Simplex; Histoplasmosis; Homosexuality; Humans; Ketoconazole; Male; Mycobacterium avium; Mycobacterium Infections; Pneumonia, Pneumocystis; Tuberculosis

We have reported the first case of successful treatment of disseminated histoplasmosis in a renal allograft recipient using a short course (14 days) of amphotericin B in combination with prolonged therapy (161 days) with ketoconazole. This regimen should decrease the risk of antibiotic induced nephrotoxicity, but it requires further study. Five days of treatment with ketoconazole alone was ineffective in our patient's infection. Our protocol might not be as efficacious in patients who are more profoundly immunocompromised, eg, bone marrow allograft recipients. Because relapse of histoplasmosis may occur as long as nine years after treatment, immunocompromised patients being treated with ketoconazole must have close long-term clinical follow-up.

Topics: Acute Disease; Adult; Amphotericin B; Drug Combinations; Follow-Up Studies; Histoplasmosis; Humans; Immunosuppression Therapy; Ketoconazole; Kidney Transplantation; Male; Postoperative Complications

Twelve patients with hematologic malignancies complicated by fungal infections were treated with liposomal amphotericin B (L-AmpB). Nine patients were granulocytopenic; the three additional patients with normal granulocyte counts were immunosuppressed. All patients had biopsy findings or cultural evidence of the progression of their fungal infection while being treated with conventional amphotericin B. Doses of 0.8-1.0 mg/kg of L-AmpB were administered intravenously every 24-72 hr. Three patients had a complete remission, five had a partial remission, and four showed no improvements. A total of 161 doses of L-AmpB were administered. Fever and chills occurred on seven occasions. No hematologic or blood chemistry abnormalities related to L-AmpB treatment were observed.

Topics: Adolescent; Adult; Amphotericin B; Aspergillosis; Candidiasis; Female; Histoplasmosis; Humans; Leukemia; Liposomes; Lymphoma; Male; Middle Aged; Mucormycosis; Mycoses; Neoplasms; Sarcoma, Kaposi

N-D-Ornithyl amphotericin B methyl ester (N-D-ornithyl AmE) has a lower toxicity for animals than does amphotericin B (AmB), and peak serum levels can be achieved that are fourfold higher than those obtained with an equivalent dose of AmB. However, N-D-ornithyl AmE has one-fourth the in vitro activity and between one-fifth and one-eighth the in vivo activity of AmB. N-D-ornithyl AmE and the corresponding lysyl derivative also lack the immunoadjuvant effects of AmB.

Topics: Adjuvants, Immunologic; Amphotericin B; Animals; Antifungal Agents; Female; Histoplasma; Histoplasmosis; Mice; Mice, Inbred AKR; Microbial Sensitivity Tests

Topics: Adult; Amphotericin B; Histoplasmosis; Humans; Laryngeal Diseases; Male

Hematogenous (disseminated) histoplasmosis occurred in 31 of 4158 children with cancer or immune deficiency disorders. Approximately half of the 31 patients had pulmonary lesions, reacted to the histoplasmin skin test, and generated complement-fixing antibodies to Histoplasma capsulatum. In a comparative study delayed hypersensitivity to histoplasmin was demonstrated in 36 (5.7%) of 634 children at the time of diagnosis of cancer. Patients with cancer who were reactive to histoplasmin before treatment were at no greater, and possibly less, risk for hematogenous histoplasmosis than were nonreactors. All of the 27 patients who received treatment for greater than 1 day recovered; three had recurrences that responded to treatment.

Topics: Adolescent; Amphotericin B; Antineoplastic Agents; Child; Child, Preschool; Female; Histoplasmosis; Humans; Immunosuppression Therapy; Infant; Ketoconazole; Male; Risk

Disseminated histoplasmosis developed in a previously healthy man as the initial manifestation of the acquired immune deficiency syndrome. Following apparently successful therapy with intravenous amphotericin B, he presented two months later with a subacute pneumonitis syndrome diagnosed by bronchoscopy as Pneumocystis carinii pneumonia. He showed response to intravenous trimethoprim/sulfamethoxazole with resolution of his symptoms and clearing of chest radiographic findings. While he was receiving antibiotics, oral candidiasis developed and has persisted for more than two months despite topical therapy and discontinuation of all antibiotics.

Topics: Acquired Immunodeficiency Syndrome; Adult; Amphotericin B; Candidiasis, Oral; Histoplasmosis; Humans; Lymphocytes; Male; Pneumonia; Pneumonia, Pneumocystis; Pseudomonas Infections

Topics: Acquired Immunodeficiency Syndrome; Amphotericin B; Histoplasmosis; Humans; Immunity, Cellular

A case of chronic disseminated histoplasmosis, presenting 16 years after returning to Scotland from West Bengal, is reported. The difficulties and pitfalls in diagnosis and management are emphasised.

Topics: Aged; Amphotericin B; Diagnosis, Differential; Histoplasmosis; Humans; India; Male; Travel

Topics: Amphotericin B; Histoplasmosis; Humans

Granulomatous diseases caused by infectious agents are being seen more frequently than before. Infection with Histoplasma capsulatum is one such granulomatous disease. This condition may have protean manifestations, with involvement of the larynx of particular interest to the Otolaryngologist. Histoplasmosis of the larynx may present difficult diagnostic problems and may closely mimic carcinoma. A case of histoplasmosis of the larynx treated at the University of Cincinnati Medical Center is presented and used to highlight the mode of presentation and the management of this particular disease. The clinical presentation of histoplasmosis is discussed with emphasis on involvement of the upper aerodigestive tract. The diagnostic tests of practical value are outlined. Amphotericin B is the treatment for this disease entity.

Topics: Aged; Amphotericin B; Diagnosis, Differential; Histoplasmosis; Humans; Laryngeal Diseases; Male

Fungal endarteritis resulting from progressive disseminated histoplasmosis may cause arterial aneurysms, or lead to infection of pre-existing aneurysms. Three patients with Histoplasma capsulatum infections of abdominal aortic aneurysms are reported. All had previous disseminated histoplasmosis and atherosclerotic peripheral vascular disease. All were considered cured of systemic infection when their aneurysms were discovered. Atherosclerotic vascular lesions may become infected during the course of systemic fungal disease and may serve as a haven for viable organisms in patients whose dissemination recurs despite seemingly adequate antifungal therapy. In treating these patients, resection of all infected arterial tissue, revascularization through uninfected tissues, and long-term antimicrobial therapy are recommended.

Topics: Adult; Aged; Amphotericin B; Aorta, Abdominal; Aortic Aneurysm; Arteriosclerosis; Female; Histoplasmosis; Humans; Imidazoles; Ketoconazole; Male; Middle Aged; Piperazines

During two large outbreaks, ten episodes of histoplasmosis were documented in eight renal allograft recipients. Another episode occurred before the outbreaks. Associated infections with cytomegalovirus occurred in five patients and may have further impaired cellular immunity. Prolonged fever was the predominant clinical finding; and dissemination was observed in seven of our nine patients, including three with meningitis. Special stains of tissues and the histoplasmal complement fixation test provided useful diagnostic information rapidly, while cultures were eventually positive in seven patients. Treatment with amphotericin B resulted in prompt clinical improvement in all patients, but relapse occurred in two patients one year following therapy.

Topics: Adult; Amphotericin B; Complement Fixation Tests; Cytomegalovirus Infections; Disease Outbreaks; Female; Histoplasma; Histoplasmosis; Humans; Indiana; Kidney; Kidney Transplantation; Male; Middle Aged; Postoperative Complications; Serologic Tests; Time Factors; Urban Population

Clinical and laboratory features have been reviewed in 66 episodes of disseminated histoplasmosis that occurred during two large urban outbreaks in Indianapolis. Immunosuppression, age greater than 54 years, and presence of other serious underlying illnesses predisposed to the disseminated form of the disease; only 21% of patients lacked one of these risk factors. Central nervous system findings, splenomegaly, hepatomegaly, and lymphopenia suggested disseminated disease but were present in only about one-third of patients. Miliary or diffuse pulmonary infiltrates also suggested dissemination and were noted in about one-third of patients, while mediastinal lymphadenopathy was present in only 17%. Histoplasmal serologic tests, positive in 90% of patients, provided useful diagnostic clues. The diagnosis could be confirmed by culture in 88% of patients, and special stains were positive in about two-thirds. Although 10% of patients recovered without treatment, 11 patients (17%) died because of failure to suspect the diagnosis and initiate therapy promptly. Amphotericin B was effective in all patients receiving at least 500 mg, but relapse occurred if the total dose was less than 30 mg/kg. Ketoconazole appeared effective in non-immunosuppressed patients but not in those with underlying immunosuppression; however, a controlled trial comparing ketoconazole and amphotericin B is required to establish the role of this new fungistatic oral agent.

Topics: Adolescent; Adult; Aged; Amphotericin B; Child; Child, Preschool; Disease Outbreaks; Histoplasmosis; Humans; Immune Tolerance; Indiana; Ketoconazole; Middle Aged; Radiography; Urban Population

A series of clinical studies of histoplasmosis based on demonstrations of etiology led to descriptions of chronic pulmonary histoplasmosis, the principal type in adults, and amphotericin B as an effective therapy. A participant recreates the atmosphere of discovery during the contributions of a team comprising a mycologist, a surgeon and two physicians using cultures of excised lung and sputum to clearly identify cases of chronic pulmonary histoplasmosis. Subsequently cooperating physicians in several V.A. Hospitals carried out randomized studies of treatment, dosage, and side effects that established Amphotericin B as the sole curative therapy for chronic pulmonary histoplasmosis for 20 years.

Topics: Amphotericin B; Drug Evaluation; Histoplasmosis; History, 20th Century; Hospitals, Veterans; Humans; Lung Diseases, Fungal; Tennessee; United States; United States Department of Veterans Affairs

Rheumatologic manifestations were noted in 24 (6.3%) of 381 patients with symptomatic histoplasmosis who were seen during a recent epidemic in Indianapolis. Typically, these patients had rapidly additive, rather than migratory, arthritis or arthralgia, which was symmetric in 50%. Ten patients had oligo- or monarticular disease. Knees, ankles, wrists, and small joints of the hand were the most common sites affected. Eleven patients had erythema nodosum. The rheumatologic manifestations were usually mild and, in all but 2 patients, resolved without treatment or with a brief course of nonsteroidal antiinflammatory drugs. The joint disease in patients with erythema nodosum was essentially the same as that seen in patients who did not develop skin lesions. However, those without erythema nodosum more frequently exhibited systemic features, e.g., chills, fever, anemia, and elevated erythrocyte sedimentation rates. Rheumatologic complaints led 16 of the patients in this series (67%) to seek medical attention, and in 3 patients they constituted the sole presenting complaint.

Topics: Adolescent; Adult; Amphotericin B; Anti-Inflammatory Agents; Arthritis; Child; Erythema Nodosum; Female; Histoplasmosis; Humans; Indiana; Male; Middle Aged; Prednisone

Topics: Amphotericin B; Histoplasmosis; Humans; Male; Middle Aged

An immunocompromised patient with severe hypoxemia was found by transbronchial lung biopsy to have Torulopsis glabrata as the sole pathogen in lung. An antibody response to this organism was demonstrated, confirming its role as a pathogen and indicating a role for serodiagnosis of T glabrata infection.

Topics: Adult; Amphotericin B; Candida; Drug Therapy, Combination; Histoplasmosis; Humans; Immunosuppression Therapy; Kidney Failure, Chronic; Lung Diseases, Fungal; Male; Pneumonia; Rifampin

A 6-yr-old boy with systemic histoplasmosis received intravenous amphotericin B for two months as an outpatient utilizing techniques developed for home parenteral nutrition. The therapy was administered on alternate days in the emergency room by nurses trained to use aseptic technique. No complications occurred. The merits of this technique include avoidance of prolonged hospitalization with its high cost and risk of nosocomial infection and better patient acceptance with the patient living at home and continuing many of his usual activities.

Topics: Ambulatory Care; Amphotericin B; Catheterization; Catheters, Indwelling; Child; Histoplasmosis; Humans; Infusions, Parenteral; Jugular Veins; Male; Vena Cava, Superior

Topics: Amphotericin B; Bone Neoplasms; Child, Preschool; Diphosphonates; Histoplasmosis; Humans; Kidney; Kidney Tubular Necrosis, Acute; Male; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate

Progressive disseminated histoplasmosis (PDH) is a rare consequence of infection with Histoplasmia capsulatum. Usually fatal if untreated, PDH generally is cured by appropriate amphotericin B treatment. Of 31 persons with uncomplicated PDH treated with amphotericin B, we found that relapse occurred in five (16%) after an interval of up to nine years after initial therapy. Review of these five cases and 31 additional relapsing cases from the literature indicates that fungal endocarditis or endarteritis without surgical treatment, underlying lymphoreticular neoplasm, and amphotericin B dosage of less than 2 g appear to be associated with relapse of PDH.

Topics: Aged; Amphotericin B; Antifungal Agents; Endocarditis; Histoplasmosis; Humans; Imidazoles; Ketoconazole; Leukemia, Lymphoid; Lymphoma, Non-Hodgkin; Male; Middle Aged; Piperazines; Recurrence; Retrospective Studies; Time Factors

Topics: Acute Disease; Adolescent; Adult; Aged; Alabama; Amphotericin B; Bone Diseases; Chronic Disease; Histoplasmosis; Humans; Imidazoles; Ketoconazole; Lung Diseases, Fungal; Male; Mediastinal Diseases; Middle Aged; Pericarditis; Piperazines

Incorporation of amphotericin B into liposomes significantly altered its toxicity, tissue distribution, and efficacy. Compared with intravenously administered amphotericin B-desoxycholate, liposome-amphotericin B showed a reduced acute toxicity and a maximal tolerable dose 9 times greater than amphotericin B-desoxycholate. Liposome-amphotericin B also produced higher tissue and lower serum concentrations than amphotericin B-desoxycholate, and was significantly more effective in prolonging survival of mice infected with Histoplasma capsulatum.

Topics: Amphotericin B; Animals; Histoplasmosis; Liposomes; Mice

Topics: Adult; Amphotericin B; Delirium; Depressive Disorder; Histoplasmosis; Humans; Infusions, Parenteral; Male

Topics: Aged; Amphotericin B; Bronchi; Female; Fever of Unknown Origin; Histoplasma; Histoplasmosis; Humans; Lung; Pulmonary Fibrosis; Radiography

Topics: Adolescent; Adult; Aged; Amphotericin B; Endocarditis; Female; Histoplasmosis; Humans; Male; Middle Aged

Three patients with acute pulmonary histoplasmosis presented with extensive, diffuse bilateral infiltrates on chest roentgenograms. Fungal elements were seen in the bronchial secretions of two patients; Histoplasma capsulatum was grown from the third patient and from soil from the patients' workplace. Two patients were severely hypoxemic and required short courses of amphotericin B therapy; in one of these two, progressive deterioration dictated corticosteroid therapy as well, with a dramatic clinical response. Radiologic resolution of disease occurred more quickly in the treated patients. Initial pulmonary function tests suggested mild restriction in each, with normal test results by the fourth month of follow-up. Our experience suggests that amphotericin B may shorten the course of acute histoplasmosis and that corticosteroid therapy may be efficacious in controlling the symptoms related to hyperresponsiveness in fulminant primary disease.

Topics: Adolescent; Adrenal Cortex Hormones; Adult; Amphotericin B; Histoplasmosis; Humans; Lung Diseases, Fungal; Male; Radiography; Respiratory Distress Syndrome

Topics: Adult; Amphotericin B; Fever of Unknown Origin; Histoplasmosis; Humans; Immunologic Deficiency Syndromes; Male

A case of localised histoplasmosis of the gingivae, with no osseous involvement is described in a 50-year-old man. The diagnosis was based on histology, growth on culture and a positive histoplasmin latex test. Therapy was commenced with intravenous amphotericin but was changed to intravenous miconazole because of serious immediate side effects and the development of marked renal impairment and moderate suppression of erythropoiesis. Rebiopsy of the gingival margin showed therapy to be effective. No source of the infection could be traced.

Topics: Amphotericin B; Gingival Diseases; Histoplasmosis; Humans; Imidazoles; Injections, Intravenous; Male; Miconazole; Middle Aged

Two patients with culture-negative chronic meningitis were diagnosed as having Histoplasma capsulatum meningitis based on serial serologic studies; both had antibody in the cerebrospinal fluid as well as the serum. The patients were treated successfully with amphotericin B and had favorable clinical responses. Three control patients with active histoplasmosis and positive serum serologic tests, but without meningeal involvement, did not have antibody in the cerebrospinal fluid. Patients with chronic meningitis of obscure cause should have serial serum and cerebrospinal fluid antibody studies for H. capsulatum.

Topics: Adult; Aged; Amphotericin B; Complement Fixation Tests; Female; Histoplasmosis; Humans; Male; Meningitis; Middle Aged

Topics: Adrenal Glands; Adult; Aged; Amphotericin B; Bone and Bones; Bone Marrow; Central Nervous System; Child; Child, Preschool; Digestive System; Endocarditis; Female; Hepatomegaly; Histoplasmosis; Humans; Infant; Kidney; Larynx; Lung; Lymphatic System; Male; Middle Aged; Oropharynx; Retrospective Studies; Splenomegaly; Sulfonamides; Tennessee

The clinical features of 24 cases of disseminated canine histoplasmosis are presented. The enteric form predominated and the age at presentation was from five months to ten years. The principal clinical findings were chronic diarrhea, weight loss, pyrexia and anemia.A premortem diagnosis was reached in 20 cases, by demonstrating Histoplasma capsulatum organisms in peripheral blood smears, rectal scrapings or surgical biopsies. Five of seven dogs treated with amphotericin B were released in asymptomatic condition. Four of these cases relapsed six to 15 months following therapy. The overall mortality rate was 80%.

Topics: Amphotericin B; Animals; Dog Diseases; Dogs; Histoplasma; Histoplasmosis

Endocarditis is a rare manifestation of disseminated Histoplasma capsulatum infection. A 22-year-old man presented with a seven month history of fever, weight loss, and progressive aortic insufficiency. The diagnosis of H. capsulatum was suggested by a diagnostic rise in complement fixation titers and positive echocardiographic findings. The diagnosis was confirmed prior to surgery by positive bone marrow culture. Progressive congestive heart failure necessitated replacement of the aortic valve which subsequently grew H. capsulatum. In this case, a combination of amphotericin B therapy and valve replacement was curative.

Topics: Adult; Amphotericin B; Aortic Valve; Complement Fixation Tests; Echocardiography; Endocarditis; Heart Murmurs; Heart Valve Diseases; Histoplasmosis; Humans; Liver; Male; Skin Tests

Deep-seated fungal infections with unusual clinical courses developed in three previously healthy patients following jejunoleal bypass surgery. Pulmonary blastomycosis disseminated and then relapsed despite repeated courses of amphotericin B in a 40-year-old man; chronic progressive pulmonary histoplasmosis developed in a 38-year-old nonsmoking man; and histoplasmosis of mediastinal nodes became symptomatic in a 32-year-old man. Cell-mediated immunity was evaluated in two patients; no defects were found. However, male patients were found to be at a significantly higher risk of infection than female patients (3/32 vs 0/101; P less than .02). A significantly higher percentage of prebypass weight was lost by the infected men than the uninfected men (P less than .05). Accelerated weight loss clearly preceded the onset of the infection in two of the patients. Jejunoileal bypass surgery should be regarded as a risk factor for serious fungal infection, especially in men with accelerated weight loss.

Topics: Adult; Amphotericin B; Blastomycosis; Female; Histoplasmosis; Humans; Ileum; Immunity, Cellular; Jejunum; Lung Diseases, Fungal; Male; Mediastinal Diseases; Mycoses; Obesity; Postoperative Complications; Risk; Sex Factors; Tuberculosis

The authors present 10 cases of histoplasmosis, 3 due to H. capsulatum, and 7 to H. duboisii. The presenting signs were stomatological or laryngeal with H. capsulatum, and ganglionic, cutaneous, or skeletal with H. duboisii. Diagnosis was confirmed by the discovery of histoplasms in the lesions: 7 times the examination of a needle biopsy sample was positive; in 8 cases out of 10, culture on Sabouraud's medium was positive; in 3 cases out of 4 the inoculated hamster showed the presence of a histoplasmosis. Histological examination of lesions biopsies demonstrated histoplasms in the 9 cases studied. The intradermal reaction to histogical examination of lesion biopsies demonstrated histoplasms in the 9 cases studied. The intradermal reaction to histoplasmin, positive in only 1 out of 7 cases, and serological tests which showed precipitating antibodies in only 4 cases out of 10, are of very little diagnostic value. All patients were treated with amphotericin B, sometimes associated with clotrimazole (3 cases), miconazole (1 case), and rifampicin (2 cases). Two relapses occurred, one, after too soon an interruption of treatment relapsed two months later, and the other followed 18 months after a total dose of 4,200 mg of amphotericin. Surgical treatment of active subcutaneous ganglionic and bony foci may be necessary, and was employed in three cases, with a favourable result in a case of severe disseminated histoplasmosis.

Topics: Adolescent; Adult; Africa; Aged; Amphotericin B; Child; Child, Preschool; Clotrimazole; Female; Histoplasmosis; Humans; Infant; Lymph Node Excision; Male; Miconazole; Middle Aged; Mouth Diseases; Rifampin

A patient is reported who had Histoplasma capsulatum endocarditis, a rare form of disseminated histoplasmosis. He also had disseminated intravascular coagulopathy and defects in cell-mediated immune responses to Histoplasma antigens. Prompt etiologic diagnosis was made by stain of tissue from a mouth ulcer and confirmed by culture of the organism from blood. An echocardiogram compared to a previous normal echocardiogram indicated changes consistent with a vegetation. Histologic examination of the resected valve demonstrated organisms. Amphotericin B administration (3.4 g) plus an aortic valve replacement resulted in cure.

Topics: Adult; Amphotericin B; Disseminated Intravascular Coagulation; Endocarditis; Female; Heart Failure; Histoplasma; Histoplasmosis; Humans; Male; Middle Aged

Five cases of disseminated histoplasmosis complicating renal transplantation are reported. Nine previously reported cases from the literature are reviewed. In this setting disseminated histoplasmosis usually presents as a nonspecific systemic febrile illness that may be fulminant or more subacute. Five of 14 patients presented with skin lesions; only one patient presented with primary pulmonary symptoms of cough and dyspnea. Three of our patients and three others previously reported on survived the infection and maintained good function in the transplanted kidney despite prolonged therapy with amphotericin B. Immunosuppression was the only predisposing factor that could be identified with certainty in the five patients reported on herein. However, in two of the five patients the onset of disseminated histoplasmosis coincided with a well documented cytomegalovirus infection; the viral infection may have been a factor predisposing to infection in these two cases.

Topics: Adult; Amphotericin B; Female; Glomerulonephritis; Histoplasmosis; Humans; Kidney Failure, Chronic; Kidney Transplantation; Male; Middle Aged; Polycystic Kidney Diseases; Transplantation, Homologous

This report describes a case in which an intracranial histoplasmoma was successfully treated with surgical removal and amphotericin B. This is the third reported case of its kind. The authors discuss problems of preoperative diagnosis in a patient with depressed cell-mediated immunity, and no evidence of extracerebral dissemination.

Topics: Adult; Amphotericin B; Brain Diseases; Female; Histoplasmosis; Humans; Meningitis

Topics: Amphotericin B; Asthma; Histoplasma; Histoplasmosis; Humans; Immunosuppression Therapy; Male; Middle Aged; Prednisone; Skin Diseases, Parasitic

A patient with oesophageal stenosis caused by Histoplasma granulomas is reported. He was treated with an initial combined course of intravenous amphotericin B and oral rifampicin. Complications included adrenal insufficiency, operative perforation of the oesophagus, amphotericin nephrotoxicity and tuberculosis. The histoplasmosis has not recurred for over 3 years.

Topics: Aged; Amphotericin B; Drug Therapy, Combination; Esophageal Stenosis; Granuloma; Histoplasmosis; Humans; Male; Rifampin

Topics: Amphotericin B; Angola; Black People; Child; Diagnosis, Differential; Disease Reservoirs; Drug Therapy, Combination; Histoplasmosis; Humans; Male; Sulfamethoxazole; Trimethoprim

In this retrospective study of 115 cases of histoplasmids, there were 66 male and 49 female patients ranging in age from 2 months to 79 years. The most common presenting symptoms were cough, chest pain, wheezing, weight loss, hemoptysis, and shortness of breath. Thirty-five patients (30%) were asymptomatic. Two patients had manifestations of obstruction of the superior vena cava. Radiologic findings simulated carcinoma, tuberculosis, pneumonia, and viral infections. Sixty-five patients had various operative proceudres, such as lung biopsy, wedge resection, lobectomy, pneumonectomy, resection of lymph node, and bypass of superior vena cava, for diagnosis and treatment. There were two deaths and two postoperative complications. A total of 15 patients received intravenous amphotericin B. Four patients with pneumonic infiltrates developed disseminated histoplasmosis.

Topics: Adolescent; Adult; Aged; Amphotericin B; Child; Child, Preschool; Diagnosis, Differential; Female; Histoplasmosis; Humans; Infant; Male; Middle Aged; Pneumonectomy; Radiography

From an observation of pulmonary histoplasmosis with Histoplasma capsulatum in a Haiti woman living in France for 2 years, the authors recall the mycological and epidemiological data of this fungus as well as the main clinical radiological and biological signs of the disease. Because of its tendancy to dissemination, histoplasmosis can have a bad prognosis. It is difficult to diagnose in our countries and facing a chronic pulmonary form, a diagnosis of tuberculosis is often thought of. But its possibility is to be envisaged in case of a journey in countries of endemia, and the disease should be confirmed by: -- several samplings to trace the fungus, bringing the mycological prove of the disease; -- serum uses; -- modalities and difficulties of the treatment by Amphotericin B are also recalled.

Topics: Adult; Amphotericin B; Female; France; Haiti; Histoplasmosis; Humans; Lung Diseases, Fungal

Nude (nu/nu) mice were infected with Histoplasma capsulatum and treated with varying doses of 3 drug regimens: oral ambruticin, intraperitoneal amphotericin B, and amphotericin B plus oral rifampin. Therapy with amphotericin B alone was the most effective regimen. High-dose ambruticin (50 mg/kg of body weight every 8 hours) led to significantly prolonged survival compared to that of untreated control animals, but no long-term cures. Addition of rifampin produced no benefit and might actually have decreased the efficacy of amphotericin B; this combination may be deleterious in a setting of immunodeficiency.

Topics: Administration, Oral; Amphotericin B; Animals; Antifungal Agents; Drug Evaluation, Preclinical; Drug Therapy, Combination; Histoplasmosis; Injections, Intraperitoneal; Mice; Mice, Nude; Pyrans

Topics: Adult; Aged; Amphotericin B; Female; Histoplasmosis; Humans; Male; Mali; Middle Aged

Infection with Histoplasma capsulatum in 58 patients whose immune responses were suppressed (Immunosuppressed patients) (16 from the present series and 42 described previously) was analyzed. The most common underlying diseases were Hodgkin's disease (29 per cent), chronic lymphocytic leukemia (19 per cent) and acute lymphocytic leukemia (17 per cent). Sixty-three per cent of the patients had received cytotoxic drugs, and 57 per cent had taken corticosteroids. Widely disseminated infection occurred in 88 per cent of the patients, with predominant involvement of lungs and organs of the reticuloendothelial system. Localized pulmonary infection was present in the remaining patients. The most useful diagnostic method was bone marrow biopsy with microscopic examination for the intracellular yeast form of H. capsulatum. Biopsy of oral lesions, lung, liver and lymph node also proved diagnostically helpful. Growth of H. capsulatum in culture was frequently too slow to be beneficial in diagnosing histoplasmosis in ill patients. Serologic methods were of little diagnostic help in this population of immunosuppressed patients. The response to amphotericin B therapy was excellent (6.7 per cent mortality rate) in those patients in whom the diagnosis was established early and in whom a full course of antifungal therapy could be given. In contrast, the mortality rate in patients who received no antifungal therapy or less than 1 g of amphotericin B was 100 per cent.

Topics: Adult; Aged; Amphotericin B; Diagnosis, Differential; Female; Histoplasmosis; Hodgkin Disease; Humans; Immunosuppression Therapy; Kidney Transplantation; Leukemia, Lymphoid; Lupus Erythematosus, Systemic; Male; Middle Aged; Pneumonia; Sarcoidosis; Transplantation, Homologous

Forty-seven men on the Isthmus of Panama were exposed to histoplasmosis in an old bunker inhabited by bats. The resulting epidemic was studied with serial clinical, serological, and radiological examinations. Thirty-seven (78.7%) of the men showed serological evidence of infection and 26 (70.3%) had symptoms. Incubation periods ranged from 4 to 30 days. A general relationship between severity of illness and degree of exposure was noted. The agar gel diffusion test for precipitin antibodies was more sensitive than the complement-fixation test or slide test in detecting infection with Histoplasma capsulatum. Decontamination procedures and environmental studies are described.

Topics: Amphotericin B; Animals; Chiroptera; Complement Fixation Tests; Disease Outbreaks; Formaldehyde; Histoplasmosis; Humans; Male; Mice; Panama Canal Zone; Precipitin Tests

A patient is presented in whom a left atrial myxoma was found to be infected with Histoplasma capsulatum. Histoplasmosis has not been previously associated with this tumor, nor has any fungus without preceding bacterial endocarditis and long-term antibiotic therapy. The clinical course in foru previously reported cases of bacterially infected myxoma is reviewed. There have been 18 prior cases of Histoplasma endocarditis and in two the patients have survived. Their clinical presentation and response to therapy are also reviewed, and pertinent therapeutic conclusions drawn. The role of echocardiography in this patient's evaluation and the ultimate successful therapy are discussed.

Topics: Amphotericin B; Echocardiography; Endocarditis; Female; Heart Atria; Heart Neoplasms; Histoplasmosis; Humans; Middle Aged; Myxoma

A case of central nervous system histoplasmosis complicated by obstruction of the fourth ventricle is described. The patient rarely exhibited systemic symtoms of infection despite positive cultures for Histoplasma capsulatum from bone marrow, blood and urine. Infection recurred despite the administration of a total of 5 g of systemic amphotericin B. An additional course combined with intrathecal amphotericin B was terminated because of transverse myelitis.

Topics: Adolescent; Amphotericin B; Central Nervous System Diseases; Histoplasmosis; Humans; Hydrocephalus; Male

Histoplasmosis due to Histoplasma capsulatum var duboisii developed in a Canadian immigrant one year after his entry into Canada. He had lived in Guinea for two years prior to immigration. Lymphatic infection characterized the course of his illness. The clinical and pathologic features of this disease's distinctive skin and bone manifestations are outlined. The causal agent's mycologic features are compared with those of H capsulatum var capsulatum. Treatment with amphotericin B was successful.

Topics: Adult; Amphotericin B; Canada; Dermatomycoses; Emigration and Immigration; Guinea-Bissau; Histoplasma; Histoplasmosis; Humans; Male

A patient who has had three distinct recurrences of disseminated histoplasmosis over 22 years is presented. Measurements of cellular and humoral immune response to histoplasmin antigens were compared with previously reported data. Although initially sulfisoxazole therapy led to regression of disease, over the past 13 years she has required three courses of amphotericin B, each time with resolution of signs and symptoms. Despite minimal evidence of a cellular or humoral immune response to this organism, the patient has done well. Although disseminated histoplasmosis is often a fatal disease, this woman has tolerated the infection well.

Topics: Adult; Amphotericin B; Antibody Formation; Female; Histoplasmosis; Humans; Immunity, Cellular; Mouth Diseases; Pharyngeal Diseases; Recurrence; Skin Manifestations; Sulfisoxazole

Topics: Adult; Amphotericin B; Gastritis; Histoplasmosis; Humans; Male; Radiography

Ambruticin (W7783) was evaluated in vivo in mice subacutely or nonlethally infected with Histoplasma capsulatum. Results were compared with those obtained with amphotericin B, the drug of choice in human histoplasmosis. In one experiment, ambruticin was shown to be capable of curing infected animals as evidenced by totally negative liver and spleen cultures obtained when mice were sacrificed after 4 weeks of oral treatment with 150 mg of drug per kg per day. The 50% cure dose for ambruticin was between 75 and 150 mg/kg per day; the 50% cure dose for oral amphotericin B in this experiment was between 1.56 and 6.25 mg/kg per day. In a second experiment, both oral ambruticin (150 mg/kg per day) and oral amphotericin B (25 mg/kg per day) were again curative, but to a lesser degree than in the first experiment. Biological cures were obtained with both drugs after 3 and 4 weeks of treatment but not after 2 weeks.

Topics: Amphotericin B; Animals; Antifungal Agents; Histoplasmosis; Mice; Pyrans; Time Factors

Topics: Adult; Amphotericin B; Female; Histoplasmosis; Hodgkin Disease; Humans

Two cases of African histoplasmosis culturally proven to be caused by Histoplasma duboisii are reported from Eastern Nigeria. One case had cutaneous papules and subcutaneous nodules all over his body while the other patient had cutaneous papules, an abscess over the right scapula, enlarged cervical, axillary and inguinal lymph nodes, and possible lung involvement. None of the 35 soil samples collected from the environment of the two patients were found positive for H. duboisii. In the first case, most of the lesions cleared with Septrin given orally. The 2nd case responded very well to treatment with intravenous Amphotericin B except for persistance of swellings in the inguinal lymph nodes. The effect of intralesional injection of Amphotericin B on this residual lymph node infection is now being assessed.

Topics: Adult; Amphotericin B; Drug Combinations; Histoplasmosis; Humans; Male; Sulfamethoxazole; Trimethoprim

In an extension of promising inhibitory results in vitro against Histoplasma capsulatum, correlated earlier using substituent constants developed by regression analysis with 77 disulfides, one symmetrical and 14 unsymmetrical disulfides were prepared (3--17). About half were active in vitro against H. capsulatum (and one against Candida albicans). Groups that seemed most to lead to promising inhibition among the unsymmetrical disulfides were o-HO2CC6H4, (CH2)4SO2Na, Me2NC(S), p-ClC6H4, and perhaps p-CH3C6H4; the first two also might be used to increase solubility. Earlier inhibitory promise of the morpholino group did not materialize. None of the group 3--17 was significantly active in vivo. The unsymmetrical disulfides were prepared by reaction of thiols with sulfenyl chlorides or with acyclic or cyclic thiosulfonates. Two six-membered heterocyclic disulfides (5 and 6) were prepared by a novel cyclization, in which carbon disulfide reacted with an (N-alkylamino)ethyl Bunte salt, followed by ring closure; an explanation is suggested for formation of a thiazoline when the N-alkyl group is absent. One of the disulfides disproportionated with astonishing ease (31; 0.3--1 h at 25 degrees C).

Topics: Amphotericin B; Animals; Candida albicans; Candidiasis; Disulfides; Histoplasma; Histoplasmosis; Mice; Structure-Activity Relationship

Histoplasma meningitis (HM) has been reported to occur primarily in association with disseminated histoplasmosis (DH). We report a case of histoplasma meningitis occurring in a patient with common variable hypogammaglobulinemia (CVH) in which no manifestations of DH were observed. L. L., a 66-year-old Caucasian male, clerical worker, developed occasional episodes of dizziness and tinnitus in mid-1971. During 1972, increasing frequency of these episodes and gradually progressive confusion were noted. In January 1973, vomiting, forther confusion, obnubilation, and a left central facial paresis developed and he was hospitalized. Physical examination revealed no pulmonary abnormalities, lymphadenopathy or hepatosplenomegaly. Over the ensuing 6-week evaluation, there was occasional fever to 38.5 degrees C. Chest roentgenogram was normal. Cerebral angiography suggested a mass in the left cerebellar hemisphere. EEG was diffusely slow. Multiple CSF examinations revealed: Glucose 7-18 mg/with a normal blood glucose, protein 109-256 mg/and cells 66-140 (95 + % mononuclear). Histoplasma capsulatum was cultured from CSF but not from sputum, urine, blood or bone marrow. Skin tests for PPD, histoplasmosis, coccidiodomycosis, blastomycosis, mumps, dinitrochlorobenzene and streptokinase-streptodornase were negative then and 6 months later. Histoplasma serum antibody was absent. Immunoglobulin analysis revealed IgG 430 mg %, IgA 46 mg %, and IgM 35 mg %, which with the history and skin test results suggested CVH. Treatment with 2.51 gm of amphotericin B given intravenously over a 3-month period resulted in complete reversal of all neurologic signs and clearing of the confusion. The remission has been maintained for two years. This case represents a primary infection of the CNS by histoplasma. The relationship between the HM and the CVH will be discussed.

Topics: Agammaglobulinemia; Aged; Amphotericin B; Cerebrospinal Fluid; Diagnosis, Differential; Histoplasma; Histoplasmosis; Humans; Immunoglobulin A; Immunoglobulin G; Immunoglobulin M; Lymphocytes; Male; Meningitis; Skin Tests

A patient wtih acute epidemic pulmonary histoplasmosis was treated with 500 mg of amphotericin B. Traditionally, such patients have not been treated, since the illness is usually self-limited; however, fatalities have been reported, and some authorities have recommended therapy with small doses of amphotericin B. Patients with acute pulmonary histoplasmosis who are acutely ill should be considered for low-dose treatment with amphotericin B, inasmuch as they are likely candidates for early dissemination. Cures have been reported with as little as 105 mg of amphotericin B administered intravenously.

Topics: Acute Disease; Adult; Amphotericin B; Drug Evaluation; Histoplasmosis; Humans; Lung Diseases, Fungal; Male

Topics: Acute Disease; Amphotericin B; Child; Female; Histoplasmosis; Humans; Lung Diseases, Fungal; Radiography

A case of disseminated histoplasmosis followed later by disseminated coccidioidomycosis is described. The clinical illness and immunologic studies suggest subtle defects that may have existed antecedent to infection and, thus, provided an opportunity for widespread dissemination by these normally nonopportunistic organisms. Poor correlation was noted between the clinical course and in vitro tests of cell-mediated immunity.

Topics: Adult; Amphotericin B; Coccidioides; Coccidioidomycosis; Complement Fixation Tests; Histoplasma; Histoplasmosis; Humans; Lymphocyte Activation; Male; Precipitins; Skin Tests

Topics: Adolescent; Adult; Aged; Amphotericin B; Amyloidosis; Blastomycosis; Carcinoma; Child; Diabetes Complications; Female; Histoplasmosis; Humans; Lymphoma; Male; Middle Aged; Spheroplasts

Amphotericin B in combination with rifampicin was more effective in the treatment of murine histoplasmosis and blastomycosis than either agent alone. The increased therapeutic effects were not accompanied by an increase in toxicity.

Topics: Amphotericin B; Animals; Blastomycosis; Dose-Response Relationship, Drug; Drug Therapy, Combination; Female; Histoplasmosis; Mice; Rifampin

Topics: Africa; Amphotericin B; Blastomycosis; Central America; Histoplasmosis; Humans; Paracoccidioidomycosis; South America; Sporotrichosis

These experiments demonstrate that susceptibility to Histoplasma infection of the mouse is dramatically influenced by genetic and immunologic factors, and that these factors appear to exert little influence on response to therapy. They further demonstrate that such influence may vary in different visceral organs. The explanation for these observations remains to be elucidated.

Topics: Amphotericin B; Animals; Antilymphocyte Serum; Female; Histoplasma; Histoplasmosis; Immunosuppression Therapy; Liver; Lung; Mice; Mice, Inbred C57BL; Mice, Inbred Strains; Species Specificity; Spleen

Sixteen patients with pericarditis caused by Histoplasma capsulatum were studied. Fourteen were less than 30 years old, and no patient had an underlying illness or was receiving immunosuppressive therapy. All patients experienced a flu-like prodromal illness lasting from 2 weeks to 4 months. Pneumonitis or hilar adenopathy, or both, was found in 12; pleural effusion, uncommon in primary pulmonary histoplasmosis, was found in seven patients. Pericardial fluid, pleural fluid and bone marrow cultures yielded no growth. All patients demonstrated a fourfold or greater change in complement-fixing antibody titers. No patient had disseminated disease, and only one required treatment with ampholericin B. The illness ran a protracted course, and in six patients symptomatic pericarditis recurred. Ultimately all recovered. Ten patients were restudied 6 months to 12 years after recover. Only one patient had pericardial calcification, and none had constrictive pericarditis. This form of granulomatous pericarditis, unlike that caused by Mycobacterium tuberculosis, appears to carry a good prognosis.

Topics: Adolescent; Adult; Amphotericin B; Calcinosis; Diagnosis, Differential; Female; Follow-Up Studies; Histoplasmosis; Humans; Male; Middle Aged; Pericarditis; Prognosis

A patient with culturally proved chronic pulmonary histoplasmosis was treated with amphotericin B. Complement fixation titers decreased but sputum cultures remained positive for Histoplasma capsulatum 5 months after original therapy. Lobectomy and a subsequent course of amphotericin B were necessary. Exceeding the minimal inhibitory concentrations of amphotericin B did not eradicate the organism and declining complement fixation titers failed to have prognostic significance.

Topics: Amphotericin B; Complement Fixation Tests; Female; Histoplasma; Histoplasmosis; Humans; Lung Diseases, Fungal; Middle Aged; Sputum

Cutaneous lesions as a manifestation of histoplasmosis, primarily a disease of the respiratory system, are rare and most commonly appear secondary to progressive dissemination. A patient with documented progressive, disseminated histoplasmosis, having been treated previously with amphotericin B, presented on a second occasion with cutaneous lesions as the chief complaint. Biopsy and cultures of these lesions were positive for Histoplasma capsulatum. A review of the English literature revealed only 7 reported cases of secondary skin histoplasmosis in the past 20 years. All patients, including the current one, either had diseases associated with depressed immunity or were receiving steroid therapy.

Topics: Adult; Amphotericin B; Dermatomycoses; Histoplasmosis; Humans; Lung Diseases, Fungal; Male; Recurrence

Renal transplant recipients are susceptible to a number of fungal infections amenable to therapy with amphotericin B, but azotaemia is an almost invariable sequel to the use of this agent. As intravenous mannitol has been shown to minimize nephrotoxicity induced by amphotericin B in dogs we treated four kidney transplant recipients who had systemic fungal infections with mannitol and amphotericin B. None showed significant reduction in renal function though a mild metabolic acidosis did develop.

Topics: Acidosis; Adult; Amphotericin B; Candidiasis; Cryptococcosis; Histoplasmosis; Humans; Injections, Intravenous; Kidney Diseases; Kidney Function Tests; Kidney Transplantation; Male; Mannitol; Middle Aged; Postoperative Complications; Transplantation, Homologous; Uremia

Topics: Actinomycosis; Amphotericin B; Blastomycosis; Candida albicans; Candidiasis, Cutaneous; Chromoblastomycosis; Coccidioidomycosis; Cryptococcosis; Dermatomycoses; Flucytosine; Griseofulvin; Histoplasmosis; Mucormycosis; Mycetoma; Sporotrichosis; Tinea Capitis; Tinea Pedis; Tinea Versicolor

Topics: Amphotericin B; Antibodies; Bone Marrow; Bone Marrow Cells; Child, Preschool; Complement Fixation Tests; Disseminated Intravascular Coagulation; Follow-Up Studies; Hepatomegaly; Histoplasmosis; Humans; Infant; Injections, Intravenous; Precipitins; Skin Tests; Splenomegaly

We present a case of histoplasmosis with skin manifestations occurring 17 years after initial diagnosis. The clinical manifestations of disseminated disease are discussed. Amphotericin B administered through an A-V shunt resulted in prompt resolution of the skin lesions.

Topics: Aged; Amphotericin B; Arteriovenous Shunt, Surgical; Histoplasmosis; Humans; Lung Diseases, Fungal; Male; Skin Manifestations

The comparative efficacy of amphotericin B and amphotericin B methyl ester (AME) against experimental histoplasmosis, blastomycosis, cryptococcosis, and candidosis in mice was assessed by determining the effect of daily intraperitoneal therapy on 21-day survival and persistence of organisms in internal organs. AME, like amphotericin B, was effective against each of the experimental infections, but the efficacy was lower than the parent compound. For Histoplasma and Blastomyces infections the mean effective dose (ED(50)) of amphotericin B was 0.3 mg/kg, whereas the corresponding values for AME, respectively, were 2.4 and 2.8 mg/kg. For Cryptococcus infection the ED(50) for amphotericin B was 0.2 mg/kg compared with 2.0 mg/kg for AME. The ED(50) of amphotericin B for Candida infection was lower than 0.05 mg/kg and the value of AME was between 0.5 to 0.05 mg/kg. The colony counts from internal organs of the surviving animals after the therapeutic regimens were compatible with the data on survival.

Topics: Amphotericin B; Animals; Blastomycosis; Candidiasis; Cryptococcosis; Esters; Histoplasmosis; Male; Mice

We acknowledge that for most patients with istoplasmic chorioretinitis, the only treatment available is steroids. We agree with Schlaegel that steroids have to be used in adequate doses and for long periods of time. Alternate-day treatment should be instituted as soon as possible. Because it takes the adrenals 10 days to to weeks to be suppressed by sterid therapy, we treat our patients with daily doses for as short a time as possible and then witch over o alernate-day treatment. A short-acting steroid such as prednisone, prednisolone, or methylprednisolone should be used at the outset if long-term therapy is necessary and one anticipates using alternate-day therapy...

Topics: Adrenal Cortex Hormones; Amphotericin B; Chorioretinitis; Desensitization, Immunologic; Histoplasmin; Histoplasmosis; Humans; Light Coagulation; Xenon

Two cases of disseminated histoplasmosis caused by H. capsulatum in Nigerian children are reported. This is a rare infection in this part of the world. The main clinical features were fever, weight loss, lassitude, lymphadenopathy, hepatosplenomegaly and severe anaemia, features indistinguishable from those of tuberculosis, Hodgkins and other reticuloses. Recognition of this infection in this environment is possible if it is considered in the differential diagnosis of pyrexia of undetermined origin and appropriate laboratory tests carried out on suitable specimens such as bone marrow, splenic aspirate or biopsy material. Treatment of choice is amphotericin B given intravenously, starting with 0-25 mg/kg. and increasing slowly to 1 mg/kg. Other useful drugs are Septrin and rifampicin which can be given concurrently. Subcutaneous abscesses and multiple bone lesions occurred in both our cases presumably as a result of blood stream infection, or embolisation from endocarditis.

Topics: Amphotericin B; Child; Child, Preschool; Histoplasma; Histoplasmosis; Humans; Male; Nigeria; Prednisolone; Sulfamethoxazole; Trimethoprim

Topics: Amphotericin B; Dose-Response Relationship, Drug; Drug Administration Schedule; Histoplasmosis; Humans; Infusions, Parenteral; Male; Middle Aged; Remission, Spontaneous

Topics: Amphotericin B; Antifungal Agents; Antigens, Fungal; Aspergillosis; Biopsy; Blastomycosis; Candidiasis; Coccidioidomycosis; Complement Fixation Tests; Cryptococcosis; Fluorescent Antibody Technique; Fungi; Histoplasmin; Histoplasmosis; Humans; Immunity, Maternally-Acquired; Immunodiffusion; Immunosuppression Therapy; Lung; Methods; Mycoses; Precipitin Tests; Silver; Skin Tests; Sporotrichosis; Staining and Labeling; Stilbamidines

Topics: Amphotericin B; Female; Histoplasmosis; Humans; Injections, Intramuscular; Middle Aged; Mouth Mucosa; Pharyngeal Diseases; Skin Diseases, Infectious; Ulcer

Topics: Adolescent; Age Factors; Agranulocytosis; Amphotericin B; Bone Marrow; Child; Child, Preschool; Female; Hepatomegaly; Histoplasmosis; Humans; Leukemia, Lymphoid; Leukopenia; Male; Radiography; Remission, Spontaneous; Splenomegaly

Topics: Amphotericin B; Diagnosis, Differential; Female; Histoplasmosis; Humans; Male; Middle Aged; South Carolina

Topics: Adolescent; Amphotericin B; Calcinosis; Child; Female; Histoplasmosis; Humans; Pericarditis, Constrictive; Radiography

Topics: Adult; Amphotericin B; Congo; Hip Joint; Histoplasma; Histoplasmosis; Humans; Joint Diseases; Lung Diseases, Fungal; Lymphatic Diseases; Male; Shoulder Joint; Skin Manifestations

A 61-year-old woman presented with malaise, intermittent fever, weight loss, and epigastric pain. Histoplasma capsulatum was eventually isolated from a liver biopsy and from the bone marrow and the patient was successfully treated with amphotericin B.

Topics: Alkaline Phosphatase; Amphotericin B; Aspartate Aminotransferases; Biopsy; Bone Marrow; Clinical Enzyme Tests; Complement Fixation Tests; Female; Fever; Hematocrit; Hepatomegaly; Histoplasma; Histoplasmosis; Humans; Liver; Middle Aged; Pain

Topics: Amphotericin B; Diagnosis, Differential; Histoplasmosis; Humans; Male; Middle Aged; Mississippi; Ohio; Pharyngeal Diseases; Tonsillitis

Topics: Amphotericin B; Child, Preschool; Histoplasmosis; Humans; Leukemia, Lymphoid; Male

Topics: Amphotericin B; Antifungal Agents; Blastomycosis; Coccidioidomycosis; Cryptococcosis; Flucytosine; Histoplasmosis; Humans; Meningitis; Mycoses; Natamycin; Nocardia Infections; Penicillin G; Potassium Iodide; Sporotrichosis; Stilbamidines; Sulfonamides

Topics: Amphotericin B; Ascites; Furosemide; Histoplasmosis; Hodgkin Disease; Humans; Hypoproteinemia; Male; Middle Aged; Spironolactone; Splenomegaly

Topics: Amphotericin B; Asthma; Coccidioidomycosis; Complement Fixation Tests; Female; Glucocorticoids; Histoplasmosis; Humans; Male; Middle Aged; Mycoses; Nocardia Infections; Prednisone; Sulfadiazine

Topics: Amphotericin B; Bronchial Fistula; Fistula; Histoplasma; Histoplasmosis; Humans; Male; Middle Aged; Pleural Diseases; Skin Diseases

Topics: Adult; Aged; Amphotericin B; Blastomycosis; Diagnosis, Differential; Histoplasmosis; Humans; Laryngeal Diseases; Laryngeal Neoplasms; Lip Diseases; Male; Middle Aged; Mouth Diseases; Mouth Neoplasms; Mycoses

Topics: Amphotericin B; Antifungal Agents; Aspergillosis; Blastomycosis; Candidiasis; Coccidioidomycosis; Cryptococcosis; Flucytosine; Histoplasmosis; Humans; Iodides; Mycoses; Nystatin; Sporotrichosis

Topics: Adult; Amphotericin B; Bone Marrow; Bone Marrow Cells; Complement Fixation Tests; Female; Histoplasma; Histoplasmosis; Humans; Leukocyte Count; Lung Diseases, Fungal; Lymph Nodes; Male; Penis; Prednisone; Rectum; Sarcoidosis; Sexually Transmitted Diseases; Skin Tests; Sputum; Vulva

Topics: Amphotericin B; Autopsy; Histoplasmosis; Humans; Larynx; Male; Middle Aged; Skin Tests

Topics: Adolescent; Amphotericin B; Chronic Disease; Diagnosis, Differential; Histoplasma; Histoplasmosis; Humans; Male; Punctures; Pyoderma

Topics: Amphotericin B; Animals; Blastomycosis; Dog Diseases; Dogs; Histoplasmosis; Injections, Intravenous

Topics: Addison Disease; Adrenal Glands; Amphotericin B; Autopsy; Histoplasma; Histoplasmosis; Humans; Hydrocortisone; Lung; Male; Middle Aged; Oral Manifestations; Sodium Chloride; Thrombophlebitis; Tongue Diseases; Ulcer; Vena Cava, Inferior

Five cases are described in which fear of the possibly hazardous effects of giving amphotericin to patients with kidney disease resulted in death from progressive infection by an amphotericin-sensitive fungus (Cryptococcus neoformans in three cases, Blastomyces dermatitidis in one case, and Histoplasma capsulatum in one case).

Topics: Adrenal Insufficiency; Adult; Amphotericin B; Attitude of Health Personnel; Blastomycosis; Cryptococcosis; Decerebrate State; Drug Prescriptions; Female; Histoplasmosis; Hodgkin Disease; Humans; Kidney Diseases; Lung Diseases, Fungal; Male; Medication Errors; Meningitis; Meningoencephalitis; Mycoses; Phobic Disorders; Sarcoidosis; Spinal Diseases

Topics: Amphotericin B; Biopsy; Histoplasma; Histoplasmin; Histoplasmosis; Humans; Lymphatic Diseases; Male; Precipitin Tests; Radiography, Thoracic; Senegal; Skin Manifestations; Skin Tests

Topics: Aged; Amphotericin B; Animals; Diagnosis, Differential; Histoplasma; Histoplasmosis; Humans; Liver; Male; Mice; Spleen; Tongue; Tongue Neoplasms

Topics: Adolescent; Adult; Aged; Amphotericin B; Anemia; Child; Endocarditis; Female; Histoplasma; Histoplasmosis; Humans; Infant; Larynx; Liver; Male; Meningitis; Middle Aged; Mouth; Prospective Studies; Thrombocytopenia; Urine

Topics: Acid-Base Equilibrium; Acidosis, Renal Tubular; Amphotericin B; Blastomycosis; Carbon Dioxide; Glomerular Filtration Rate; Histoplasmosis; Humans; Hydrogen-Ion Concentration; Hypokalemia; Kidney Diseases; Kidney Tubules; Mycoses; Partial Pressure; Potassium; Uric Acid

Topics: Adult; Aged; Amphotericin B; Blood Urea Nitrogen; Chronic Disease; Histoplasma; Histoplasmosis; Humans; Lung Diseases, Fungal; Middle Aged; Sputum; Time Factors

Topics: Amphotericin B; Female; Histoplasmosis; Humans; Laryngeal Diseases; Middle Aged; Tongue Diseases

Topics: Addison Disease; Adult; Aged; Amphotericin B; Autopsy; Complement Fixation Tests; Female; Histoplasma; Histoplasmosis; Humans; Lung; Male; Middle Aged; Oral Manifestations; Precipitin Tests; Radiography; Skin Tests; Sulfamethoxazole; Tongue; Tongue Diseases; United Kingdom

Topics: Acid-Base Equilibrium; Acidosis, Renal Tubular; Amphotericin B; Blastomycosis; Carbon Dioxide; Glomerular Filtration Rate; Histoplasmosis; Humans; Hydrogen-Ion Concentration; Hypokalemia; Kidney Diseases; Kidney Tubules; Mycoses; Partial Pressure; Potassium; Uric Acid

Topics: Adult; Amphotericin B; Hand; Histoplasmosis; Humans; Male; Recurrence; Tendons; Wrist

Topics: Amphotericin B; Histoplasmosis; Humans; Hydrocortisone

Topics: Adrenal Glands; Adult; Aged; Amphotericin B; Asia; Female; Histoplasmosis; Humans; Male; Middle Aged

Topics: Amphotericin B; Histamine H1 Antagonists; Histoplasmosis; Humans; Male; Middle Aged; Mouth Diseases

Topics: Amphotericin B; Blastomycosis; Cardiomegaly; Heart Failure; Histoplasmosis; Humans; Hydrocortisone; Hypokalemia; Lung Diseases, Fungal; Male; Middle Aged; Potassium; Sodium; Water-Electrolyte Balance

Topics: Adult; Africa, Western; Amphotericin B; Bacteriological Techniques; Diagnosis, Differential; Female; Histoplasma; Histoplasmosis; Humans; Male; Middle Aged; Mouth Diseases; Skin Diseases

Topics: Amphotericin B; Animals; Antifungal Agents; Antigens; Complement Fixation Tests; Dogs; Histoplasmosis; Humans; Hypersensitivity, Delayed; Immunodiffusion

Topics: Amphotericin B; Biopsy; Colitis; Diarrhea; Histoplasma; Histoplasmosis; Humans; Intestinal Diseases; Male; Microscopy, Electron; Middle Aged; Mucous Membrane; Rectum

Topics: Adult; Amphotericin B; Fever; Fever of Unknown Origin; Histoplasmosis; Humans; Male; Middle Aged; Tuberculosis, Miliary

Topics: Addison Disease; Adolescent; Adult; Amphotericin B; Child; Communicable Disease Control; Female; Follow-Up Studies; Health Facilities; Histoplasma; Histoplasmosis; Humans; Male; Mortality

Topics: Adult; Amphotericin B; Australia; Chorioretinitis; Eye Diseases; Eye Manifestations; Hemorrhage; Histoplasmosis; Humans; Male; Prednisone; Retinal Vessels; Visual Acuity

Topics: Amphotericin B; Female; Histoplasmosis; Humans; Injections, Intravenous; Male; Prognosis

Topics: Amphotericin B; Blood Urea Nitrogen; Coccidioidomycosis; Fever; Histoplasmosis; Humans; Injections, Intramuscular; Injections, Intravenous; Methods; Nausea; Pain; Procaine; Sporotrichosis; Stimulation, Chemical; Vomiting

Topics: Adolescent; Adult; Age Factors; Aged; Amphotericin B; Child; Histoplasmosis; Humans; Middle Aged

Topics: Amphotericin B; Chronic Disease; Histoplasmosis; Lung Diseases, Fungal

Topics: Acute Disease; Amphotericin B; Drug Hypersensitivity; Histoplasmosis; Humans; Lung Diseases, Fungal

Topics: Adult; Amphotericin B; Anemia; Female; Folic Acid Deficiency; Histoplasmosis; Humans; Mononuclear Phagocyte System; Pregnancy; Pregnancy Complications, Hematologic; Pregnancy Complications, Infectious; Radiography; Sternum

Topics: Amphotericin B; Analysis of Variance; Animals; Antibodies, Fungal; Autopsy; Blastomyces; Blastomycosis; Body Weight; Complement Fixation Tests; Disease Models, Animal; Dogs; Histoplasma; Histoplasmosis; Lung; Male; Placebos; Skin Tests

Topics: Amphotericin B; Animals; Aspergillosis; Blastomycosis; Candidiasis; Cat Diseases; Cats; Coccidioidomycosis; Cryptococcosis; Dog Diseases; Dogs; Histoplasmosis; Mycoses; Sporotrichosis

Topics: Adolescent; Amphotericin B; Complement Fixation Tests; Histoplasmin; Histoplasmosis; Humans; Lung Diseases, Fungal; Male; Skin Tests; Time Factors

Topics: Amphotericin B; Histoplasmosis; History, 20th Century; Humans; Lung Diseases, Fungal; Maryland; Virginia

Topics: Amphotericin B; Animals; Antibodies; Blood Urea Nitrogen; Complement Fixation Tests; Creatinine; Dog Diseases; Dogs; Female; Histoplasma; Histoplasmin; Histoplasmosis; Immunodiffusion; Kidney Function Tests; Lymph Nodes; Male; Skin Tests

Topics: Adult; Amphotericin B; Cuba; Diagnosis, Differential; Disease Outbreaks; Histoplasmosis; Humans; Lung; Male; Radiography; Sarcoidosis; Tuberculosis, Pulmonary

Topics: Amphotericin B; Complement Fixation Tests; Histoplasmosis; Humans; Middle Aged; Skin Tests

Topics: Adult; Aged; Amphotericin B; Diagnosis, Differential; Female; Histoplasmosis; Humans; Laryngeal Diseases; Male; Middle Aged; Otorhinolaryngologic Diseases; Pharyngeal Diseases; Tracheal Diseases

Topics: Adolescent; Adult; Aged; Amphotericin B; Female; Follow-Up Studies; Histoplasmosis; Humans; Lung Diseases, Fungal; Male; Middle Aged; Postoperative Care; Postoperative Complications; Radiography; Solitary Pulmonary Nodule

Topics: Adult; Age Factors; Amphotericin B; Chronic Disease; Female; Follow-Up Studies; Histoplasmosis; Humans; Lung Diseases, Fungal; Male; Middle Aged

Topics: Adolescent; Adult; Aged; Amphotericin B; Complement Fixation Tests; Female; Histoplasmosis; Humans; Male; Middle Aged; Skin Tests

Topics: Amphotericin B; Biopsy; Histoplasma; Histoplasmosis; Humans; Male; Middle Aged; Prostatic Diseases; Radiography; Seminal Vesicles; Skin Diseases; Skin Manifestations

Topics: Adult; Amphotericin B; Australia; Biopsy; Gingival Diseases; Histoplasma; Histoplasmosis; Humans; Liver; Male; Radiography; Soil Microbiology; Ulcer

Topics: Adolescent; Adult; Aged; Amphotericin B; Chronic Disease; Coccidioides; Coccidioidomycosis; Complement Fixation Tests; Diagnosis, Differential; Female; Histoplasmosis; Humans; Lung Diseases, Fungal; Male; Middle Aged; Radiography; Skin Tests; Sputum; Tuberculosis, Pulmonary

Topics: Adult; Aged; Amphotericin B; Bronchiectasis; Bronchography; Child, Preschool; Complement Fixation Tests; Diagnosis, Differential; Gastric Lavage; Histoplasmosis; Humans; Lung Diseases, Fungal; Male; Middle Aged; Skin Tests

Topics: Adult; Aged; Amphotericin B; Biopsy; Carcinoma, Bronchogenic; Coronary Disease; Diagnosis, Differential; Female; Glottis; Histoplasmosis; Humans; Laryngeal Diseases; Laryngoscopy; Lung Neoplasms; Male; Middle Aged; Mouth Diseases; Oral Manifestations; Palate; Tongue Diseases

Topics: Addison Disease; Administration, Oral; Amphotericin B; Histoplasma; Histoplasmosis; Humans; Injections, Intravenous; Male; Middle Aged; Potassium

Topics: Amphotericin B; Histoplasma; Histoplasmosis; Humans; Laryngeal Diseases; Male; Middle Aged

Topics: Adult; Aged; Aminohippuric Acids; Amphotericin B; Biological Transport, Active; Blood Urea Nitrogen; Coccidioidomycosis; Cryptococcosis; Glomerular Filtration Rate; Histoplasmosis; Humans; Inulin; Kidney Concentrating Ability; Kidney Function Tests; Kidney Tubules; Male; Middle Aged; Mycoses; Natriuresis; Potassium; Urea

Topics: Amphotericin B; Ampicillin; Colon; Colostomy; Complement Fixation Tests; Hemorrhage; Histoplasmosis; Humans; Hydrocortisone; Laparotomy; Male; Middle Aged

Topics: Amphotericin B; Electrocardiography; Fever; Histoplasmosis; Humans; Laryngeal Diseases; Male; Middle Aged; Nausea; Vocal Cords; Vomiting

Topics: Amphotericin B; Chronic Disease; Histoplasmosis; Humans

Topics: Adult; Amphotericin B; Chronic Disease; Follow-Up Studies; Histoplasmosis; Humans; Lung Diseases, Fungal; Middle Aged

Topics: Adult; Aged; Amphotericin B; Blastomyces; Blastomycosis; Bone and Bones; Bone Diseases; Breast; Breast Diseases; Female; Granuloma; Histoplasmosis; Humans; Lung; Lung Diseases, Fungal; Lymph Nodes; Male; Middle Aged; Pneumonia; Skin; Skin Diseases; Smoking; Tuberculosis, Pulmonary

Topics: Amphotericin B; Diagnosis, Differential; gamma-Globulins; Histoplasmosis; Humans; Male; Middle Aged; Sulfadiazine

Topics: Actinomycosis; Africa; Amphotericin B; Aspergillosis; Blastomycosis; Candidiasis; Coccidioidomycosis; Farmer's Lung; France; Histoplasmosis; Humans; Hypersensitivity; Lung Diseases, Fungal; Nystatin; Sputum; United States

Topics: Amphotericin B; Complement Fixation Tests; Embolism; Endocarditis; Fluorescent Antibody Technique; Histoplasmosis; Humans; Male; Middle Aged

Topics: Acidosis, Renal Tubular; Amphotericin B; Electrolytes; Histoplasmosis; Humans; Kidney; Kidney Concentrating Ability; Male; Middle Aged

Topics: Actinomycosis; Amphotericin B; Antifungal Agents; Blastomycosis; Candidiasis; Coccidioidomycosis; Cryptococcosis; Histoplasmosis; Mucormycosis; Mycoses; Nocardia Infections; Sporotrichosis

Topics: Age Factors; Aged; Amphotericin B; Complement Fixation Tests; Female; Histoplasmosis; Humans; Joint Diseases; Knee Joint; Skin Tests; Vaginitis

Topics: Amphotericin B; Female; Histoplasmosis; Humans; Lung Diseases, Fungal; Male

Topics: Aminosalicylic Acids; Amphotericin B; Drug Resistance, Microbial; Histoplasmosis; Humans; Isoniazid; Lung Diseases; Male; Middle Aged; Mycobacterium; Mycobacterium Infections; Radiography, Thoracic; Sputum; Streptomycin

Topics: Actinomycosis; Adult; Amphotericin B; Biopsy; Blastomycosis; Coccidioidomycosis; Cryptococcosis; Diagnosis, Differential; Female; Histoplasmosis; Humans; Male; Middle Aged; Mycoses; Nystatin; Respiratory Tract Infections; Skin; Skin Diseases; Skin Ulcer; South America; Sputum

The antifungal activity of pyrrolnitrin, previously shown to be effective against superficial infections, was evaluated against experimental systemic mycoses. Pyrrolnitrin was inhibitory in vitro at <0.78 to 100 mug/ml to Candida albicans, Cryptococcus neoformans, Blastomyces dermatitidis, Sporotrichum schenckii, and Histoplasma capsulatum. Pyrrolnitrin activity was reduced about 90% in sera. After multiple subcutaneous doses of pyrrolnitrin at 20 mg/kg, activity was recovered in mouse blood and urine as well as kidney, liver, and brain homogenates. Multiple daily doses (50 mg/kg) of this antibiotic were effective in reducing by 74% the number of viable cells of C. albicans recovered from kidney homogenates. Multiple doses (15 mg/kg) resulted in a 74% reduction in the number of C. neoformans from brain homogenates. Pyrrolnitrin was ineffective in reducing the recovery of B. dermatitidis or H. capsulatum from liver or spleen homogenates of infected mice. When compared with amphotericin B, hamycin, 5-fluorocytosine, and saramycetin, this antibiotic was less effective. This study indicates that pyrrolnitrin would have limited usefulness as a systemic antifungal agent.

Topics: Amphotericin B; Animals; Antifungal Agents; Blastomyces; Blastomycosis; Blood; Candida; Candidiasis; Cryptococcosis; Cryptococcus; Histoplasma; Histoplasmosis; Mice; Neurospora; Sporothrix

Topics: Amphotericin B; Child; Dacryocystitis; Eye Diseases; Female; Histoplasmosis; Humans; Lacrimal Apparatus; Orbit; Radiography; Skull; Tibia

Topics: Adult; Amphotericin B; Histoplasmosis; Humans; Injections, Intravenous; Lung Diseases, Fungal

Topics: Adult; Aged; Amphotericin B; Coccidioidomycosis; Cryptococcosis; Female; Histoplasmosis; Humans; Male; Middle Aged; Mononuclear Phagocyte System; Mycoses; Phagocytosis; Serum Albumin, Radio-Iodinated

Topics: Aged; Amphotericin B; Dermatitis, Exfoliative; Histoplasma; Histoplasmosis; Humans; Male; Mycosis Fungoides; Prednisone

Topics: Adolescent; Adult; Aged; Amphotericin B; Anemia; Animals; Cote d'Ivoire; Cricetinae; Dyspnea; Electrocardiography; Female; Hepatomegaly; Histoplasma; Histoplasmosis; Humans; Male; Splenomegaly; Tachycardia; Time Factors

Topics: Amphotericin B; Child, Preschool; Complement Fixation Tests; Female; Fluorescent Antibody Technique; Histoplasma; Histoplasmosis; Humans; Infant; Male; Methods; Sulfonamides

Topics: Adult; Amphotericin B; Chronic Disease; Female; Histoplasmosis; Humans; Lung Diseases, Fungal; Male; Postoperative Complications

Topics: Adolescent; Adult; Aged; Amphotericin B; Blastomycosis; Cryptococcosis; Female; Histoplasmosis; Humans; Lung Diseases, Fungal; Male; Middle Aged; Mycoses; Myocardial Infarction; Radiography

Topics: Amphotericin B; Animals; Antifungal Agents; Aspergillosis; Blastomycosis; Candidiasis; Cryptococcosis; Histoplasmosis; Humans; Mice; Mucormycosis; Mycoses; Nocardia Infections; Prognosis; Sulfanilamides; Sulfonamides

Topics: Adult; Amphotericin B; Histoplasmosis; Humans; Male; Uganda

Topics: Amphotericin B; Ampicillin; Candida; Chloramphenicol; Cortisone; Female; Histoplasmosis; Humans; Liver; Lupus Erythematosus, Systemic; Middle Aged; Prednisone; Salmonella paratyphi A; Urinary Tract Infections

Topics: Alkenes; Amphotericin B; Animals; Antifungal Agents; Blastomycosis; Coccidioidomycosis; Cryptococcosis; Female; Histoplasmosis; Mice

Topics: Adolescent; Adult; Aged; Amphotericin B; Bone Marrow; Cerebrospinal Fluid Proteins; Cryptococcosis; Cryptococcus; Culture Techniques; Feces; Female; Glucose; Histoplasma; Histoplasmosis; Humans; Intracranial Pressure; Male; Meningitis; Middle Aged; Skin; Sputum

Topics: Amphotericin B; Histoplasma; Histoplasmosis; Humans; Male; Middle Aged; Mouth Diseases; Pharyngeal Diseases; Time Factors

Topics: Adolescent; Adult; Aged; Amphotericin B; Child; Child, Preschool; Female; Histoplasmosis; Humans; Infant; Male; Middle Aged; Uveitis

Topics: Adrenal Cortex Hormones; Adult; Amphotericin B; Antitubercular Agents; Female; Histoplasmosis; Humans; Male; Radiography

Topics: Aged; Amphotericin B; Histoplasmosis; Humans; Male; Mouth Diseases; Oral Manifestations; Ulcer

Topics: Adult; Amphotericin B; Anti-Bacterial Agents; Endocarditis, Bacterial; Histoplasmosis; Humans; Lymph Nodes; Male; Mediastinal Diseases; Mitral Valve; Prednisone

Topics: Adolescent; Adult; Aged; Amphotericin B; Aspergillosis; Biopsy; Coccidioidomycosis; Cryptococcosis; Female; Histoplasmosis; Humans; Lung Diseases, Fungal; Male; Middle Aged; Nocardia Infections; Radiography

Topics: Amphotericin B; Histoplasmosis; Humans

Topics: Addison Disease; Adrenal Gland Diseases; Adult; Aged; Amphotericin B; Chronic Disease; Diagnosis, Differential; Female; Histoplasma; Histoplasmosis; Humans; Laryngeal Diseases; Male; Mechlorethamine; Middle Aged; Mouth Diseases; Oral Manifestations; Tongue Diseases

Topics: Amphotericin B; Histoplasmosis; Humans; Male; Middle Aged; Tongue Diseases; Ulcer

Topics: Adult; Amphotericin B; Chorioretinitis; Female; Histoplasmosis; Humans; Male; Middle Aged; Uveitis

Topics: Amphotericin B; Complement Fixation Tests; Histoplasmosis; Humans; Lung Diseases; Male; Middle Aged; Oral Manifestations; Tongue Diseases

Topics: Adult; Amphotericin B; Brain Diseases; Cerebral Ventriculography; Electroencephalography; Histoplasmosis; Humans; Liver Cirrhosis; Male

Topics: Adult; Amphotericin B; Histoplasmosis; Humans; Lung Diseases, Fungal; Male

Topics: Amphotericin B; Histoplasmosis; Humans; Lung Diseases, Fungal

Topics: Adrenal Cortex Hormones; Adult; Aged; Agranulocytosis; Amphotericin B; Anti-Bacterial Agents; Aspergillosis; Candidiasis; Child; Child, Preschool; Female; Histoplasmosis; Humans; Leukemia, Lymphoid; Leukemia, Myeloid, Acute; Lung Diseases, Fungal; Male; Middle Aged

Topics: Adult; Amphotericin B; Histoplasma; Histoplasmosis; Humans; In Vitro Techniques; Lung Diseases, Fungal; Middle Aged; Radiography, Thoracic; Tuberculosis, Pulmonary

Topics: Aged; Amphotericin B; Diagnosis, Differential; Histoplasmosis; Humans; Male; Respiratory Tract Infections

Topics: Amphotericin B; Animals; Ciliary Body; Eye Diseases; Histoplasmosis; Hyperemia; In Vitro Techniques; Iritis; Necrosis; Rabbits

Topics: Adult; Amphotericin B; Female; Histoplasmosis; Humans

Topics: Aged; Amphotericin B; Biopsy; Diagnosis, Differential; Histoplasmosis; Humans; Intestine, Small; Male; Radiography; Stomach Diseases; Stomach Neoplasms

Three cases of histoplasmosis, a disease seldom reported in California, were diagnosed clinically by the authors in San Diego County. It is probable that there is a higher incidence of this disease in California than is at present recognized. Travel history, histoplasmin skin testing and serologic studies for mycotic infection are important in the diagnosis. Cultures of secretions and biopsy material are of great value if positive; but negative cultures (at least in non-endemic areas) do not rule out the disease. Travel and migration to and from endemic areas present opportunities for this disease to constitute a diagnostic problem far from the geographic area in which the disease was acquired.Although usually benign, histoplasmosis may be severe in the acute state, may disseminate or may be chronically active and progressive. Amphotericin B is the only effective chemotherapeutic agent and it is usually reserved for these forms of the disease.

Topics: Amphotericin B; California; Child; Female; Histoplasmosis; Humans; Male; Middle Aged

Topics: Amphotericin B; Blastomycosis; Central Nervous System Diseases; Coccidioidomycosis; Cryptococcosis; Histoplasmosis; Humans; Meningitis; Mycoses; Penicillins; Sputum; Sulfonamides

Topics: Amphotericin B; Diagnosis; Drug Therapy; Fungi; Histoplasmosis; Lung Diseases; Lung Diseases, Fungal; Pathology; Radiography, Thoracic; Surgical Procedures, Operative

Topics: Adolescent; Amphotericin B; Child; Complement Fixation Tests; Drug Therapy; Histoplasmosis; Humans; Infant; Lung Diseases; Lung Diseases, Fungal; Mediastinum; Pericarditis; Prednisone; Radiography, Thoracic; Skin Tests; Tracheal Stenosis

Topics: Amphotericin B; Drug Therapy; Histoplasma; Histoplasmosis; Humans; Intestinal Diseases; Intraabdominal Infections; Pathology

Topics: Amphotericin B; Biomedical Research; Blastomycosis; Chlorpromazine; Coccidioidomycosis; Cryptococcosis; Drug Therapy; Fever; Histoplasmosis; Humans; Lactose; Nausea; Pentobarbital; Sporotrichosis; Toxicology; Vomiting

Topics: Amphotericin B; Colonic Diseases; Drug Therapy; Histoplasmosis; Humans; Rectum

Topics: Adrenocorticotropic Hormone; Amphotericin B; Blood Transfusion; Bone Marrow Examination; Drug Therapy; England; Geriatrics; Histoplasmosis; Lymphoma, Large B-Cell, Diffuse; Lymphoma, Non-Hodgkin; Neoplasms; Pathology; Prednisolone; Sarcoma; Toxicology

Topics: Agammaglobulinemia; Amphotericin B; Biopsy; Blood Protein Electrophoresis; Drug Therapy; Histoplasmosis; Humans; Intestinal Diseases; Intestinal Mucosa; Intestine, Small; Pathology; Protein-Losing Enteropathies; Radiography; Serum Albumin; Serum Albumin, Radio-Iodinated; Serum Globulins; South Africa

Topics: Amphotericin B; Coccidioidomycosis; Complement Fixation Tests; Histoplasmosis; Humans; Lung Diseases, Fungal; Male; Middle Aged

Topics: Amphotericin B; Anemia; Anemia, Aplastic; Bone Marrow Examination; Diagnosis, Differential; Histoplasmosis; Humans; Leukemia; Pancytopenia; Prednisolone

Topics: Adrenal Gland Diseases; Amphotericin B; Brain Diseases; Cerebrospinal Fluid; Cryptococcosis; Dermatomycoses; Diagnosis; Gastroenterology; Geriatrics; Histoplasmosis; Humans; Lung Diseases; Lung Diseases, Fungal; Meningitis; Pathology

Topics: Amphotericin B; Black People; Complement Fixation Tests; Diagnosis, Differential; Histoplasmosis; Humans; Infant; Lung Diseases; Lung Diseases, Fungal; Pathology; Radiography, Thoracic; Rest; Surgical Procedures, Operative; Tennessee; Tuberculosis; Tuberculosis, Pulmonary

Topics: Amphotericin B; Child; Diagnosis, Differential; Exudates and Transudates; Histoplasmosis; Humans; Lung Diseases; Pleural Effusion

Topics: Amphotericin B; Biopsy; Fungi; Histoplasmosis; Humans; Injections, Intravenous; Lung Diseases; Lung Diseases, Fungal; Pathology; Pharynx; Toxicology

Topics: Amphotericin B; Chronic Disease; Histoplasmosis; Humans; Pathology; Respiratory Tract Infections

Topics: Africa; Africa, Western; Amphotericin B; Anti-Bacterial Agents; Antibiotics, Antitubercular; Black People; Dermatologic Agents; Diagnosis; Epidemiology; Histoplasma; Histoplasmosis; Humans; Pathology; Radiography

Topics: Actinomycosis; Amphotericin B; Biomedical Research; Blastomycosis; Candidiasis; Coccidioidomycosis; Cryptococcosis; Cycloserine; Erythromycin; Histoplasmosis; Humans; Mycoses; Nocardia Infections; Penicillins; Pharmacology; Sporotrichosis; Stilbamidines; Sulfamerazine; Tetracycline

Topics: Actinomycosis; Amphotericin B; Anti-Bacterial Agents; Antifungal Agents; Aspergillosis; Blastomycosis; Candidiasis; Coccidioidomycosis; Cryptococcosis; Histoplasmosis; Humans; Iodides; Lung Diseases, Fungal; Nocardia Infections; Penicillin G; Sporotrichosis; Stilbamidines; Sulfonamides; Toxicology

Topics: Amphotericin B; Brain Neoplasms; Cerebral Cortex; Diagnosis, Differential; Drug Therapy; Histoplasmosis; Humans

Topics: Amphotericin B; Drug Therapy; Histoplasmosis; Humans; Lung Diseases; Lung Diseases, Fungal; Mexico; Prognosis; Toxicology

Topics: Amphotericin B; Antigen-Antibody Reactions; Child; Complement Fixation Tests; Drug Therapy; Fungi; Histoplasmosis; Humans; Infant; Lung Diseases; Lung Diseases, Fungal; Pathology; Radiography, Thoracic; Skin Tests; Sulfanilamide; Sulfanilamides; Sulfonamides

Topics: Amphotericin B; Child; Drug Therapy; Histoplasmosis; Humans; Infant; Lung Diseases; Lung Diseases, Fungal; Radiography, Thoracic; Sulfonamides; Tuberculosis; Tuberculosis, Pulmonary

Topics: Amphotericin B; Complement Fixation Tests; Diagnosis, Differential; Histoplasmosis; Humans; Lung Diseases; Lung Diseases, Fungal; Pathology; Radiography, Thoracic; Skin Tests; Toxicology

Topics: Amphotericin B; Blood; Blood Chemical Analysis; Blood Urea Nitrogen; Creatine; Creatinine; Cryptococcosis; Drug Therapy; Hematocrit; Histoplasmosis; Kidney Calculi; Kidney Diseases; Pathology; Phenolphthaleins; Potassium; Sodium; Sodium, Dietary; Toxicology; Urea; Urine

Topics: Adolescent; Africa; Amphotericin B; Black People; Bone Diseases; Child; Diagnosis; Fractures, Bone; Fractures, Spontaneous; Histoplasma; Histoplasmosis; Humans; Nigeria; Paraplegia; Pathology; Radiography; Ribs; Skull; Spinal Cord Compression; Spinal Diseases

Topics: Amphotericin B; Colonic Diseases; Histoplasmosis; Humans

Topics: Amphotericin B; Histoplasmosis; Humans

Topics: Amphotericin B; Blastomycosis; Coccidioidomycosis; Histoplasmosis; Humans; Mycoses

Topics: Amphotericin B; Histoplasmosis; Humans; Hypersensitivity; Silicon Dioxide

Topics: Amphotericin B; Histoplasmosis; Humans; Larynx

Topics: Amphotericin B; Histoplasmosis; Humans; South Africa

Topics: Amphotericin B; Biopsy; Epidemiology; Face; Histoplasmosis; Humans; Palate; Pharynx; Thailand; Tongue

Topics: Amphotericin B; Coloring Agents; Diagnosis, Differential; Histoplasmosis; Humans; Mouth; Oral Surgical Procedures; Pathology, Oral; Photomicrography; Staining and Labeling; Surgery, Oral

Topics: Adolescent; Amphotericin B; Auscultation; Biopsy; Complement Fixation Tests; Electrocardiography; Histoplasma; Histoplasmin; Histoplasmosis; Humans; Immunodiffusion; Pathology; Pericarditis; Precipitin Tests; Skin Tests

Topics: Amphotericin B; Cerebrospinal Fluid; Geriatrics; Histoplasma; Histoplasmosis; Humans; Meningitis

Topics: Amphotericin B; Bronchoscopy; Complement Fixation Tests; Histoplasmosis; Humans; Lung Diseases; Lung Diseases, Fungal; Pneumonectomy; Postoperative Complications; Skin Tests; Sputum

Topics: Actinomycosis; Amphotericin B; Aspergillosis; Blastomycosis; Candidiasis; Coccidioidomycosis; Histoplasmosis; Humans; Lung Diseases, Fungal; Nocardia Infections; Nystatin; Sulfadiazine

Case reports of three residents of Ontario with clinical histoplasmic chorioretinitis are presented. The diagnosis was made on the basis of the clinical appearance, the presence of calcified lesions in the chest, a negative skin test to tuberculin, and a positive skin test to toxoplasmin. All patients were treated with intravenous amphotericin B. Except for transitory elevation of blood urea nitrogen, there were no serious complications from the drug and in all cases the lesions in the eyes were improved. Histologic or cultural proof of the presence of fungus in the eye is not available, but clinical and laboratory findings can combine to point to the diagnosis of histoplasmosis. In such cases, since vision is at stake, treatment with amphotericin B should be considered.

Topics: Amphotericin B; Blood Chemical Analysis; Blood Urea Nitrogen; Canada; Chorioretinitis; Histoplasmin; Histoplasmosis; Humans; Hydrocortisone; Kidney Diseases; Leukocyte Count; Nitrogen; Ontario; Prednisone; Toxicology; Tuberculin Test; Urea

Topics: Amphotericin B; Angola; Epidemiology; Histoplasmosis; Humans; Lymph Nodes; Neck; Scalp

Topics: Actinomycosis; Amphotericin B; Anti-Bacterial Agents; Blastomycosis; Coccidioidomycosis; Cryptococcosis; Fungi; Histoplasmosis; Humans; Lung Diseases; Lung Diseases, Fungal; Nocardia Infections; Penicillins; Radiography, Thoracic; Sulfadiazine; Thoracic Diseases

Topics: Amphotericin B; Chorioretinitis; Diagnosis; Drug Therapy; Eye Diseases; Histoplasmosis; Humans

Topics: Amphotericin B; Anti-Bacterial Agents; Antifungal Agents; Drug Therapy; Fungi; Histoplasmosis; Humans; Lung Diseases, Fungal; Respiratory Tract Infections; Toxicology

Topics: Abscess; Amphotericin B; Chronic Disease; Histoplasmosis; Humans; Lung Abscess; Pulmonary Surgical Procedures; Respiratory Tract Infections

Topics: Amphotericin B; Antifungal Agents; Child; Fungicides, Industrial; Histoplasmosis; Infant

Topics: Amphotericin B; Histoplasmosis; Humans; Lung Abscess

Topics: Amphotericin B; Antifungal Agents; Endocarditis; Histoplasma; Histoplasmosis; Humans

Topics: Amphotericin B; Animals; Antifungal Agents; Fungicides, Industrial; Histoplasma; Histoplasmosis; Rabbits

Topics: Amphotericin B; Antifungal Agents; Child; Fungicides, Industrial; Histoplasmosis; Infant

Topics: Amphotericin B; Antifungal Agents; Chorioretinitis; Histoplasmosis; Retinitis; Uveitis

Topics: Amphotericin B; Antifungal Agents; Child; Fungicides, Industrial; Histoplasma; Histoplasmosis; Humans; Infant; Medical Records; Meningitis; Physiological Phenomena

Topics: Acute Disease; Amphotericin B; Antifungal Agents; Fungicides, Industrial; Histoplasmosis

Topics: Amphotericin B; Antifungal Agents; Fungicides, Industrial; Histoplasmosis; Lung Diseases

Topics: Amphotericin B; Antifungal Agents; Follow-Up Studies; Histoplasmosis; Humans; Lung Diseases

Topics: Amphotericin B; Antifungal Agents; Histoplasmosis; Humans

Topics: Amphotericin B; Antifungal Agents; Disease; Histoplasmosis; Humans; Lung Diseases; Medical Records; Mononuclear Phagocyte System

Topics: Amphotericin B; Antifungal Agents; Child; Histoplasmosis; Humans; Infant

Topics: Amphotericin B; Antifungal Agents; Child; Fungicides, Industrial; Histoplasmosis; Humans; Infant

Topics: Amphotericin B; Antifungal Agents; Fungicides, Industrial; Histoplasmosis; Humans

Topics: Amphotericin B; Antifungal Agents; Fungicides, Industrial; Histoplasmosis

Topics: Amphotericin B; Antifungal Agents; Fungicides, Industrial; Histoplasmosis