Disseminated histoplasmosis

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Case report of a young child with disseminated histoplasmosis and review of hyper immunoglobulin e syndrome (HIES)

Case report of a young child with disseminated histoplasmosis and review of hyper immunoglobulin e syndrome (HIES)

WSR contributed to literature search relevant to STAT3, interpretation of the results, and wrote the first draft of this report. SRA contributed to the diagnostic procedures for disseminated histoplasmosis, formulated treatment and prevention regimen, wrote the relevant section, and critically revised the report. CFM contributed to overall diagnostic procedures and management, and critical revision of the report. JDV carefully assessed HIES scores (Table 1), contributed to literature search, the section pertaining to the Th17 cell and fungal infection pathogenesis aspect. RAS contributed to the critical diagnostic procedures for disseminated histoplasmosis and immune deficiency, formulated treatment regimen, and critically revised the manuscript. EKP contributed to genetic evaluation and interpretation of the STAT3 variant results, and critical manuscript revision. JCW contributed to genetic evaluation, interpretation of the STAT3 variant results, and critical manuscript revision. VN conducted Th17 cell analysis. DBL directed overall diagnostic priorities and management, contributed to literature search and manuscript preparation. All authors read and approved the final manuscript.
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Progressive disseminated histoplasmosis presenting with cachexia and hypercalcemia

Progressive disseminated histoplasmosis presenting with cachexia and hypercalcemia

drome, long-standing fever, and night sweats. The infection may involve multiple organ systems, including the gastro- intestinal tract (with resulting ulceration), adrenal glands (precipitating adrenal insufficiency), the reticuloendothelial system (causing hepatosplenomegaly), bone marrow (leading to pancytopenia), the central nervous system, and the lungs. On rare occasions, progressive disseminated histoplasmosis has been associated with hypercalcemia, and this is attributed to increased 1, 25 dihydroxyvitamin D production from the fungal granulomas. 4–10

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Disseminated Histoplasmosis in an Immunocompetent Patient from a Non Endemic Region, North India: Pointers to Potential Endemicity

Disseminated Histoplasmosis in an Immunocompetent Patient from a Non Endemic Region, North India: Pointers to Potential Endemicity

Progressive Disseminated Histoplasmosis (PDH) reported worldwide is yet a rare entity in India. Although, usually associated with an underlying immunocompromised state but few reports of this disease in non- immunocompetent individuals have been surfacing in last decade. We report PDH from Himalayan state of Uttarakhand North India in an agriculturist, non immunocompromised who

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A case report of disseminated histoplasmosis and concurrent cryptococcal meningitis in a patient treated with ruxolitinib

A case report of disseminated histoplasmosis and concurrent cryptococcal meningitis in a patient treated with ruxolitinib

To the best of our knowledge this is the first case of both disseminated histoplasmosis and cryptococcal men- ingitis. This case draws attention to three key factors. The first is the degree of immunosuppression seen with ruxolitinib and the increasing number of reported fungal cases associated with the drug [5–8]. The second, which was noted on initial phase III trials of ruxolitinib, but must be emphasized, is that the adverse effects from immunosuppression may occur at various intervals after the initiation of ruxolitinib. And third, there is a scarcity of clinical trials and pharmacokinetic studies on the newer azoles that can support their use as step down therapy in severe CNS infections with these fungi.
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Disseminated histoplasmosis in an immunocompetent individual diagnosed with gastrointestinal endoscopy: a case report

Disseminated histoplasmosis in an immunocompetent individual diagnosed with gastrointestinal endoscopy: a case report

Histoplasmosis is one of the invasive fungal infections and presents with symptoms mainly in the lungs [1]. Disseminated histoplasmosis (DH) is rare and its lesions in the gastrointestinal tract are even uncommon [1–3]. The concomitant involvement of the upper and lower gastrointestinal tract has never been described in the immunocompetent individuals. Here, a case of dissemi- nated histoplasmosis in the non-endemic area was pre- sented in an immunocompetent patient diagnosed by gastrointestinal endoscopy.

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Case of disseminated histoplasmosis in a HIV infected patient revealed by nasal involvement with maxillary osteolysis

Case of disseminated histoplasmosis in a HIV infected patient revealed by nasal involvement with maxillary osteolysis

Background: Disseminated Histoplasmosis (DH) is a rare manifestation of Acquired Immune Deficiency Syndrome (AIDS) in European countries. Naso-maxillar osteolysis due to Histoplasma capsulatum var. capsulatum ( Hcc) is unusual in endemic countries and has never been reported in European countries. Differential diagnoses such as malignant tumors, cocaine use, granulomatosis, vasculitis and infections are more frequently observed and could delay and/or bias the final diagnosis.

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Disseminated Histoplasmosis in a Mon Immunocompromised Child

Disseminated Histoplasmosis in a Mon Immunocompromised Child

Disseminated Histoplasmosis in a Non Immunocompromised Child Disseminate d Histo plasmosis in a Non~ Immunocompromised Child M Hasliza, MBBS (Mal) * , N A Nur Atiqah, MRCP (Paed), C B Lim, MRCP (Paed)[.]

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Disseminated Histoplasmosis Presenting as Skin Nodules

Disseminated Histoplasmosis Presenting as Skin Nodules

Discussion: Histoplasmosis is a rare fungal infection caused by dimorphic fungus Histoplasma capsulatum, occurring in AIDS patients and other immunocompromised individuals. It usually causes pulmonary infection, following which dissemination to the other parts of the body can occur through lymphatics and bloodstream. Skin lesions mimicking tuberculosis or malignancy can be presenting feature of disseminated histoplasmosis in 10% of patients. Histoplasmosis is endemic in Central and South America and Africa. In India it is endemic in east Indian states.
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Multicenter Validation of Commercial Antigenuria Reagents To Diagnose Progressive Disseminated Histoplasmosis in People Living with HIV/AIDS in Two Latin American Countries

Multicenter Validation of Commercial Antigenuria Reagents To Diagnose Progressive Disseminated Histoplasmosis in People Living with HIV/AIDS in Two Latin American Countries

Settings and study design. We analyzed retrospectively residual urine samples collected from patients seen at two HIV clinics, one in Guatemala City, Guatemala (Clínica Familiar Luis Angel García/ Hospital General San Juan de Dios), and the other in Medellín, Colombia (Hospital La María). These urine samples were collected using the same study protocol (CDC protocol 4250) and were tested using the CDC polyclonal ELISA (HPA) (10, 23). Samples were collected from 2008 to 2014 and stored at ⫺ 80°C. We included 589 urine samples from the two regions of endemicity (Guatemala, n ⫽ 466; Colombia, n ⫽ 80). Of the 546 samples from PLHIV, 63 were from cases confirmed to have histoplasmosis by isolation of H. capsulatum from clinical samples (35 from Guatemala and 28 from Colombia). Of the remaining 483 patients infected with HIV, 371 were reported to be infected only with HIV and 112 patients were diagnosed with other infections. Mycobacterium disease was diagnosed in 87 of these 112 patients, with 65 of these 87 patients having Mycobacterium tuberculosis infection and 22 having other mycobacterial infections. Other fungal infections were diagnosed in 21 patients: cryptococcosis (n ⫽ 12), Pneumocystis pneumonia (n ⫽ 3), paracoccidioidomycosis (PCM; n ⫽ 3), aspergillosis (n ⫽ 2), and candidiasis (n ⫽ 1). Bacterial infections by Salmonella enterica were diagnosed in 2 patients, and parasitic infection by Toxoplasma and viral infection by cytomegalovirus were diagnosed in 1 patient each. Finally, we added to the analysis a total of 43 urine samples from non-HIV-infected controls. The patients’ samples are described in Fig. 1.
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ACUTE DISSEMINATED HISTOPLASMOSIS IN CHILDREN

ACUTE DISSEMINATED HISTOPLASMOSIS IN CHILDREN

normal glandular structure and reticuloendothelial cells contained many yeast-like bodies similar to those seen in the liver and spleen.. Adrenal glands and kidneys were not involved.[r]

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Treatment Of Disseminated Histoplasmosis With Ethyl Vanillate

Treatment Of Disseminated Histoplasmosis With Ethyl Vanillate

Four months prior to admission she developed fever, cough and progressive weight loss. capsulatum was isolated from the bone marrow and blood at Louisville Children’s Hospital. She was g[r]

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Acute histoplasmosis in immunocompetent travelers: a systematic review of literature

Acute histoplasmosis in immunocompetent travelers: a systematic review of literature

We were able to identify in the literature 814 cases of histoplasmosis acquired by immunocompetent travelers, for a total of 835 patients including those diagnosed at CTD. Considering that this occurrence is certainly under-diagnosed and under-reported, we assume that the published cases must be the tip of the iceberg. We hope that our systematic review may contribute to raise awareness of the possible occurrence of this condition in travelers visiting endemic countries/areas. It is true that most cases are clinically not severe, nevertheless most of the subjects presented symptoms of various degree, moreover usually long lasting, often implying otherwise unnecessary, invasive diagnostic procedures under the suspicion of more common (and serious) causes such as TB or lung malignancies. Only less than 10% of the sub- jects were apparently asymptomatic, although it should be recognized the low probability of a pauci- or asymptomatic case to be identified and described in the literature. Of particular note, a relatively large group of patients had Disseminated Histoplasmosis (DH), confirming that this condition, although typical of immunosuppressed individuals, may also occur in immunocompetent subjects. Moreover, given the long course of the infection, an unrecognized/untreated case of histoplasmosis may reactivate later in life, under immune suppressant conditions. Are there any definite risk factors for DH in immunocompetent in- dividuals? We found several associations between dis- seminated histoplasmosis and other covariates at univariate analysis (Table 2). However, these results appear to be very inconsistent and were not con- firmed by multivariate analysis and therefore no con- clusion can be drawn from them. At multivariate analysis, the only risk factors resulting significant were exposition to cave-bats and outdoor activities. We found no association between the attack rate and the different endemic areas, hence we cannot suppose that there is a difference in the aggressiveness of the different strains throughout the world. In contrast with this conclu- sion, some authors [86 – 90] supposed that different and Table 2 Baseline Demographic and Travel Characteristics of the
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Histoplasmosis Presenting as Granulomatous Hepatitis: Case Report and Review of the Literature

Histoplasmosis Presenting as Granulomatous Hepatitis: Case Report and Review of the Literature

Background. Histoplasma capsulatum is the most common endemic mycosis in the United States and is a frequent cause of opportunistic infection in immunodeficient hosts. Histoplasmosis is most often self-limiting and goes unrecognized in the immunocompetent population but can progress to disseminated histoplasmosis in patients with an impaired immune system. Liver involvement as a part of disseminated histoplasmosis which usually originates in the lung is well known. However, extrapulmonary hepatic histoplasmosis as a primary manifestation is extremely rare. Case Presentation. We report a rare case of histoplasmosis that presented as persistent fever and abnormal liver function tests in a 66-year-old female with rheumatoid arthritis, receiving infliximab. Conclusion. Emphasizing histoplasmosis as a major cause of acute granulomatous hepatitis and fever of unknown origin in cell mediated immunodeficient population, this case highlights the need for high index of suspicion and the importance of prompt diagnosis since any delay of treatment can be life threatening in this population.
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Evaluation of Commercially Available Reagents for Diagnosis of Histoplasmosis Infection in Immunocompromised Patients

Evaluation of Commercially Available Reagents for Diagnosis of Histoplasmosis Infection in Immunocompromised Patients

One of the earliest immunoassays for the detection of urine histoplasma antigen used polyclonal antibodies against histo- plasma galactomannan for both capture and detection (8, 9), and early publications showed the utility of this assay for the diagnosis and management of patients with disseminated histoplasmosis. The clinical sensitivity (Sn) and specificity (Sp) of the assay have been well characterized in a variety of populations (10–13), and several generations of laboratory-developed tests (LDTs) based on the approach have been offered by one of the largest histoplasma reference laboratories in the United States (MiraVista Diagnos- tics, Indianapolis, IN). Because the reagents used in the assay are not commercially available, alternative assays have been evaluated by other investigators with varying success. An LDT assay using a similar format but based on a commercially available polyclonal anti-Histoplasma antibody showed reasonable analytical perfor- mance but had limited clinical validation data (14). A similar en- zyme immunoassay (EIA) developed by the Centers for Disease Control and Prevention using an in-house-produced polyclonal antibody demonstrated 85% sensitivity in AIDS patients (15).
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Miliary Histoplasmosis in a Patient with Rheumatoid Arthritis

Miliary Histoplasmosis in a Patient with Rheumatoid Arthritis

There are no randomized controlled studies that es- tablish the optimal duration of treatment for pulmonary miliary histoplasmosis. Relapse of histoplasmosis after treatment is a valid concern, especially in immunocom- promised patients. Studies assessing optimal treatment duration of histoplasmosis in immunocompromised pa- tients have been limited to AIDS patients, solid-organ transplant recipients, and bone marrow transplant re- cipients. A 2014 multicenter retrospective cohort study by Myint et al. evaluated the Infectious Diseases Society of America (IDSA) guideline recommendations on when to discontinue antifungal therapy in patients with AIDS and histoplasmosis. The study concluded that antifungal therapy could be discontinued in patients who were adherent to therapy and completed at least 1 year of antifungal treatment, had a CD4 count >150 cells/mL, HIV RNA <400 copies/mL, Histoplasma urine antigen <2 ng/mL, and no CNS involvement [20]. However, our patient’s clinical characteristics are different from those previously studied since our patient has rheumatoid arthritis that requires chronic immunosuppression. In patients with progressive disseminated histoplasmosis who remain immunocompromised, it is suggested to treat indefinitely [1]. In a 2017 review of histoplasmosis in transplant recipients, it was recommended that patients with posttransplant histo- plasmosis complete at least 12 months of therapy, show clinical resolution of signs and symptoms of infection, and have a urine and serum Histoplasma antigen <2 ng/mL before discontinuing therapy [21]. After discontinuing therapy, patients should be monitored for clinical signs of infec- tion and have Histoplasma antigens measured every three months. In our patient, monitoring of Histoplasma anti- gens may be difficult to interpret as he had both a negative serum and urine Histoplasma antigen in the presence of active infection.
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Histoplasmosis Myocarditis in an Immunocompetent Host After a Recreational Mud Run

Histoplasmosis Myocarditis in an Immunocompetent Host After a Recreational Mud Run

Mud runs are an increasingly popular recreational fitness activity across the United States, combining a running race through an obstacle course with submersion in mud.‍ Recent reports estimate 4 million people have participated in these types of events over the last 5 years.‍ We describe an atypical case of myocarditis and multiorgan failure from disseminated histoplasmosis in a previously healthy pediatric patient, likely acquired during participation in a mud run.‍ Although cases of histoplasmosis- associated endocarditis and pericarditis have been reported in the literature, cases of histoplasmosis myocarditis are rare.‍
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Cryptococcal fungemia and probable histoplasmosis in a patient infected with HIV  Case report

Cryptococcal fungemia and probable histoplasmosis in a patient infected with HIV Case report

Other laboratory tests showed hyperferritinemia (pa- tient value = 1000 ng/mL, reference value 23–336 ng/ mL) and mild elevation of alkaline phosphatase (patient value = 152 U/L, reference value = 38–126 U/L) which raised suspicion for histoplasmosis due to the findings of hepatomegaly, skin rash and the random micronodular compromise seen in the chest images. A galactomannan antigen test for Histoplasma capsulatum was performed in urine (with enzyme immunoassay (EIA), Immuno Mycologics IMMY) and was positive with 137 ng / mL (reference value < 0.5 ng / ml), which confirmed the diagnosis of disseminated histoplasmosis. Due to these findings, fluconazole was stopped and maintenance ther- apy was initiated with Itraconazole 200 mg T.I.D for three days and then B.I.D at least for 1 year.
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Gastrointestinal Histoplasmosis Presenting as an Acute Abdomen with Jejunal Perforation

Gastrointestinal Histoplasmosis Presenting as an Acute Abdomen with Jejunal Perforation

[2] M. Assi, D. S. McKinsey, M. R. Driks et al., “Gastrointestinal histoplasmosis in the acquired immunodeficiency syndrome: report of 18 cases and literature review,” Diagnostic Micro- biology and Infectious Disease, vol. 55, no. 3, pp. 195–201, 2006. [3] A. Putot, S. Perrin, A. Jolivet, and V. Vantilcke, “HIV- associated disseminated histoplasmosis in western French Guiana, 2002–2012,” Mycoses, vol. 58, no. 3, pp. 160–166, 2015. [4] K. N. Suh, T. Anekthananon, and P. R. Mariuz, “Gastroin- testinal histoplasmosis in patients with AIDS: case report and review,” Clinical Infectious Diseases, vol. 32, no. 3, pp. 483–491, 2001.
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Adrenal histoplasmosis in Cushing's Syndrome with bilateral adrenocortical nodular hyperplasia

Adrenal histoplasmosis in Cushing's Syndrome with bilateral adrenocortical nodular hyperplasia

Adrenal histoplasmosis in Cushing's Syndrome with bilateral adrenocortical nodular hyperplasia Adrenal histoplasmosis in Cushing's Syndrome with bilateral adrenocortical nodular hyperplasia T T Tan, M[.]

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<p>HIV-Associated Histoplasmosis: Current Perspectives</p>

<p>HIV-Associated Histoplasmosis: Current Perspectives</p>

Another study from Kansas City, where skin test reac- tivity among Navy groups was 43% 33 stated “ the patho- physiology of histoplasmosis in patients with AIDS involves reactivation of latent infection in some cases. ” 1 However, the annual incidence among patients with CD4 counts <150 cells/µL that were felt to have been exposed to Histoplasma previously (reactive skin test, pulmonary calci fi cations or positive serology) was no different than in those with no prior exposure, 15.9% and 13.5%, respec- tively. They concluded that “ the incidence of histoplasmo- sis was too low to determine whether a reactivation occurred more frequently than dissemination of exogen- ously acquired infection ” .
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