Primary cutaneous histoplasmosis difficult to treat in immunocompetent patient: case report and literature review

Abstract

Histoplasmosis is an infection caused by the dimorphic fungus Histoplasma capsulatum. The disease is endemic in several regions of tropical and temperate climate. The fungus presents opportunistic behavior, causing widespread infection in immunocompromised patients, resulting from complication of primary pulmonary infection, due to exogenous reinfection or reactivation of a quiescent source. In immunocompetent individuals, approximately 95% of pulmonary infections are asymptomatic. However, prolonged exposure to high amount spores may lead to acute or chronic lung infection. Due to the low amount of inoculum, primary cutaneous histoplasmosis caused by traumatic implantation is extremely rare and effectively treated with triazoles. Thus, the present study aims to report a case of primary cutaneous histoplasmosis that is difficult to treat in an immunocompetent patient, and to review the literature on the incidence of drug-resistant Histoplasma capsulatum strains in clinical practice.

Is Micro and Nanotechnology Helping Us Fight Histoplasmosis?

“…Currently, only AmBisome® has been evaluated in the treatment of disseminated histoplasmosis [2,31]. Besides, some case reports have also stressed its clinical efficacy in the rare primary cutaneous form of the disease in immunocompetent patients [9][10][11].…”

“…The infection is caused by inhaling aerosols that contain the infecting particles of the dimorphic fungus, Histoplasma capsulatum and it affects most frequently the lung [8]. Nevertheless, it can also affect the skin [9][10][11], and the central nervous system (CNS) causing meningitis [12] or even evolve into a progressive disseminated infection that may trigger an inflammatory response and bring rheumatological and heart complications (pericarditis), with high morbidity rates [13,14].…”

“…The disease severity spectrum ranges from asymptomatic or mild lung disease to severe pneumonitis with respiratory compromise, depending on inoculum amount, exposure intensity, and host's immunity [9,14,15].…”

Histoplasmosis diseminada con manifestaciones cutáneas en síndrome inflamatorio de reconstitución inmune: reporte de caso

“…La Histoplasmosis es una micosis producida por el hongo dimórfico Histoplasma capsulatum, el cual se encuentra en forma de micelio filamentoso, con micro y macroconidias en terrenos contaminados con materia fecal de aves y murciélagos 3,4 . Presenta una distribución mundial siendo endémica en zonas tropicales y templadas como gran parte de Latinoamérica, África y Asia oriental 2,4 .…”

“…En el curso clínico de la enfermedad se presentan síntomas dados por fiebre, pérdida de peso, dolor torácico retroesternal, disnea progresiva y lesiones mucocutáneas; estas últimas caracterizadas por una presentación tardía y heterogénea. En adición a lo anterior, la histoplasmosis diseminada progresiva puede provocar manifestaciones severas incluyendo disfunción hepática, encefalopatía, pancitopenia, coagulación intravascular diseminada y shock séptico 2,3,4 .…”