Delayed Diagnosis of Pulmonary Histoplasmosis in an Immunocompetent Young Asthmatic Female from Florida, a Non-Endemic Area for Histoplasma Capsulatum

Gudala, Meghana; Hegde, Satyanarayan

doi:10.21767/2471-8521.100001

Cited by 5 publications

(3 citation statements)

References 33 publications

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“…Delay of diagnosis can lead to progression of disease, as can inappropriate treatment. If inflammatory causes are incorrectly suspected, corticosteroid use would likely lead to progression of histoplasmosis [22].…”

Section: Discussionmentioning

confidence: 99%

Difficult to Diagnose: An Unusual Cause of Cavitary Lung Lesion

2020

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Objective: Unknown ethiology Background: Cavitary lung lesions are commonly identified on thoracic imaging, but typically require further workup for definitive diagnosis. Case Report: Here, we present the case of a 40-year-old Middle Eastern male who presented with an unusual cause of cavitary lung lesion with associated pleural mass and pleural thickening. He underwent bronchoscopic biopsy and computer tomography (CT)-guided core needle biopsy, both of which were non-diagnostic. Surgical biopsy subsequently revealed hyalinized necrotizing granulomatous tissue, consistent with histoplasmosis, and the patient was treated with itraconazole, which he responded well to. Conclusions: This case demonstrates the importance of identifying unusual causes of cavitary lung lesions and emphasizes the role of using proper tissue sampling for diagnosis.

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Section: Discussionmentioning

confidence: 99%

Difficult to Diagnose: An Unusual Cause of Cavitary Lung Lesion

2020

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“…Individuals from endemic areas of H. capsulatum will have been exposed early in life and therefore likely have a memory response to Histoplasma . However, non-endemic asthmatics visiting an endemic region may be more susceptible to developing histoplasmosis, as a case study of a young asthmatic who developed pulmonary histoplasmosis after visiting an endemic region shows (39).…”

Section: Discussionmentioning

confidence: 99%

Aeroallergens Exacerbate Histoplasma capsulatum Infection

Bueter

Deepe

2018

The Journal of Immunology

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Allergens such as house dust mites (HDM) and papain induce strong Th2 responses, including elevated IL-4, IL-5 and IL-13 and marked eosinophilia in the airways. Histoplasma capsulatum (H. capsulatum) is a dimorphic fungal pathogen that induces a strong Th1 response marked by IFNγ and TNFα production, leading to rapid clearance in non-immunocompromised hosts. Th1 responses are generally dominant and overwhelm the Th2 response when stimuli for both are present, though there are instances when Th2 stimuli downregulate a Th1 response. We determined if the Th2 response to allergens prevents the host from mounting a Th1 response to H. capsulatum in vivo. C57BL/6 mice exposed to HDM or papain and infected with H. capsulatum exhibited a dominant Th2 response early, characterized by enhanced eosinophilia and elevated Th2 cytokines in lungs. These mice manifested exacerbated fungal burdens, suggesting that animals skewed towards a Th2 response by an allergen are less able to clear the H. capsulatum infection despite an intact Th1 response. On the other hand, secondary infection is not exacerbated by allergen exposure, indicating the memory response may suppress the Th2 response to HDM and quickly clear the infection. In conclusion, an in vivo skewing towards Th2 by allergens exacerbates fungal infection, even though there is a concurrent and unimpaired Th1 response to H. capsulatum.

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“…During the histopathological observation, other organisms also could mimic the appearance like that of H. capsulatum. So, this could be eliminated by using another stain like methenamine silver or periodic acid-Schiff stains, which visualize H. capsulatum [30]. Detection of circulating Histoplasma associated antigen in urine and serum is another diagnostic option to detect the presence of the fungi using an immunological technique like sandwich enzyme immunoassay (EIA), and it was first described in 1986 [31].…”

Section: Identification Of H Capsulatum and Diagnosis Of Histoplasmosismentioning

confidence: 99%

Infectious sources of Histoplasmosis and molecular techniques for its identification

Bhandari

Rayamajhee²,

Dhungel

et al. 2019

Nepal J Biotechnol

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Histoplasmosis, a fungal infection caused by Histoplasma capsulatum (H. capsulatum), acquired from contaminated soil with droppings of chicken or birds and found to be distributed in many parts of the world. The prevalence of histoplasmosis has not well studied in Nepal. The common symptoms of acute and epidemic histoplasmosis include high fever, cough, and asthenia and weight loss. Most of the infections associated with histoplasmosis are asymptomatic. People with compromised immune systems such as HIV/AIDS (PLWHA), cancer, and organ transplant recipients are at risk of developing this disease. In this review, we have summarised the current status of histoplasmosis in Nepal and molecular techniques available for its identification. To date, the significant outbreak is not reported in Nepal, but the risk of infection for the vulnerable population cannot be undermined. Appropriate preventive measures and treatment on time can reduce the burden of this fungal disease. Further, this review is also focused on molecular identification of H. capsulatum. Hence, careful considerations by concerned stakeholders for national surveillance programs and the treatment of patients on time after proper diagnosis is highly recommended.

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Delayed Diagnosis of Pulmonary Histoplasmosis in an Immunocompetent Young Asthmatic Female from Florida, a Non-Endemic Area for Histoplasma Capsulatum

Cited by 5 publications

References 33 publications

Difficult to Diagnose: An Unusual Cause of Cavitary Lung Lesion

Difficult to Diagnose: An Unusual Cause of Cavitary Lung Lesion

Aeroallergens Exacerbate Histoplasma capsulatum Infection

Infectious sources of Histoplasmosis and molecular techniques for its identification

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