Disseminated Histoplasmosis in Patients With AIDS

Nightingale, Steven; Parks, James J.; Pounders, Steven; Burns, Dennis K.; Reynolds, Jack; Hernandez, J. M.

doi:10.1097/00007611-199006000-00007

Cited by 60 publications

(24 citation statements)

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“…In a series of 980 patients with AIDS studied by Nightingale et al, those with disseminated histoplasmosis had a median CD4 count of 33/mm 3 . 22 Aspergillosis is rare and occurs in patients with CD4 counts below 50/mm 3 . 23 Risk factors for aspergillosis include neutropenia, corticosteroid use, and underlying lung disease.…”

Section: Pneumoniamentioning

confidence: 99%

Diagnosing HIV-Related disease

Jung

Paauw

1998

J Gen Intern Med

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OBJECTIVE: To summarize current information on the relation between CD4 counts and the risk of different HIV-related diseases. MEASUREMENTS AND MAIN RESULTS: MEDLINE search ofEnglish language articles between 1985 and 1996 using the medical subject heading (MeSH) term "CD4 lymphocyte count" and searches using key words of multiple HIV-related diseases were conducted. Some HIV-related diseases can be stratified to different CD4 count levels. Regardless of their CD4 count, HIV-infected patients are susceptible to sinusitis, Kaposi's sarcoma, community-acquired pneumonia, and oral hairy leukoplakia. In advanced HIV, when CD4 is below 200/ mm 3 , Pneumocystis carinii pneumonia, toxoplasmosis, progressive multifocal leukoencephalopathy, Mycobacterium avium complex, molluscum contagiosum, and bacillary angiomatosis all increase in incidence. In very advanced HIV disease, when CD4 counts are below 50/mm 3 , patients are at risk of pseudomonas pneumonia, cytomegalovirus retinitis, central nervous system lymphoma, aspergillosis, and disseminated histoplasmosis.KEY WORDS: CD4 count; HIV-related disease; risk stratification. J GEN INTERN MED 1998;13:131-136.

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Section: Pneumoniamentioning

confidence: 99%

Diagnosing HIV-Related disease

Jung

Paauw

1998

J Gen Intern Med

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“…While infections are typically self-limited in immunocompetent individuals, patients with impaired T-cell immunity are susceptible to developing acute pulmonary infection and subsequent disseminated disease [2]. In the Ohio and Mississippi river valleys where the organism is endemic, disseminated histoplasmosis remains a common and potentially life-threatening AIDS-defining illness [3]. Histoplasma capsulatum is a thermally dimorphic fungus, growing in a filamentous mycelial form in the soil and as an encapsulated yeast at 37°C or higher in the body.…”

Section: Introductionmentioning

confidence: 99%

Duodenal Histoplasmosis Presenting with Upper Gastrointestinal Bleeding in an AIDS Patient

Spinner

Paulin

Wester

2012

Case Reports in Gastrointestinal Medicine

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Gastrointestinal histoplasmosis (GIH) is common in patients with disseminated disease but only rarely comes to clinical attention due to the lack of specific signs and symptoms. We report the unusual case of a 33-year-old Caucasian male with advanced AIDS who presented with upper GI bleeding from diffuse erosions throughout the duodenum. Biopsy of the lesions revealed small bowel mucosa with granulomatous inflammation and macrophages with small intracellular yeasts consistent with disseminated histoplasmosis. The patient demonstrated significant clinical improvement following a two-week course of liposomal amphotericin B. To our knowledge, this is the first case report of duodenal histoplasmosis leading to clinically significant bleeding, manifesting with worsening anemia and melanotic stools. Given our findings, we maintain that GIH should be considered on the differential diagnosis for GI bleeding in AIDS patients at risk, specifically those with advanced immunosuppression (i.e., CD4+ cell counts <100 cells/mm3) who reside in endemic areas (Ohio or Mississippi river valleys) and/or have a prior history of histoplasmosis. For diagnostic evaluation, we recommend checking a urine Histoplasma quantitative antigen EIA as well as upper and/or lower endoscopy with biopsy. We recommend treatment with a two-week course of liposomal amphotericin B followed by indefinite itraconazole.

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“…Microscopic identification of histoplasma in May-Grünwald-Giemsa-stained slides is an acceptable approach, but an experienced operator is needed to obtain reliable results. The fungus can be cultured from different sources such as blood, bone marrow, respiratory secretions, or localized skin lesions in more than 85% of the cases (11,12,17,20). Cultures from bone marrow yield the highest frequency of positive isolations (70 to 90%), while respiratory specimens give positive results less frequently (50 to 90%).…”

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confidence: 99%