Esophageal fistula complicating mediastinal histoplasmosis

Coss, Kevin C.; Wheat, L. Joseph; Conces, Dewey J.; Brashear, Richard E.; Hull, Meredith T.

doi:10.1016/0002-9343(87)90709-1

Cited by 21 publications

(5 citation statements)

References 11 publications

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“…The duration of symptoms depends upon the extent of exposure, underlying lung disease, general immune status and specific immunity to H. capsulatum. Mediastinal lymph nodes are the most common site of involvement while EB involvement is rare [128]. In this review, patients presented mainly with hemoptysis (72%) probably related to fibrosing mediastinitis.…”

Section: Discussionmentioning

confidence: 99%

Endobronchial Fungal Disease: An Under-Recognized Entity

Karnak

Avery²,

Gildea

et al. 2006

Respiration

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Most fungi enter the human body via inhalation; however, endobronchial fungal infection (EBFI) seems to be a rare manifestation compared to pulmonary or systemic disease. This presentation seems to be related to environmental factors as well as to the host status. With the increasing popularity of flexible bronchoscopy, it is being recognized with a higher frequency. Bronchoscopic findings in EBFI vary from mild mucosal inflammation to central airway obstruction. We searched English literature related to the topic and found 228 total cases of EBFI: Aspergillus species (121), Coccidioides immitis (38), Zygomycetes (31), Candida species (14) Cryptococcus neoformans (13), and Histoplasma capsulatum (11). We have also included a single case of endobronchial Pseudallescheria boydii infection in a lung transplant recipient that has not been reported previously. Most patients were immunocompromised, exhibited systemic manifestations of the primary infection, and responded to appropriate therapy. EBFI should be included in the differential diagnosis of any form of airway lesions in immunocompromised patients, especially among residents from the endemic areas.

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Section: Discussionmentioning

confidence: 99%

Endobronchial Fungal Disease: An Under-Recognized Entity

Karnak

Avery²,

Gildea

et al. 2006

Respiration

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“…If necrotic, these nodes may erode into adjacent structures, producing fistula. While enlarged nodes regress spontaneously, antifungal therapy may be useful in the more symptomatic cases (39)(40)(41)(42)(43).…”

Section: Self-limited Histoplasmosis With Low-inoculummentioning

confidence: 99%

Diagnosis and management of Histoplasmosis

1989

Eur. J. Clin. Microbiol. Infect. Dis.

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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.

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“…Case 2 demonstrates an esophageal fistula that presumably resulted from decompression of the inflammatory contents of an infected node through the esophageal wall. 6 Histoplasmosis is acquired by inhaling aerosolized spores of the mycelial form of H. capsulatum that are released when contaminated sites are disturbed. 7 The diagnosis of histoplasmosis is usually established with serological tests.…”

Section: Discussionmentioning

confidence: 99%