Histoplasmose pulmonar cavitária crônica simulando tuberculose

Abstract

Objective: To evaluate cases of chronic pulmonary histoplasmosis diagnosed in recent years at the Complexo Hospitalar Santa Casa in Porto Alegre, in the state of Rio Grande do Sul, Brazil. Methods: Cases diagnosed at the Santa Casa Hospital Complex within the last 25 years were reviewed. Four cases in which the diagnosis was made through histopathological analysis or culture and confirmed by with serologic testing are described. Cases from the Brazilian literature are also discussed. Results: The principal clinical manifestations were cough, dyspnea, fever, anorexia and weight loss. Among the radiological findings were emphysema, cystic cavities, bronchiectasis and pleural thickening. All patients had an epidemiological history of contact with chicken feces. One of the patients presented Aspergillus fumigatus colonization of cavities. Conclusion: Chronic pulmonary histoplasmosis must be considered in patients with chronic obstructive pulmonary disease presenting cavitary lesions of the lung, sputum smear microscopy negative for acid-fast bacilli and negative tuberculin skin test. Hemoptysis occurring in the presence of cured or fading pulmonary lesions is suggestive of Aspergillus colonization. Original ArticleJ Bras Pneumol. 2005;31(4):318-24Chronic pulmonary histoplasmosis mimicking tuberculosis 319

Mapping histoplasmosis in South East Asia – implications for diagnosis in AIDS

“…Additionally, as primary pulmonary histoplasmosis is usually asymptomatic or mild it will go largely unreported. The chronic pulmonary form of the disease is easily misdiagnosed as tuberculosis [50,51] leading to lack of recognition and under reporting. Therefore, the high percentage of disseminated disease in our literature should not be taken as representative of the disease pattern in South East Asia.…”

“…Positivity rates are epidemiologically useful in the study of histoplasmosis. The global rate of histoplasmin positivity rate is 5–14%, while it may reach 80–90% in the hyperendemic areas [51]. The rate of histoplasmin test reactivity was 13.6% among the healthy population in Indonesia and there was a significant correlation between reactivity and animal, presence of bat, cave adventure and history of visiting forest area [38].…”

Loop-mediated Isothermal Amplification and nested PCR of the Internal Transcribed Spacer (ITS) for Histoplasma capsulatum detection

“…Furthermore, the symptoms of disseminated histoplasmosis are nonspecific, such as fever, cough, weight loss, diarrhea, adynamia, hepatosplenomegaly, hypotension, chills, skin rashes and, in severe cases, altered mental status and respiratory failure [11,12]. Since other systemic diseases such as tuberculosis and other mycoses may also present some of these symptoms, clinical diagnosis is inconclusive [13–16].…”