Histoplasmosis in a pediatric oncology center

Adderson, Elisabeth E.

doi:10.1016/j.jpeds.2003.10.035

Cited by 57 publications

(30 citation statements)

References 27 publications

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“…Histoplasmosis and cancer might have co-existed in some patients, as previously reported. [10] As with any retrospective study, our results may have been influenced by recall, reporting and information bias. It will be important to validate our findings prospectively and in geographic areas where the epidemiology of mediastinal masses differs from the current study.…”

Section: Discussionmentioning

confidence: 95%

“…Past efforts to compare and contrast the presentation of benign and malignant mediastinal masses have found that no clinical, laboratory or radiological feature was sufficiently sensitive to distinguish these etiologies. [4, 5, 10] These studies have been relatively small or evaluated highly selected patient populations, and there have been advances in diagnostic microbiology and diagnostic imaging since these reports were published. We, therefore, sought to identify the characteristics that would be most useful in predicting final diagnosis by comparing the clinical, laboratory and radiographic features of a large group of children and adolescents with mediastinal masses residing in a geographic region that is highly endemic for histoplasmosis.…”

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confidence: 99%

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Distinguishing Benign Mediastinal Masses from Malignancy in a Histoplasmosis-Endemic Region

Naeem

Metzger

Arnold

et al. 2015

The Journal of Pediatrics

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Objective To describe the characteristics of benign and malignant mediastinal masses, which may predict their etiology and facilitate the safe and timely management of patients, especially those residing in histoplasmosis-endemic regions. Study design We conducted a retrospective review of the health records of 131 patients aged <19 years who were referred to two tertiary care children's hospitals from 2005-2010 for the evaluation of mediastinal masses. Results Most patients (79%) had benign masses, including 98 with confirmed or suspected histoplasmosis. Overall, patients with benign etiologies were younger, more likely to be African American, more likely to complain of cough and to have pulmonary nodules by chest computed tomographs than patients with cancer. Patients with malignant disease were more likely to complain of malaise and to have neck swelling, abnormal extrathoracic lymphadenopathy, lymphopenia, anterior mediastinal involvement and/or pleural effusion. Positive histoplasmosis serologic tests were specific but insensitive for a benign etiology. No single clinical, laboratory or radiologic feature was sufficiently sensitive and specific to distinguish between benign and malignant masses. For cancer, however, the presence of lymphopenia, anterior mediastinal involvement or enlarged cervical lymph nodes on computerized tomography had a sensitivity of 93%, specificity of 95%, positive predictive value of 86%, and negative predictive value of 97% for cancer. Sixty-four patients (49%) underwent invasive testing, including 37 (36%) of patients with benign masses. Conclusions Patients in this series who had involvement of the anterior mediastinum, lymphopenia or enlarged cervical lymph nodes had a high likelihood of cancer. Expectant management of patients lacking these characteristics may be safe and reduce unnecessary invasive testing.

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Section: Discussionmentioning

confidence: 95%

mentioning

confidence: 99%

Distinguishing Benign Mediastinal Masses from Malignancy in a Histoplasmosis-Endemic Region

Naeem

Metzger

Arnold

et al. 2015

The Journal of Pediatrics

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“…Histoplasmosis in this study presented general constitutional clinical manifestations without specific laboratory and imaging findings, which could illustrate the high misdiagnosis rate to some extent. Pulmonary infiltration (46.7%) in imaging test has been reported by certain authors and others have reported higher frequencies (54‐66%) . Both the pulmonary imaging results and clinical manifestations are similar to tuberculosis, which showed nodes, cavities or infiltration in lungs, especially when histoplasma capsulatum impairs the lung tissues and patients show nonspecific pulmonary symptoms .…”

Section: Discussionmentioning

confidence: 62%

Clinical features and endemic trend of histoplasmosis in China: A retrospective analysis and literature review

Jiang

et al. 2020

Clinical Respiratory J

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Introduction Histoplasmosis is a rare mycosis with nonspecific clinical manifestation and a high misdiagnosis rate, which is an epidemic disease that occurred in several endemic areas. Cases of histoplasmosis were sporadic in China. Objective We detected the clinical characteristics and endemic trend of histoplasmosis to understand it more profoundly. Method The clinical data of 34 cases of histoplasmosis hospitalized in Xiangya Hospital of Central South University from 2003 to 2016 were analyzed retrospectively. The relevant literature were reviewed roundly which were about histoplasmosis from 2001 to 2019 reported in the Chinese mainland. Results Thirty‐four patients were included in the study, male predominance. About 44.1% were combined with underlying disease and HIV infection was observed in eight patients. Common clinical manifestations were fever (94.1%), followed by lymphadenopathy (70.6%) and anemia (67.6%). Organ involvement included lungs (52.9%), oral cavity (5.9%) and intestine (5.9%). Patients were diagnosed by bone marrow smears (44.1%), lymph node biopsy (41.1%), lung tissue biopsy (8.8%) and intestinal tissue biopsy (5.9%). About 70.6% received amphotericin B, while 38.2% received itraconazole therapy and 79.4% were improved. About 611 cases of histoplasmosis in the Chinese mainland were obtained in the study from the related literature, with 217 (37.0%) cases occurred in Yunnan province, 69 (11.9%) cases in Hunan province and 67 (11.6%) cases in Hubei province. All of them were high incidence area of histoplasmosis. Conclusion Histoplasmosis is a rare mycosis with high diagnosis rate and has a prominent geographical distribution in China, which should be considered highly in clinical work.

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“…In contrast, disease is progressive in individuals with defective cell-mediated immunity. In many cases, the cause for immune deficiency is easily identified, and often includes the extremes of age, solid organ transplantation [12], treatment with immunosuppressive medications [13], acquired immunodeficiency syndrome (AIDS) [14], idiopathic CD4 + leucopenia [15], deficiency in the interferon-γ/interleukin-12 pathway [16], or malignancy [17]. In other cases, the cause for immunodeficiency remains unknown, awaiting a more complete understanding of immunity in histoplasmosis and development of better tests for diagnosis of immunodeficiency.…”

Section: Progressive Disseminated Histoplasmosis (Pdh)mentioning

confidence: 99%