Histoplasmosis in an elderly Polish tourist – a case report

Abstract

Background Histoplasmosis is a mycosis caused by soil-based fungus Histoplasma capsulatum endemic in the USA, Latin America, Africa and South-East Asia. The disease is usually self-resolving, but exposure to a large inoculum or accompanying immune deficiencies may result in severe illness. Symptoms are unspecific with fever, cough and malaise as the most common. Thus, this is a case of disease which is difficult to diagnose and very rare in Europe. As a result, it is usually not suspected in elderly patients with cough and dyspnea. Case presentation This is a case of a 78-year-old patient, admitted to our department due to respiratory failure, cough, shortness of breath, fever and weight loss with no response to antibiotics administered before the admission. Chest CT revealed numerous reticular and nodular infiltrations with distribution in all lobes. The cytopathology of BAL showed small parts of mycelium and numerous oval spores. Considering clinical presentation and history of travel to Mexico before onset of disease, pulmonary histoplasmosis was diagnosed. After introduction of antifungal treatment rapid improvement was achieved in terms of both clinical picture and respiratory function. Conclusions Since the risk of Histoplasma exposure in Europe is minimal, patients, who present with dyspnea, fever and malaise are not primarily considered for diagnosis of histoplasmosis. However, taking into account increasing popularity of travelling, also by elderly or patients with impaired immunity, histoplasmosis should be included into differential diagnosis.

Histoplasmosis Diagnosed in Europe and Israel: A Case Report and Systematic Review of the Literature from 2005 to 2020

“…Primary immunodeficiency was diagnosed in 1.4% of the patients [12,20,40,73,86], and was notable for two cases of idiopathic CD4+ lymphocytopenia [40,73] and one case of IFN-γ autoantibodies identified during the patient's follow-up [71,86]. In the case of travellers, the most frequent route of exposure to Histoplasma was the exploration of bat-ridden caves and/or contact with bat guano, which was described in 52.2% of the cases for which this information was available [15,33,99,100,108,109,112,114,115,124,133,134,136], thus confirming this well-known risk factor [6,8], which should always be investigated in subjects presenting with respiratory symptoms, especially if they have recently travelled to Latin America [153].…”

“…There were eight cases (13.3%) of single or multiple nodular lung lesions mimicking neoplasia or severe sarcoidosis [95,97,107,[119][120][121]128,133], three cases of chronic cavitary histoplasmosis [101,102,127], and one patient with fibrosing mediastinitis [130]. Five patients (6.2%) presented with a picture of PDH [103,116,123,125,126], and two showed central nervous system involvement [103,134]. Oropharyngeal ulcerations (tongue, uvula, gingiva, tonsils, hard palate) were described in five patients, and three had primary cutaneous histoplasmosis.…”

Histoplasma capsulatum as a cause for prolonged pulmonary illness in an immunocompetent returning traveller from Bangladesh

“…Histoplasmosis may be under-diagnosed and under-reported in endemic areas due to a reduced diagnostic and reporting capacity [ 4 ]. The occurrence of histoplasmosis in non-endemic areas is rare and its nonspecific features and specific investigations make this a challenging diagnosis [ 10 ].…”