Pericarditis as a Manifestation of Histoplasmosis during Two Large Urban Outbreaks

Wheat, L. Joseph; Stein, Leon; Corya, Betty C.; Wass, Justin L.; Norton, James A.; Grider, Kathy; Slama, Thomas G.; French, Morris L. V.; Köhler, Richard

doi:10.1097/00005792-198303000-00004

Cited by 64 publications

(21 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…A small proportion of patients with acute pulmonary histoplasmosis develop pericarditis as a complication of the infection. In the large outbreak of histoplasmosis in Indianapolis, pericarditis was identified in 6% of patients (137). This complication occurs predominantly in younger patients.…”

Section: Pulmonary Histoplasmosismentioning

confidence: 99%

“…The presentation is typical of that of acute pericarditis, with substernal chest pain and dyspnea as the prominent symptoms. Most patients have a pleural effusion, and many have mediastinal lymphadenopathy as well as pneumonia (101,137) (Fig. 4).…”

Section: Pulmonary Histoplasmosismentioning

confidence: 99%

“…Pericarditis associated with acute pulmonary histoplasmosis responds to treatment with nonsteroidal anti-inflammatory agents; rarely, corticosteroids may have to be used (137). Antifungal agents should not be used, because the pericarditis reflects an inflammatory reaction to H. capsulatum rather than an active infection of the pericardium.…”

Section: Complications Of Pulmonary Histoplasmosismentioning

confidence: 99%

See 2 more Smart Citations

Histoplasmosis: a Clinical and Laboratory Update

2007

View full text Add to dashboard Cite

SUMMARY Infection with Histoplasma capsulatum occurs commonly in areas in the Midwestern United States and Central America, but symptomatic disease requiring medical care is manifest in very few patients. The extent of disease depends on the number of conidia inhaled and the function of the host's cellular immune system. Pulmonary infection is the primary manifestation of histoplasmosis, varying from mild pneumonitis to severe acute respiratory distress syndrome. In those with emphysema, a chronic progressive form of histoplasmosis can ensue. Dissemination of H. capsulatum within macrophages is common and becomes symptomatic primarily in patients with defects in cellular immunity. The spectrum of disseminated infection includes acute, severe, life-threatening sepsis and chronic, slowly progressive infection. Diagnostic accuracy has improved greatly with the use of an assay for Histoplasma antigen in the urine; serology remains useful for certain forms of histoplasmosis, and culture is the ultimate confirming diagnostic test. Classically, histoplasmosis has been treated with long courses of amphotericin B. Today, amphotericin B is rarely used except for severe infection and then only for a few weeks, followed by azole therapy. Itraconazole is the azole of choice following initial amphotericin B treatment and for primary treatment of mild to moderate histoplasmosis.

show abstract

Section: Pulmonary Histoplasmosismentioning

confidence: 99%

Section: Pulmonary Histoplasmosismentioning

confidence: 99%

Section: Complications Of Pulmonary Histoplasmosismentioning

confidence: 99%

See 1 more Smart Citation

Histoplasmosis: a Clinical and Laboratory Update

2007

View full text Add to dashboard Cite

show abstract

“…These manifestations often last for months and are best managed by treatment with anti-inflammatory agents without antifungal therapy (44,45). Pericarditis is another inflammatory complication of acute self-limited histoplasmosis (46). Clinical findings resemble those seen in viral pericarditis, except that chest roentgenograms may show mediastinal lymphadenopathy, and pericardial fluid is often bloody, Affected patients typically respond to anti-inflammatory treatment and rarely require antifungal therapy.…”

Section: Self-limited Histoplasmosis With Low-inoculummentioning

confidence: 99%

Diagnosis and management of Histoplasmosis

1989

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

View full text Add to dashboard Cite

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.

show abstract

“…In the United States, Hc is endemic to the Ohio and Mississippi River Valleys, and it has been estimated that 500,000 new infections occur each year (1). Although the course of infection is mild in most immunocompetent individuals, Hc may produce progressive disseminated infections in individuals immunocompromised by hematologic malignancies (2)(3)(4)(5) and cytotoxic therapy (6)(7)(8). More importantly, disseminated histoplasmosis is seen with increasing frequency (5-25% of patients) as a complication of AIDS, particularly in the Ohio and Mississippi River Valleys where Hc is endemic (9)(10)(11)(12).…”

Section: Introductionmentioning

confidence: 99%

Modulation of the effector function of human macrophages for Histoplasma capsulatum by HIV-1. Role of the envelope glycoprotein gp120.

Chaturvedi

Newman²

1997

J. Clin. Invest.

View full text Add to dashboard Cite

We have demonstrated that monocyte-derived macrophages (M ) from HIV ϩ individuals are deficient in their capacity to phagocytose Histoplasma capsulatum (Hc) yeasts, and are more permissive for the intracellular growth of Hc. To determine whether these defects in M function were caused by HIV infection of the M and/or by pathological events associated with HIV infection, cultured normal human M were infected with the HIV-1 BaL strain. Virus production, quantified by reverse transcriptase activity and p24 antigen, was evident on day 8 after infection and peaked on day 16. On days 12, 16, and 20 after infection, HIV-1-infected M were deficient in their capacity to recognize and bind Hc yeasts compared with control M , and also were more permissive for the intracellular growth of Hc. Culture of normal M with the envelope glycoprotein gp120 inhibited phagocytosis of Hc yeasts by M in a concentration-dependent manner, but did not cause more rapid intracellular growth of Hc. Normal M cultured in the serum of HIV ϩ individuals with impaired M function subsequently were deficient in their capacity to phagocytose Hc yeasts, and were more permissive for the intracellular growth of yeasts compared with M cultured in normal serum. Conversely, culture of normal M in the serum of HIV ϩ patients with normal M function did not affect the interaction of Hc yeasts with M . Moreover, when M from HIV ϩ individuals that were initially defective in host defense against Hc were cultured in normal HIV Ϫ serum, normal M function was demonstrated. Adsorption of gp120 from the serum of two HIV ϩ patients removed the capacity of the serum to cause a M defect in phagocytosis of Hc, but had no effect on the capacity of the serum to cause accelerated intracellular growth. These data demonstrate that observed defects in M interaction with Hc yeasts may be caused by gp120 and other, as yet unknown serum component(s) probably released into serum by HIV-infected cells. (

show abstract

Pericarditis as a Manifestation of Histoplasmosis during Two Large Urban Outbreaks

Cited by 64 publications

References 0 publications

Histoplasmosis: a Clinical and Laboratory Update

Histoplasmosis: a Clinical and Laboratory Update

Diagnosis and management of Histoplasmosis

Modulation of the effector function of human macrophages for Histoplasma capsulatum by HIV-1. Role of the envelope glycoprotein gp120.

Contact Info

Product

Resources

About