Persistence of histoplasma in adrenals 7 years after antifungal therapy

Kothari, Deepak; Chopra, Shweta; Bhardwaj, Minakshi; Ajmani, Ajay K.; Kulshreshtha, Bindu

doi:10.4103/2230-8210.111679

Cited by 7 publications

(2 citation statements)

References 10 publications

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“…6 Duration of treatment for adrenal histoplasmosis is not clear from existing information and treatment regimens advocate antifungals given for periods ranging from 6 months to 2 years. 14 Deepak Kothari et al (2013) reported persistence of H. capsulatum in adrenal biopsy material 7 years after treatment with Itraconazole for nine months and suggested that prolonged therapy with regular reviews of adrenal morphology and histology is needed. 14 We too have seen one of our patients with adrenal histoplasmosis relapsed after one year of completion of treatment.…”

Section: Discussionmentioning

confidence: 99%

“…14 Deepak Kothari et al (2013) reported persistence of H. capsulatum in adrenal biopsy material 7 years after treatment with Itraconazole for nine months and suggested that prolonged therapy with regular reviews of adrenal morphology and histology is needed. 14 We too have seen one of our patients with adrenal histoplasmosis relapsed after one year of completion of treatment. Another immunocompetent patient developed signs and symptoms of relapse 1.5 years after of completion of therapy.…”

Section: Discussionmentioning

confidence: 99%

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Clinico-pathological correlation and outcome analysis of disseminated histoplasmosis treated with conventional amphotericin B.

Modak

Dutta²,

De³

et al. 2015

Sri Lankan J Infec Dis

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Introduction Disseminated histoplasmosis is a treatable common opportunistic infection in HIV infected people and not uncommon in others in a tropical country like India. The objective of our study was to evaluate clinical-pathological correlation and treatment outcome of disseminated histoplasmosis treated with conventional Amphotericin B in an endemic area. Material and methods This was a retrospective observational study of twenty-two cases of disseminated histoplasmosis admitted to a tertiary care hospital from January 2009 to December 2012 and treated with Amphotericin B followed by oral Itraconazole therapy for one year. Results of treatment outcome including relapse and mortality were analyzed in January 2014. Results Histoplasmosis was diagnosed in patients with advanced HIV (72%) illness with a mean CD4 count of 63.43/l. Tuberculosis and diabetes were other co-morbid illnesses and it was less common among immunocompetent patients (9%). Fifty percent of the patients presented with cutaneous lesions along with systemic manifestations while 27% had only mucocutaneous lesions. Adrenal histoplasmosis (18%) was common in HIV negative subjects. HIV positive patients showed excellent response to Amphotericin B followed by Itraconazole therapy. In 27% HIV positive patients, the disease manifested as IRIS (immune reconstitution inflammatory syndrome). Relapse was seen in 2(9%) patients. After one year of completion of therapy 16 patients were cured, 3 patients (13.6%) died in the early part of treatment and one was lost to follow up.Treatment response in HIV infected patients showed excellent results but long term maintenance itraconazole therapy was inevitable (12-32 months). Conclusions It is concluded that early diagnosis and treatment can prevent a fatal disease like disseminated histoplasmosis with conventional Amphotericin B followed by Itraconazole. Adrenal histoplasmosis was common among the HIV negative population. Extensive follow up is required to identify early relapse which may need further prolongation of therapy for cure.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Clinico-pathological correlation and outcome analysis of disseminated histoplasmosis treated with conventional amphotericin B.

Modak

Dutta²,

De³

et al. 2015

Sri Lankan J Infec Dis

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“Polka Dot Macrophages” on cytology of bilateral adrenal masses—Nailing disseminated histoplasmosis

Grover

Selhi

Sood

et al. 2017

Diagnostic Cytopathology

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Histoplasma capsulatum is a saprophytic fungus that in immunocompetent individuals causes self-limited pulmonary infection; however, in immunosuppressed patients involvement of the reticuloendothelial system, alimentary tract, urinary tract, and central nervous system is fairly common. Rarely patients present with bilateral adrenal masses which mimic tuberculosis and metastasis on radiology because of associated central necrosis. Ultrasound guided FNAC aided by special stains like Periodic Acid Schiff (PAS) and Gomori Methenamine Silver (GMS) may help in early diagnosis in such dubious cases. Polka dot macrophages were the clue to diagnosis of histoplasmosis on toluidine blue rapid staining, Hematoxylin & Eosin, and Pap stained smears. We report this case because of its rarity, diagnostic difficulty on radiology, and rapidity of diagnosis by FNA due of its characteristic cytomorphology.

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Antifungal Therapy for Histoplasmosis: Focus on Susceptibility, Resistance, and Effectiveness in Humans and Experimental Infection

Wheat

2017

Antimicrobial Drug Resistance

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Persistence of histoplasma in adrenals 7 years after antifungal therapy

Cited by 7 publications

References 10 publications

Clinico-pathological correlation and outcome analysis of disseminated histoplasmosis treated with conventional amphotericin B.

Clinico-pathological correlation and outcome analysis of disseminated histoplasmosis treated with conventional amphotericin B.

“Polka Dot Macrophages” on cytology of bilateral adrenal masses—Nailing disseminated histoplasmosis

Antifungal Therapy for Histoplasmosis: Focus on Susceptibility, Resistance, and Effectiveness in Humans and Experimental Infection

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