Pulmonary, Mediastinal, and Cardiac Presentations of Histoplasmosis

Prager, Richard L.; Burney, Donald P.; Waterhouse, G; Bender, Harvey W.

doi:10.1016/s0003-4975(10)61279-9

Cited by 23 publications

(11 citation statements)

References 18 publications

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“…12 It is possible that systemic histoplasmosis could have resulted in sinoatrial disease in this patient. Histoplasmosis was not found in the patient's myocardium, however.…”

Section: Discussionmentioning

confidence: 92%

R Efractory a Systole and D Eath F Ollowing the P Rehospital a Dministration of a Denosine

Christopher

Key²,

Persse³

2000

Prehospital Emergency Care

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In use since the 1980s, adenosine is an effective, safe treatment for narrow-complex supraventricular tachycardias. Well-recognized adverse effects of adenosine include chest pain, flushing, transient asystole, metallic taste, bronchospasm, respiratory arrest, and (rarely) proarrhythmic effects. 1 These adverse effects have always been reported to be transient and overwhelmingly benign. Several prehospital adenosine studies demonstrate benefit with little morbidity and no mortality. 2-4 This is a case of refractory asystole and subsequent death following the prehospital administration of adenosine. CASE REPORTA 38-year-old Asian male, reportedly ill for two weeks, unseen by his family for two days, was found on the floor of his residence with questionable altered mental status by family members. The emergency medical services (EMS) system was notified via 9-1-1 and a paramedic ambulance was dispatched, arriving at the location minutes later. They found an Asian male, alert, sitting upright with family members' support. He was in obvious distress with rapid shallow respirations and single-word responses. Communication was difficult because English was the patient's second language. Both the patient and the family stated that he had no past medical history, was taking no medications, and had no medication allergies. The patient denied shortness of breath; however, he did indicate that he was experiencing palpitations and a vague chest discomfort.Initial vital signs showed a blood pressure of 170/100 mm Hg, a pulse of 180 beats/min, and a respiratory rate of 22 breaths/min. Physical exam found the patient to be alert and oriented to person, place, and time, well hydrated with moist mucous membranes, skin reddened but warm and dry, pupils midsized and sluggish, breath sounds shallow with minimal air movement without wheezing, and peripheral extremities with capillary refill of less than 2 seconds. Jugular venous distension and cardiac sounds were not reported. A three-lead rhythm strip was interpreted to be supraventricular tachycardia and blood glucose was reported to be normal.The patient was placed on 15 L/min of oxygen by nonrebreather mask and transported to the ambulance. Following a carotid massage, the heart rate was noted to have increased to 230 beats/min with a narrow QRS complex. An IV was established and the patient was given 6 mg of adenosine as per written protocol. Over a period of 30-90 seconds, the patient's heart rate progressed from 230 beats/min to bradycardia and finally to asystole. After approximately 1 minute, cardiopulmonary resuscitation (CPR) was initiated and the patient was intubated with a 7.0 endotracheal tube at 22 cm against the teeth with good bilateral breath sounds. Advanced Cardiac Life Support (ACLS) was initiated by written protocol. Multiple rounds of epinephrine and atropine were injected, for a total of 16 mg of epinephrine (given as an initial dose of 1 mg followed by three doses of 5 mg as per protocol) and 3 mg (given as three separate 1mg doses as per protocol), respecti...

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“…12 It is possible that systemic histoplasmosis could have resulted in sinoatrial disease in this patient. Histoplasmosis was not found in the patient's myocardium, however.…”

Section: Discussionmentioning

confidence: 92%

R Efractory a Systole and D Eath F Ollowing the P Rehospital a Dministration of a Denosine

Christopher

Key²,

Persse³

2000

Prehospital Emergency Care

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“…A infecção pelo H. capsulatum geralmente ocorre quando os pequenos esporos (micronídeas), trazidos pelo vento, são inalados e chegam aos alvéolos pulmonares (11) . Outras vias de infecção, como, por exemplo, pele e trato gastrintestinal, são raras (6) .…”

Section: Discussionunclassified

“…Nos indivíduos imunocompetentes a imunidade celular específica, desencadeada por linfócitos T, se desenvolve em um período de uma a quatro semanas, sendo manifestada por testes cutâneos com resultados positivos (6,11) . O desenvolvimento da hipersensibilidade leva a uma intensa reação inflamatória, com necrose caseosa e controle da infecção.…”

Section: Discussionunclassified

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Histoplasmose pulmonar aguda: relato de uma microepidemia

Martins¹,

Marchiori²,

Damato³

et al. 2003

Radiol Bras

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Os autores relatam uma microepidemia de histoplasmose pulmonar, com cinco crianças que desenvolveram a doença em um período de 7 a 14 dias após a limpeza de um forno desativado para produção de carvão vegetal. Todas apresentaram quadro de febre alta persistente, tosse seca, astenia e anorexia, com 28 dias de evolução. Quando buscaram atendimento médico, uma delas encontrava-se taquipnéica, febril, com hepatomegalia e palidez cutânea, estando as restantes em regular estado geral e já sem febre. As radiografias de tórax demonstravam, em todos os casos, infiltrados reticulonodulares grosseiros, difusos e bilaterais, além de linfonodomegalias hilares. As tomografias computadorizadas evidenciaram pequenos nódulos difusos, com distribuição aleatória, além das linfonodomegalias. Os diagnósticos foram confirmados por meio da imunodifusão em gel para Histoplasma capsulatum, que foi positiva em todas as amostras pareadas coletadas com 15 dias de intervalo. Apenas uma criança necessitou de internação, por causa de importante queda no estado geral, sendo realizado tratamento de suporte e observação. Todas as crianças evoluíram com melhora clínica, sem o uso de antifúngicos, e foram submetidas a tomografias de controle após cerca de 50 dias, que demonstraram importante regressão das lesões.

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“…35 On the other hand, surgical correction of mediastinal fibrosis is technically difficult and dangerous. The mortality rates reported for patients with mediastinal fibrosis who undergo surgery have ranged from 7% with thoracotomy, 40^12 to 50% with pneumonectomy, 35,48,49 to 100% in two patients who underwent attempted airways reconstruction. 50 However, several authors have reported successful surgical outcome in patients with localized mediastinal fibrosis for control of hemoptysis and relief of superior vena caval and pulmonary vascular obstruction.…”

Section: Treatment Considerationsmentioning

confidence: 99%

The effects of steroid therapy on pulmonary hypertension secondary to fibrosing mediastinitis

Cordasco

Ahmad

Mehta

et al. 1990

Cleveland Clinic Journal of Medicine

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Mediastinal fibrosis, a rare cause of pulmonary hypertension, may produce cough, dyspnea, and hemoptysis. Steroid therapy has been suggested for individuals with progressive symptoms, but data demonstrating the efficacy of such therapy are lacking. We present a case of pulmonary hypertension secondary to fibrosing mediastinitis. Hemodynamic and scintigraphic studies performed before and after a trial of corticosteroid therapy were unable to demonstrate any therapeutic benefit from the corticosteroids. In order to achieve better use of steroids for the treatment of this disease, we suggest that similar determinations be made on other patients with mediastinal fibrosis who receive such treatment.

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Pulmonary, Mediastinal, and Cardiac Presentations of Histoplasmosis

Cited by 23 publications

References 18 publications

R Efractory a Systole and D Eath F Ollowing the P Rehospital a Dministration of a Denosine

R Efractory a Systole and D Eath F Ollowing the P Rehospital a Dministration of a Denosine

Histoplasmose pulmonar aguda: relato de uma microepidemia

The effects of steroid therapy on pulmonary hypertension secondary to fibrosing mediastinitis

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