Serum Ferritin Levels Correlate with Disease Activity in Patients with AIDS and Disseminated Histoplasmosis

Kirn, David H.; Fredericks, Doral; McCutchan, J. Allen; Stites, Daniel P.; Shuman, Marc A.

doi:10.1093/clinids/21.4.1048

Cited by 26 publications

(11 citation statements)

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“…Furthermore, severe histoplasmosis has been reported among healthy travellers to Nicaragua after visiting a bat‐infested cave resulting in a high inoculation with H. capsulatum spores . Lastly, likewise to previous observations, elevated levels of LDH and ferritin may indicate pulmonary fungal infection .…”

Section: Discussionsupporting

confidence: 53%

A diagnostic predicament: activated sarcoidosis or pulmonary histoplasmosis. A case report

Lingscheid

Heinz

Klages

et al. 2015

Clinical Respiratory J

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We report a case of a 41-year-old man presenting with persisting fevers over 2 weeks. The patient had spent 4 weeks in Central America. He was in control of a stable stage II sarcoidosis. Laboratory and various microbiological tests as well as chest radiography led to no diagnosis. Activated sarcoidosis was hypothesized as the most likely diagnosis. However, we considered an infectious process as a differential diagnosis, in detail, the travel history imposed histoplasmosis. Chest-CT documented localized interstitial consolidations. Bronchoscopy with bronchoalveolar lavage (BAL) and biopsy was performed. Results of BAL fluid, biopsy, distinct sarcoidosis serum markers and a borderline positive histoplasmosis-serology yielded in a diagnostic dilemma as no distinct diagnosis was drawable. After the patient was already started on a prednisolone trial, the final diagnosis - pulmonary histoplasmosis - could be achieved via positive culture and PCR out of the BAL fluid. This case shows the difficult differentiation between an acute exacerbation of a chronic pulmonary disease and a concomitant infection, which was especially aggravated in this case as the histoplasmosis masqueraded an acute picture of sarcoidosis.

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Section: Discussionsupporting

confidence: 53%

A diagnostic predicament: activated sarcoidosis or pulmonary histoplasmosis. A case report

Lingscheid

Heinz

Klages

et al. 2015

Clinical Respiratory J

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“…Physical examination will often show hepatosplenomegaly, lymphadenopathy, pallor and petechiae if pancytopenia is present, and, in some patients, mucous membrane ulcerations as well as skin ulcers, nodules, or molluscum-like papules (50,104,119). Laboratory studies reveal elevated alkaline phosphatase levels, pancytopenia, an increased Westergren sedimentation rate, elevated C-reactive protein levels, high lactate dehydrogenase levels, and increased ferritin expression, none of which are specific for disseminated histoplasmosis but all of which are highly suggestive of this diagnosis in the appropriate patient (16,50,68). Hypercalcemia occurs uncommonly and is similar to that described for a number of other granulomatous diseases (90).…”

Section: Disseminated Histoplasmosismentioning

confidence: 62%

Histoplasmosis: a Clinical and Laboratory Update

2007

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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.

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“…22 Clearly, when biopsy material is available, it is important to look for both fungal and acid-fast organisms. Histopathological evaluation provided the most efficient means for establishing the diagnosis of histoplasmosis.…”

Section: Discussionmentioning

confidence: 99%

Tuberculosis and Histoplasmosis Co-Infection in AIDS Patients

Agudelo¹,

Restrepo²,

Molina³

et al. 2012

The American Journal of Tropical Medicine and Hygiene

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Abstract. Coinfection with tuberculosis in some countries occurs in 8-15% of human immunodeficiency virus (HIV) -infected patients who have histoplasmosis. This coinfection interferes with prompt diagnosis, and treatment is difficult because of drug interactions. We retrospectively reviewed the cases of 14 HIV-infected patients who had concomitant tuberculosis and histoplasmosis. The most frequent clinical manifestations were weight loss (85.7%), asthenia (78.5%), and fever (64.2%). The diagnosis of histoplasmosis was made primarily by histopathology (71.4%), and the diagnosis of tuberculosis was made by means of direct microscopic examination (71.4%). Death occurred in two patients, and relapse of both infections occurred in one patient. Moxifloxacin was substituted for rifampicin in six patients, with good outcomes noted for both infections. The clinical presentation does not readily identify acquired immunodeficiency syndrome (AIDS) patients who have tuberculosis and histoplasmosis. The use of a fluoroquinolone as an alternative agent in place of rifampicin for tuberculosis allows effective therapy with itraconazole for histoplasmosis.

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Serum Ferritin Levels Correlate with Disease Activity in Patients with AIDS and Disseminated Histoplasmosis

Cited by 26 publications

References 0 publications

A diagnostic predicament: activated sarcoidosis or pulmonary histoplasmosis. A case report

A diagnostic predicament: activated sarcoidosis or pulmonary histoplasmosis. A case report

Histoplasmosis: a Clinical and Laboratory Update

Tuberculosis and Histoplasmosis Co-Infection in AIDS Patients

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