U.A.B.C.

FACULTAD DE MEDICINA Y PSICOLOGIA CLASE: NEUMOLOGIA PRESENTADO: 28/03/2012

LUIS FRANCISCO RAMIREZ DURAZO

HISTOPLASMOSIS

INDEX:
Introduction History and Epidemiology

Pathogenesis Clinical Manifestations

Local Complications Chronic Pulmonary (Cavitary) Progressive Disseminated Histoplasmosis

Diagnosis

Treatment

INTRODUCTION:
HISTOPLASMOSIS is the illness caused by the thermal dimorphic fungus H. capsulatum.

H capsulatum var capsulatum is a dimorphic fungus:

It grows in the environment as a microconidia-bearing but converts to the yeast phase at body temperature. mold

HISTORY AND EPIDEMIOLOGY

The first case of histoplasmosis was recognized by Samuel Darling in Panama in 1906

Histoplasmosis was first diagnosed during life by Dodd and Tompkins. DeMonbreun successfully isolated the organism using animal inoculation.

HISTORY AND EPIDEMIOLOGY

HISTORY AND EPIDEMIOLOGY

HISTORY AND EPIDEMIOLOGY

SOIL

BIRD FECES

CAVES

HISTORY AND EPIDEMIOLOGY

More common in Males than Females. 50 million people in the United States have been infected.
There are up to 500,000 new infections yearly. 1 in 2000 acute infections results in disseminated histoplasmosis

PATHOGENESIS

PATHOGENESIS

CLINICAL MANIFESTATIONS:
Acute pulmonary histoplasmosis: HISTORY
FEVER HEADACHE MALAISE COUGH HEMOPTYSIS CHEST PAIN

MYALGIA
ABDOMINAL PAIN CHILLS

DYSPNEA*
JOINT PAIN 5% SKIN LESIONS 5%

CLINICAL MANIFESTATIONS:
Acute pulmonary histoplasmosis: PHYSICAL
-5-6% DEVELOP RHEUMATOLOGIC MANIFESTATIONS -AUSCULTATION MAY RARELY REVEAL RALES OR WHEEZES -10% HACE ASYMPTOMATIC PLEURAL EFFUSIONS -5% PERICARDITIS -HEPATOSPLENOMEGALY MAY OCCASIONALLY BE PRESENT

CLINICAL MANIFESTATIONS:
Chronic pulmonary histoplasmosis: HISTORY
COUGH WEIGHT LOSS FEVERS MALAISE PLEURAL THICKENING HEMOPTYSIS*

SPUTUM PRODUCTION*

CLINICAL MANIFESTATIONS:
Chronic pulmonary histoplasmosis: PHYSICAL
AUSCULTATION AS NONSPECIFIC RALES, WHEEZES

CLINICAL MANIFESTATIONS:
Progressive disseminated histoplasmosis: HISTORY
GASTROINTESTINAL: DIARRHEA AMD ABDOMINAL PAIN

CARDIAC: VALVULAR DISEASE, CARDIAC INSUFFICIENCY, DYSPNEA, PERIPHERAL EDEMA, ANGINA, AND FEVER

CNS: HEADACHE, VISUAL DISTURBANCE, CONFUSION, ALTERED CONSCIOUSNESS, NECK STIFFNESS OR PAIN

CLINICAL MANIFESTATIONS:
Acute progressive disseminated histoplasmosis: PHYSICAL
CNS: ENCEPHALOPATHY AND MENINGITIS 5-20%

HEPATOSPLENOMEGALY AND LYMPHADENOPATHY

SUPERIOR VENA CAVA=EDEMA OF FACE, NECK AND TORSO

CUTANEOUS:
ULCERATION ERYTHEMATOUS MACULOPAPULAR OROPHARYNGEAL LESIONS*

CLINICAL MANIFESTATIONS:
Chronic progressive disseminated histoplasmosis
OROPHARYNGEAL ULCERS INVOLVING BUCCAL MUCOSA TONGUE, GINGIVA AND LARYNX

CLINICAL MANIFESTATIONS:
Presumed ocular histoplasmosis syndrome:
ATROPHIC SCARS LOCATED POSTERIOR TO THE EQUATOR

IF THE SCARS ARE LOCATED ON THE MACULA: RETINAL HEMORRHAGE DETACHMENT OR EDEMA MAY BE PRESENT

[1-10% OF INDIVIDUALS LIVING IN ENDEMIC AREAS]

DIFFERENTIAL DIAGNOSES
Pneumocystis Carinii Pneumonia

Carcinoid Lung Tumors

Pneumonia, Aspiration

Chlamydial Pneumonias Coccidioidomycosis Legionella pneumonias

Pneumonia, Bacterial Pneumonia, Viral Sarcoidosis

Lymphoma, Mediastinal
Mycoplasma Infections

Tuberculosis

DIAGNOSIS: RX
-Occasionally, hilar and mediastinal nodes are enlarged

-Infiltrates, predominately in the lower lung fields

-Reticular nodular pattern

-Cavitations are rarely present.

DIAGNOSIS: CBC
Mild anemia may be present in chronic pulmonary histoplasmosis. In acute progressive disseminated histoplasmosis, pancytopenia occurs in 70-90% of patients, with a platelet count less than 70,000. Pancytopenia may occur at a lower rate in chronic progressive disseminated histoplasmosis.

DIAGNOSIS: SPUTUM CULTURES

Positive yields occur in approximately 15% patients with acute pulmonary histoplasmosis. Culture results are positive in 60-85% of specimens from patients with chronic pulmonary histoplasmosis

DIAGNOSIS: BLOOD CULTURES

Blood cultures should be performed in all patients. Results are positive in 50-70% of patients with progressive disseminated histoplasmosis.] Results are rarely positive in patients with other types of histoplasmosis.

DIAGNOSIS: HISTOLOGIC