Histoplasmosis

Histoplasmosis is an infection caused by a fungus called Histoplasma. The fungus lives

in the environment, particularly in soil that contains large amounts of bird or bat
droppings. In the United States, Histoplasma mainly lives in the central and eastern
states, especially areas around the Ohio and Mississippi River valleys. The fungus also
lives in parts of Central and South America, Africa, Asia, and Australia.
People can get histoplasmosis after breathing in the microscopic fungal spores from the
air. Although most people who breathe in the spores dont get sick, those who do may
have a fever, cough, and fatigue. Many people who get histoplasmosis will get better on
their own without medication, but in some people, such as those who have weakened
immune systems, the infection can become severe.

Where does Histoplasma live?

Histoplasma, the fungus that causes histoplasmosis, lives throughout the world, but
its most common in North America and Central America. In the United
States,Histoplasma mainly lives in soil in the central and eastern states, particularly
areas around the Ohio and Mississippi River Valleys, but it can likely live in other parts
of the U.S. as well.The fungus also lives in parts of Central and South
America, Africa, Asia, and Australia.
Histoplasma grows best in soil that contains bird or bat droppings. Bats can get
histoplasmosis and spread the fungus in their droppings.
This map shows the approximate areas (called endemic areas) where Histoplasma is
known to live or is suspected to live in the U.S. Much of whats known about where
the fungus lives in the U.S. is based on studies performed in the late 1940s and early
1950s.1
Etiologic Agents:
Histoplasma capsulatum var. capsulatum (near-worldwide distribution) andHistoplasma
capsulatum var. duboisii (in Africa).
Symptoms of Histoplasmosis
Most people who are exposed to the fungus Histoplasmanever have symptoms. Other
people may have flu-like symptoms that usually go away on their own.
Symptoms of histoplasmosis include:

Fever- Most Common

Cough

Fatigue (extreme tiredness)

Chills

Headache

Chest pain

Body aches

Coughing of blood

SOB

Incubation period:
Symptoms of histoplasmosis may appear between 3 and 17 days after a
person breathes in the fungal spores.
Prodromal Period:
For most people, the symptoms of histoplasmosis will go away within a few
weeks to a month. However, some people have symptoms that last longer than
this, especially if the infection becomes severe.

Severe histoplasmosis
In some people, usually those who have weakened immune systems,
histoplasmosis can develop into a long-term lung infection, or it can spread
from the lungs to other parts of the body, such as the central nervous system
(the brain and spinal cord).
Reservoir:
Soil, particularly when heavily contaminated with bird or bat droppings. Endemic areas
include the central and eastern United States, particularly areas around the Ohio and
Mississippi River Valleys, as well as parts of Central and South America,
Africa, Asia, and Australia.
Mode of Transmission:
Air-borne
Organ Transplant
Risk Factors:
Infants
Adults aged 55 and older
People who have weak immune systems
People who are exposed to soil that contains bird or bat droppings

Life cycle of Histoplasma

Histoplasma spores circulate in the air after contaminated soil is disturbed. The spores
are too small to see without a microscope. When people breathe in the spores, they are
at risk for developing histoplasmosis. After the spores enter the lungs, the persons
body temperature allows the spores to transform into yeast. The yeast can then travel
to lymph nodes and can spread to other parts of the body through the bloodstream.

Diagnostic Exams:
Chest
Rays

X-

CT Scans
Antigen
detection:
Enzyme
immunoassay (EIA) is typically performed on urine and/or serum, but can also
be used on cerebrospinal fluid or bronchoalveolar lavage fluid. Sensitivity is
generally higher in urine than in serum, particularly for HIV-infected persons
with disseminated histoplasmosis.
Antibody tests: Because development of antibodies to Histoplasma can take
two to six weeks, antibody tests are not as useful as antigen detection tests in
diagnosing acute histoplasmosis or in immunosuppressed persons, who may not
mount a strong immune response.
Immunodiffusion (ID): Tests for the presence of H (indicates chronic or
severe acute infection) and M (develops within weeks of acute infection
and can persist for months to years after the infection has resolved)
precipitin bands; ~80% sensitivity.
Complement Fixation (CF): Complement-fixing antibodies may take up
to 6 weeks to appear after infection. CF is more sensitive but less specific
than immunodiffusion.
Culture: can be performed on tissue and body fluids, but may take up to 6
weeks to become positive; most useful in the diagnosis of the severe forms of
histoplasmosis.
Microscopy: for detection of budding yeast in tissue or respiratory secretions;
low sensitivity.
Polymerase Chain Reaction (PCR): PCR for detection of Histoplasma directly
from clinical specimens is still experimental, but promising.
Treatment:

 Anti-fungal medication
Amphotericin B
Ketoconazole
Itraconzaole- mild to moderate infections and step down therapy
Nursing Interventions
1. Provide oxygen therapy if needed. Plan rest periods.
2. Enforce CBR.
3. Encourage fluids to liquefy secretions5
4. Obtain chest X-ray results to determine if the patient has pulmonary or pleural
effusion.
5. Assess the patient respiratory status every shift. Note diminished breath sounds or
pleural friction rub, and evaluate for effusion.
6. Check the patients cardiovascular status every shift.
7. Monitor the patients neurologic status every shift and report any changes in level
of consciousness or nuchal rigidity.
8. Observe for signs and symptoms of hypoglycemia and hyperglycemia, which
indicate adrenal dysfunction.
9. Test all stools for blood and report its presence.
10. Administer medications as ordered
a. Antifungal
Amphotericin B
Fungizone (Nephrotoxicity, check for BUN and Creatinine,
Hypokalemia)
b. Steroids
c. Mucolytics
d. Antipyretics
11. Teach the patient about drug therapy, including adverse effects.
12. Inform the patient about the need for follow-up care on a regular basis for atleast a
year.
13. Tell the patient to report to the doctor cardiac and pulmonary signs that could
indicate effusions.
Complications:
Pericarditis- heart is inflamed and full of fluid
Acute Respiratory Distress Syndrome (ARDS)- lungs filled with fluid. Low levels of
oxygen
Meningitis

 Adrenal Glands and Hormone Problems

In persons who develop progressive, chronic, or disseminated disease, symptoms may
persist for months or longer. Mortality is high in HIV-infected persons who develop
disseminated histoplasmosis.
References:
1. Manos NE, Ferebee SH, Kerschbaum WF. Geographic variation in the prevalence of
histoplasmin sensitivity. Dis Chest. 1956 Jun;29(6):649-68.
2. Colombo AL, Tobon A, Restrepo A, Queiroz-Telles F, Nucci M. Epidemiology of
endemic systemic fungal infections in Latin America. Med Mycol. 2011
Nov;49(8):785-98.
3. Loulergue P, Bastides F, Baudouin V, Chandenier J, Mariani-Kurkdjian P, Dupont B,
et
al.
Literature
review
and
case
histories
of Histoplasma capsulatum var. duboisii infections in HIV-infected patients. Emerg
Infect Dis. 2007 Nov;13(11):1647-52.
4. Chakrabarti A, Slavin MA. Endemic fungal infections in the Asia-Pacific region.
Med Mycol. 2011 May;49(4):337-44.
5. McLeod DS, Mortimer RH, Perry-Keene DA, Allworth A, Woods ML, Perry-Keene
J, et al. Histoplasmosis in Australia: report of 16 cases and literature review.
Medicine. 2011 Jan;90(1):61-8.