Histoplasmosis

Prepared by Supervised by

Mohammed Yousif sulaiman Dr. asia Abdulhamid

ABSTRACT
The diagnosis of histoplasmosis is based on a multifaceted approach that
includes clinical, radiographic, and laboratory evidence of disease. The
gold standards for laboratory diagnosis include demonstration of yeast on
pathological examination of tissue and isolation of the mold in the culture
of clinical specimens; however, antigen detection has provided a rapid,
noninvasive, and highly sensitive method for diagnosis and is a useful
marker of treatment response. Molecular methods with improved
sensitivity on clinical specimens are being developed but are not yet ready
for widespread clinical use. This review synthesizes currently available
laboratory diagnostics for histoplasmosis, with an emphasis on
complexities of testing and performance in various clinical contexts.

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List of content

ABSTRACT..................................................................................................0
INTRODUCTION.........................................................................................3
Who gets histoplasmosis?........................................................................4
Types of Histoplasmosis............................................................................5
Acute........................................................................................................5
Chronic.....................................................................................................5
Symptoms.................................................................................................6
How soon do the symptoms of histoplasmosis appear?..........................7
How long do the symptoms of histoplasmosis last?................................7
Severe histoplasmosis...............................................................................7
Is histoplasmosis contagious?..................................................................8
Complications...........................................................................................8
Can my pets get histoplasmosis?..............................................................9
How can I prevent histoplasmosis?........................................................10
Summary and conclusion........................................................................11
Reference................................................................................................12

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INTRODUCTION

Histoplasmosis is the most common endemic fungal infection in North

America and causes a wide spectrum of disease, ranging from
pulmonary to disseminated and acute to chronic. The etiologic
agent, Histoplasma capsulatum, is thermally dimorphic, existing as a
hyaline mold in the natural environment and as a yeast at body
temperature. Demonstration of the yeast on pathological stains and
isolation of the mold in culture of clinical specimens constitute the gold
standard tests for the diagnosis of histoplasmosis. In 1986, the
first Histoplasma antigen assay was developed, introducing a novel,
highly sensitive, and noninvasive diagnostic modality. Further iterations
of this assay have allowed for both greater specificity and quantitative
capacity and have revolutionized the diagnosis of histoplasmosis by
allowing physicians to make rapid diagnoses in the absence of culture
or pathological confirmation. Serologic testing for histoplasmosis is
another widely employed method for diagnosis and is particularly
useful for chronic disease manifestations in which the sensitivity of
antigen detection is suboptimal. Although not yet ready for widespread
use, molecular methods have the potential to revolutionize the
diagnosis of histoplasmosis.

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Who gets histoplasmosis?
Anyone can get histoplasmosis if they’ve been in an area
where Histoplasma lives in the environment. Histoplasmosis is often
associated with activities that disturb soil, particularly soil that contains
bird or bat droppings.

Certain groups
of people are at higher risk for developing the severe forms of
histoplasmosis:

 People who have weakened immune systems, for example,

people who:

 Have HIV/AIDS 
 Have had an organ transplant 
 Are taking medications such as corticosteroids or TNF-inhibitors 
 Infants 
 Adults aged 55 and older 

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Types of Histoplasmosis

Acute

Acute, or short-term, histoplasmosis is typically mild. It rarely

leads to complications.

The Centers for Disease Control and Prevention (CDC) estimate

that between 60 and 90 percentTrusted Source of people who live
in areas where the fungus is common have been exposed. Many
of these people probably did not have any symptoms of infection.

Chronic

Chronic, or long-term, histoplasmosis occurs far less often than

the acute form. In rare cases, it can spread throughout the body.
Once histoplasmosis has spread throughout your body it is life-
threatening if it isn’t treated.

Widespread disease usually occurs in people with impaired

immune systems. In areas where the fungus is common, the CDC
says that it may occur in up to 30 percentTrusted Source of
people with HIV.

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Symptoms
The mildest forms of histoplasmosis cause no signs or symptoms, but
severe infections can be life-threatening. When signs and symptoms
occur, they usually appear three to 17 days after exposure and can
include:

 Fever

 Chills

 Headache

 Muscle aches

 Dry cough

 Chest discomfort

 Fatigue

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How soon do the symptoms of histoplasmosis appear?
Symptoms of histoplasmosis may appear between 3 and 17 days after a
person breathes in the fungal spores.

How long do the symptoms of histoplasmosis last?

For most people, the symptoms of histoplasmosis will go away within a
few weeks to a month. 2 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).

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Is histoplasmosis contagious?
No. Histoplasmosis can’t spread from the lungs between people or
between people and animals. However, in extremely rare cases, the
infection can be passed through an organ transplant with an infected
organ.

Complications
Histoplasmosis can cause a number of serious complications, even in
otherwise healthy people. For infants, older adults and people with
compromised immune systems, the potential problems are often life-
threatening.

Complications can include:

 Acute respiratory distress syndrome. Histoplasmosis can damage

lungs to the point that the air sacs begin filling with fluid. This
prevents good air exchange and can deplete the oxygen in your
blood.

 Heart problems. Inflammation of the sac that surrounds your

heart (pericardium) is called pericarditis. When the fluid in this sac
increases, it can interfere with the heart's ability to pump blood.

 Adrenal insufficiency. Histoplasmosis can harm your adrenal

glands, which produce hormones that give instructions to virtually
every organ and tissue in your body.

 Meningitis. In some cases, histoplasmosis can cause this

inflammation of the membranes surrounding your brain and
spinal cord.

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Can my pets get histoplasmosis?

Yes. Pets, particularly cats, can get histoplasmosis, but it

is not contagious between animals and people.  Histoplasmosis in cats
and dogs is similar to histoplasmosis in humans. Like humans, many
cats and dogs that are exposed
to Histoplasma never get sick. Cats
and dogs that do develop symptoms
often have symptoms that include
coughing, lack of energy, and weight
loss. The fungus that causes
histoplasmosis grows well in soil that
contains bird droppings, but birds
don’t appear to be able to get
histoplasmosis. If you’re concerned about your pet’s risk of getting
histoplasmosis or if you think that your pet has histoplasmosis, please
talk to a veterinarian.

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How can I prevent histoplasmosis?

It can be difficult to avoid breathing in Histoplasma in areas where it’s

common in the environment. In areas where Histoplasma is known to
live, people who have weakened immune systems (for example, by
HIV/AIDS, an organ transplant, or medications such as corticosteroids
or TNF-inhibitors) should avoid doing activities that are known to be
associated with getting histoplasmosis, including: 

 Disturbing material (for example, digging in soil or chopping

wood) where there are bird or bat droppings

 Cleaning chicken coops

 Exploring caves

 Cleaning, remodeling, or tearing down old buildings

Summary and conclusion

Early diagnosis of histoplasmosis is essential to establish a suitable

antifungal therapy, which results in the reduction of mortality rates.
This becomes especially important in certain hyper-endemic regions
since they usually are disfavored areas where patients develop the

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disease in its disseminated form. While culture and histopathological
examination are considered the gold standards methods for
histoplasmosis diagnosis, these techniques show moderate sensitivity.
In addition, culture is time consuming, requiring handling fungi in BSL-3
facilities. New approaches as MALDI-ToF MS technology allow for a
rapid identification, but studies are still scarce. Antibody and antigen
detection are useful tools for an early detection of the pathogen in low
invasive clinical samples such as serum and urine.

Reference

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Horn DL. Clinical characteristics and outcomes in 303 HIV-infected
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Antifungal Therapy Alliance registry, a multicenter, observational
studyexternal icon. HIV/AIDS. 2014;6:39-47.

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