International Journal of Infectious Diseases 65 (2017) 105–106

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International Journal of Infectious Diseases

journal homepage: www.elsevier.com/locate/ijid

Medical Imagery

Usefulness of thick blood smears in the diagnosis of disseminated

histoplasmosis

Figure 1. (A) Chest X-ray showing multilobar lung infiltrates with a cottony aspect and bilateral lung nodules. (B) Thick blood film (Field stain, oil immersion, 100) showing
leukocytes and intra- and extracellular yeasts cells. (C) Peripheral blood smear (Wright stain, oil immersion, 100) showing leukocytes with intracellular yeasts cells.

The case of a 40-year-old woman who was admitted to the
emergency room in cardiopulmonary arrest is reported. The
patient’s relatives reported an illness that had developed over the
course of several weeks, consisting of general malaise, a dry and
non-productive cough, fever, and progressive dyspnea at rest.
Upon admission, cardiopulmonary resuscitation was performed
for 10 min, with subsequent return of spontaneous circulation. A
diagnosis of HIV was confirmed by serology, and laboratory tests
revealed leukocytosis with neutrophilia, anemia, a low platelet
count, prolonged clotting time, azotemia, and metabolic acidosis.
Multilobar lung infiltrates with a cottony aspect and bilateral lung
nodules were observed on chest X-ray (Figure 1A). Intra- and
extracellular ovoid structures with a nucleus and without
kinetoplast were observed in thick and thin blood smears stained
with the Field stain method. These findings suggested Histoplasma
capsulatum (Figure 1B, C). The patient died within 24 h of
admission.
The Histoplasma urinary antigen test is the method of choice for
the diagnosis of disseminated histoplasmosis (Azar and Hage,
2017). However, this test is not always available in developing
countries. Although the peripheral blood smear has been described
previously as an alternative diagnostic method, it is rarely
performed (Dieng et al., 2017). The thick blood smear is a useful,
rapid, and low cost technique for the early diagnosis of
disseminated histoplasmosis in immunocompromised patients
in low income populations living in endemic areas. During smear
preparation, erythrocyte lysis allows a high concentration of
leukocytes per field to be visualized (Centers for Disease Control
and Prevention, 2017), increasing the probability of identifying
intra- and extracellular yeasts.
Ethics statement: Written informed consent was obtained from
the patient’s relatives for the publication of this case report.
Conflict of interest: None of the authors reports a conflict of
interest, and there were no funding sources. All of the authors have

https://doi.org/10.1016/j.ijid.2017.10.007
1201-9712/© 2017 The Author(s). Published by Elsevier Ltd on behalf of International Society for Infectious Diseases. This is an open access article under the CC BY-NC-ND
license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
106 J.Y. Rodríguez et al. / International Journal of Infectious Diseases 65 (2017) 105–106

submitted the ICMJE form for the disclosure of potential conflicts of
interest.
References
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Azar MM, Hage CA. Laboratory diagnostics for histoplasmosis. J Clin Microbiol
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Dieng T, Massaly A, Sow D, Vellaissamy S, Sylla K, Tine RC, et al. Amplification of
blood smear DNA to confirm disseminated histoplasmosis. Infection 2017;
(February), doi:http://dx.doi.org/10.1007/s15010-017-0989-0.
a
Centro de Investigaciones Microbiológicas del Cesar (CIMCE),
Hospital Rosario Pumarejo de Lopez, Valledupar, Colombia
b
Universidad Nacional de Colombia, Medicine Faculty and Clínica
Universitaria Colombia, Colsanitas, Bogota, Colombia
* Corresponding author at: Centro de Investigaciones Micro-
biológicas del Cesar (CIMCE), Calle 16c no 19d-14, Barrio Dangond,
Valledupar, Colombia.
E-mail address: jyrodriguezq@gmail.com (J. Rodríguez).
Corresponding Editor: Eskild Petersen, Aarhus, Denmark

José Y. Rodrígueza,* Received 1 October 2017

Gerson J. Rodrígueza Received in revised form 8 October 2017
Maria J. Mendozaa Accepted 17 October 2017
Carlos A. Álvarez-Morenob