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Diagnosis and management of Histoplasmosis

  • L. J. Wheat
Current Topic: Review

Abstract

Histoplasmosis occurs throughout the world but is more common within the endemic areas of North America, particularly in fertile river valleys. Disease manifestations range from asymptomatic infection in the normal host with low-inoculum exposure to rapidly fatal, disseminated infection in the severely immunocompromised host, emphasizing the importance of cellular immunity in defense againstHistoplasma capsulatum. Diagnosis depends on a high index of suspicion, knowledge of the clinical and epidemiologic features of the infection, and a thorough understanding of the uses and limitations of fungal cultural and serological laboratory procedures. Recently, a method has been developed for rapid diagnosis based on detection of a polysaccharide antigen in body fluids of patients with histoplasmosis. Amphotericin B remains the preferred treatment for more severe forms of histoplasmosis, particularly in the immunocompromised host, but oral treatment with ketoconazole or newer imidozoles appears to be effective in less severe infections in non-immunocompromised individuals.

Keywords

Polysaccharide Amphotericin River Valley Ketoconazole Endemic Area 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References

  1. 1.
    Schwarz, J., Baum, G. L. The history of histoplasmosis. New England Journal of Medicine 1957, 256: 255–258.Google Scholar
  2. 2.
    Giulio, S., Mantovani, A., Mazzoni, A. Histoplasmosis in Europe. Mycopathologia et Mycologia Applicata 1970, 40: 53–74.Google Scholar
  3. 3.
    Randhawa, H. S. Occurrence of histoplasmosis in Asia. Mycopathologia et Mycologia Applicata 1970, 41: 75–89.PubMedGoogle Scholar
  4. 4.
    Siddiqi, S. H., Stauffer, J. C. Prevalence of histoplasmin sensitivity in Pakistan. American Journal of Tropical Medicine and Hygiene 1980, 29, Supplement 1: 109–111.PubMedGoogle Scholar
  5. 5.
    Grayston, J. T., Furcolow, M. L. The occurrence of histoplasmosis in epidemines — epidemiological studies. American Journal of Public Health and The Nation's Health 1953, 43: 665–676.Google Scholar
  6. 6.
    Furcolow, M. L. Environmental aspects of histoplasmosis. Archives of Environmental Health 1965, 10: 4–10.PubMedGoogle Scholar
  7. 7.
    Mac Vandiviere, H. M., Goodman, N. L., Melvin, I. G., Narain, R., Wilson, D. H. Histoplasmosis in Kentucky — can it be prevented? Kentucky Medical Association 1981, 11: 719–726.Google Scholar
  8. 8.
    Sacks, J. J., Ajello, L., Crockett, L. K. An outbreak and review of cave-associated histoplasmosis capsulati. Journal of Medical and Veterinary Mycology 1986, 24: 313–327.PubMedGoogle Scholar
  9. 9.
    Wilcox, K. R., Waisbren, B. A., Martin, J. The Walworth, Wisconsin, epidemic of histoplasmosis. Annals of Internal Medicine 1958, 49: 388–418.PubMedGoogle Scholar
  10. 10.
    Seward, C. W., Mohr, J. A., Rhoades, E. R. An outbreak of histoplasmosis in Oklahoma. American Review of Respiratory Disease 1970, 102: 950–958.PubMedGoogle Scholar
  11. 11.
    Schlech, W. F., Wheat, L. J., Ho, J. L., French, M. L. V., Weeks, R. J., Kohler, R. B., Deane, C. E., Eitzen, H. E., Band, J. D. Recurrent urban histoplasmosis, Indianapolis, Indiana. American Journal of Epidemiology 1983, 118: 301–312.PubMedGoogle Scholar
  12. 12.
    Leznoff, A., Frank, H., Telner, P., Rosensweig, J., Brandt, J. L. Histoplasmosis in Montreal during the fall of 1963, with observations on erythema multiforme. Canada Medical Association Journal 1964, 31: 1154–1160.Google Scholar
  13. 13.
    D'Allessio, D. J., Heeren, R. H., Hendricks, S. L., Ogilvie, P., Furcolow, M. L. A starling roost as the source of urban epidemic histoplasmosis in an area of low incidence 1. American Review of Respiratory Disease 1965, 92: 725–731.PubMedGoogle Scholar
  14. 14.
    Sellers, T. F., Price, W. N., Newberry, W. M. An epidemic of erythema multiforme and erythema nodosum caused by histoplasmosis. Annals of Internal Medicine 1965, 62: 1244–1262.PubMedGoogle Scholar
  15. 15.
    Tosh, F. E., Doto, I. L., D'Allessio, D. J., Medeiros, A. A., Hendricks, S. L., Chin, T. D. Y. The second of two epidemics of histoplasmosis resulting from work on the same starling roost. American Review of Respiratory Disease 1966, 94: 406–413.PubMedGoogle Scholar
  16. 16.
    Waldman, R. J., England, A. C., Tauxe, R., Kline, T., Weeks, R. J., Ajello, I., Kaufman, L., Wentworth, B., Fraser, D. W. A winter outbreak of acute histoplasmosis in northern Michigan. American Journal of Epidemiology 1983, 117: 68–75.PubMedGoogle Scholar
  17. 17.
    Dean, A. G., Bates, J. H., Sorrels, C., Sorrels, T., Germany, W., Ajello, L., Kaufman, L., McGrew, C., Fitts, A. An outbreak of histoplasmosis at an Arkansas courthouse, with five cases of probable reinfection. American Journal of Epidemiology 1978, 108: 36–46.PubMedGoogle Scholar
  18. 18.
    Brodsky, A. L., Gregg, M. B., Loewenstein, M. S., Kaufman, L., Mallison, G. F. Outbreak of histoplasmosis associated with the 1970 Earth Day activities. American Journal of Medicine 1973, 54: 333–342.PubMedGoogle Scholar
  19. 19.
    Chin, T. D. Y., Ney, P. A., Saltzman, B. N., Paxton, G. B., Rakich, J. H., Ware, M., Witmore, M., Furcolow, M. L. An epidemic of histoplasmosis among school children in Arkansas. Southern Medical Journal 1956, 49: 785–792.PubMedGoogle Scholar
  20. 20.
    Dodge, H. J., Ajello, L., Engelke, O. K. The association of a bird-roosting site with infection of school children byHistoplasma capsulatum. American Journal of Public Health 1965, 55: 1203–1211.Google Scholar
  21. 21.
    Furcolow, M. L., Tosh, F. E., Larsh, H. W., Lynch, H. J., Shaw, G. The emerging pattern of urban histoplasmosis. Studies on an epidemic in Mexico, Missouri. New England Journal of Medicine 1961, 264: 1226–1230.PubMedGoogle Scholar
  22. 22.
    DiSalvo, A. F., Johnson, W. M. Histoplasmosis in South Carolina: support for the microfocus concept. American Journal of Epidemiology 1979, 109: 480–492.PubMedGoogle Scholar
  23. 23.
    Bullock, W. E., Wright, S. D. Role of the adherence-promoting receptors, CR3, LFA-1, and p150,95, in binding ofHistoplasma capsulatum by human macrophages. Journal of Expeimental Medicine 1987, 165: 195–210.Google Scholar
  24. 24.
    Wheat, L. J., Rubin, R. H., Harris, N. L., Smith, E. J., Tewari, R., Chaudhary, S., Lascari, A., Mandell, W., Garvey, G., Goldberg, D. Systemic salmonellosis in patients with disseminated histoplasmosis. Case for “macrophage blockade” caused byHistoplasma capsulatum. Archives of Internal Medicine 1987, 147: 561–564.PubMedGoogle Scholar
  25. 25.
    Von Behren, L. A., Chaudhary, S., Rabinovich, S., Shu, M. Protective effect of poly-2-vinylpyridine-n-oxide on susceptibility of silca-treated mice to experimental histoplasmosis. Infection and Immunity 1983, 42: 818–823.PubMedGoogle Scholar
  26. 26.
    Nickerson, D. A., Havens, R. A., Bullock, W. E. Immunoregulation in disseminated histoplasmosis: characterization of splenic suppressor cell populations. Cellular Immunology 1981, 60: 287–297.PubMedGoogle Scholar
  27. 27.
    Artz, R. P., Bullock, W. E. Immunoregulatory responses in experimental disseminated histoplasmosis: lymphoid organ histopathology and serological studies. Infection and Immunity 1979, 23: 884–892.PubMedGoogle Scholar
  28. 28.
    Artz, R. P., Bullock, W. E. Immunoregulatory responses in experimental disseminated histoplasmosis: depression of T-cell-dependent and T-effector responses by activation of splenic suppressor cells. Infection and Immunity 1979, 23: 893–902.PubMedGoogle Scholar
  29. 29.
    Payan, D. G., Wheat, L. J., Brahmi, Z., Ip, S., Hansen, W. P., Hoffman, R. A., Healey, K., Rubin, R. H. Changes in immunoregulatory lymphocyte populations in patients with histoplasmosis. Journal of Clinical Immunology 1984, 4: 98–107.PubMedGoogle Scholar
  30. 30.
    Lehmann, P. F., Gibbons, J., Senitzer, D., Ribner, B. S., Freimer, E. H. T lymphocyte abnormalities in disseminated histoplasmosis. American Journal of Medicine 1983, 75: 790–794.PubMedGoogle Scholar
  31. 31.
    Deepe, G. S., Taylor, C. L., Harris, J. E., Bullock, W. E. Modulation of cellular immune responses in mice with disseminated histoplasmosis by recombinant interleukin-2. Infection and Immunity 1986, 53: 6–12.PubMedGoogle Scholar
  32. 32.
    Watson, S. R., Schmitt, S. K., Hendricks, D. E., Bullock, W. E. Immunoregulation in disseminated murine histoplasmosis: disturbances in the production of interleukin 1 and 21. Journal of Immunology 1985, 135: 3487–3493.Google Scholar
  33. 33.
    Davies, S. F., Khan, M., Sarosi, G. A. Disseminated histoplasmosis in immunologically suppressed patients. Occurrence in an nonendemic area. American Journal of Medicine 1978, 64: 94–100.PubMedGoogle Scholar
  34. 34.
    Mandell, W., Goldberg, D. M., Neu, H. C. Histoplasmosis in patients with acquired immune deficiency syndrome. American Journal of Medicine 1986, 81: 974–978.PubMedGoogle Scholar
  35. 35.
    Kaufman, C. A., Isreal, K. S., Smith, J. W., White, A. C., Schwarz, J., Brooks, G. F. Histoplasmosis in immunosuppressed patients. American Journal of Medicine 1978, 64: 923–932.PubMedGoogle Scholar
  36. 36.
    Klimpel, K. R., Goldman, W. E. Isolation and characterization of spontaneous avirulent variants ofHistoplasma capsulatum. Infection and Immunity 1987, 55: 528–533.PubMedGoogle Scholar
  37. 37.
    Medoff, G., Maresca, B., Lambowitz, A. M., Kobayashi, G., Painter, A., Sacco, M., Carratu, L. Correlation between pathogenicity and temperature sensitivity in different strains ofHistoplasma capsulatum. Journal of Clinical Investigation 1986, 78: 1638–1647.PubMedGoogle Scholar
  38. 38.
    Wheat, L. J., Slama, T. G., Eitzen, H. E., Kohler, R. B., French, M. L. V., Biesecker, J. L. A large urban outbreak of histoplasmosis: clinical features. Annals of Internal Medicine 1981, 94: 331–337.PubMedGoogle Scholar
  39. 39.
    Goodwin, R. A., Loyd, J. E., Des Prez, R. M. Histoplasmosis in normal hosts. Medicine 1981, 60: 231–266.PubMedGoogle Scholar
  40. 40.
    Kataria, Y. P., Campbell, P. B., Burlingham, B. T. Acute pulmonary histoplasmosis presenting as adult respiratory distress syndrome: effect of therapy on clinical and laboratory features. Southern Medical Journal 1981, 74: 534–537.PubMedGoogle Scholar
  41. 41.
    Wynne, J. W., Olsen, G. N. Acute histoplasmosis presenting as the adult respiratory distress syndrome. Chest 1974, 66: 158–161.PubMedGoogle Scholar
  42. 42.
    Ward, J. I., Weeks, M., Allen, D., Hutcheson, R. H., Anderson, R., Fraser, D. W., Kaufman, L., Ajello, L., Spickard, A. Acute histoplasmosis: clinical, epidemiologic and serologic findings of an outbreak associated with exposure to a fallen tree. American Journal of Medicine 1979, 66: 587–595.PubMedGoogle Scholar
  43. 43.
    Coss, K. C., Wheat, L. J., Conces, D. J., Brashear, R. E., Hull, M. T. Esophageal fistual complicating mediastinal histoplasmosis. American Journal of Medicine 1987, 83: 343–346.PubMedGoogle Scholar
  44. 44.
    Rosenthal, J., Brant, K. D., Wheat, L. J., Slama, T. G. Rheumatologic manifestations of histoplasmosis in the recent Indianapolis epidemic. Arthritis and Rheumatism 1983, 26: 1065–1070.PubMedGoogle Scholar
  45. 45.
    Medeiros, A. A., Marty, S. D., Tosh, F. E., Chin, T. D. Y. Erythema nodosum and erythema multiforme as clinical manifestations of histoplasmosis in a community outbreak. New England Journal of Medicine 1966, 274: 415–420.PubMedGoogle Scholar
  46. 46.
    Wheat, L. J., Stein, L., Corya, B. C., Wass, J. L., Norton, J. A., Grider, K., Slama, T. G., French, M. L., Kohler, R. B. Pericarditis as a manifestation of histoplasmosis during two large urban outbreaks. Medicine 1983, 62: 110–119.PubMedGoogle Scholar
  47. 47.
    Sathapatayavongs, B., Batteiger, B. E., Wheat, J., Slama, T. G., Wass, J. L. Clinical and laboratory features of disseminated histoplasmosis during two large urban outbreaks. Medicine 1983, 62: 263–270.PubMedGoogle Scholar
  48. 48.
    Hughes, W. T. Hematogenous histoplasmosis in the immunocompromised child. Journal of Pediatrics 1984, 105: 569–575.PubMedGoogle Scholar
  49. 49.
    Wheat, L. J., Smith, E. J., Sathapatayavongs, B., Batteiger, B., Filo, R. S., Leapman, S. B., French, M. V. Histoplasmosis in renal allograft recipients. Two large urban outbreaks. Archives of Internal Medicine 1983, 143: 703–707.PubMedGoogle Scholar
  50. 50.
    Wheat, L. J., Slama, T. G., Zeckel, M. L. Histoplasmosis in the acquired immune deficiency syndrome. American Journal of Medicine 1985, 78: 203–210.PubMedGoogle Scholar
  51. 51.
    Wheat, L. J., Slama, T. G., Norton, J. A., Kohler, R. B., Eitzen, H. E., French, M. L. V., Sathapatayavongs, B. Risk factors for disseminated or fatal histoplasmosis. Analysis of a large urban outbreak. Annals of Internal Medicine 1982, 96: 159–163.PubMedGoogle Scholar
  52. 52.
    Goodwin, R. A., Shapiro, J. L., Thurman, G. H., Thurman, S. S., Des Prez, R. M. Disseminated histoplasmosis: clinical and pathological correlations. Medicine 1980, 59: 1–33.PubMedGoogle Scholar
  53. 53.
    Binford, C. H. Histoplasmosis. American Journal of Clinical Pathology 1955, 25: 25–36.PubMedGoogle Scholar
  54. 54.
    Wheat, L. J., Wass, J., Norton, J., Kohler, R. B., French, M. L. V. Cavitary histoplasmosis occuring during two large urban outbreaks. Analysis of clinical, epidemiologic, roentgenographic, and laboratory features. Medicine 1984, 63: 201–209.PubMedGoogle Scholar
  55. 55.
    Latham, R. H., Kaiser, A. B., Dupont, W. D., Dan, B. B. Chronic pulmonary histoplasmosis following the excavation of a bird roost. American Journal of Medicine 1980, 68: 504–508.PubMedGoogle Scholar
  56. 56.
    Goodwin, R. A., Owens, F. T., Snell, J. D., Hubbard, W. W., Buchanan, R. D., Terry, R. T., Des Prez, R. M. Chronic pulmonary histoplasmosis. Medicine 1976, 55: 413–451.PubMedGoogle Scholar
  57. 57.
    Rubin, H., Furcolow, M. L., Yates, J. L., Brashear, C. A. The course and prognosis of histoplasmosis. American Journal of Medicine 1959, 27: 278–288.PubMedGoogle Scholar
  58. 58.
    Loyd, J. E., Tillman, B. F., Atkinson, J. B., Des Prez, R. M. Mediastinal fibrosis complicating histoplasmosis. Medicine 1988, 67: 295–310.PubMedGoogle Scholar
  59. 59.
    Wheat, J., French, M. L. V., Kohler, R. B., Zimmerman, S. E., Smith, W. R., Norton, J. A., Eitzen, H. E., Smith, C. D., Slama, T. G. The diagnostic laboratory tests for histoplasmosis. Analysis of experience in a large urban outbreak. Annals of Internal Medicine 1982, 97: 680–685.PubMedGoogle Scholar
  60. 60.
    Wheat, J., French, M. L. V., Kamel, S., Tewari, R. P. Evaluation of cross-reactions inHistoplasma capsulatum serologic tests. Journal of Clinical Microbiology 1986, 23: 493–499.PubMedGoogle Scholar
  61. 61.
    Wheat, L. J., Kohler, R. B., Tewari, R. P. Diagnosis of disseminated histoplasmosis by detection ofHistoplasma capsulatum antigen in serum and urine specimens. New England Journal of Medicine 1986, 314: 83–88.PubMedGoogle Scholar
  62. 62.
    Wheat, J., French, M., Batteiger, B., Kohler, R. Significance of histoplasma antigen in the cerebrospinal fluid of patients with meningitis. Archives of Internal Medicine 1989, 149: 302–304.PubMedGoogle Scholar
  63. 63.
    Billie, J., Stockman, L., Roberts, G. D., Horstmeier, C. D., Ilstrup, D. M. Evaluation of a lysis-centrifugation system for recovery of yeasts and filamentous fungi from blood. Journal of Clinical Microbiology 1983, 18: 469–471.PubMedGoogle Scholar
  64. 64.
    Smith, J. W., Utz, J. P. Progressive disseminated histoplasmosis. A prospective study of 26 patients. Annals of Internal Medicine 1972, 76: 557–565.PubMedGoogle Scholar
  65. 65.
    Paya, C. V., Roberts, G. D., Cockerill, F. R. Transient fungemia in acute pulmonary histoplasmosis: detection by new blood-culturing techniques. Journal of Infectious Diseases 1987, 156: 313–316.PubMedGoogle Scholar
  66. 66.
    Klatt, E. C., Cosgrove, M., Meyer, P. R. Rapid diagnosis of disseminated histoplasmosis in tissues. Archives of Pathology and Laboratory Medicine 1986, 110: 1173–1175.PubMedGoogle Scholar
  67. 67.
    Furcolow, M. L. Comparison of treated and untreated severe histoplasmosis. A communicable disease center cooperative mycoses study. Journal of the American Medical Association 1962, 183: 823–829.Google Scholar
  68. 68.
    Sarosi, G. A., Voth, D. W., Dahl, B. A., Doto, I. L., Tosh, F. E. Disseminated histoplasmosis: results of long-term follow-up. A Center for Disease Control cooperative mycosis study. Annals of Internal Medicine 1971, 75: 511–516.PubMedGoogle Scholar
  69. 69.
    Reddy, P., Gorelick, D. F., Brashear, C. A., Larsh, H. Progressive disseminated histoplasmosis a seen in adults. American Journal of Medicine 1970, 48: 629–636.PubMedGoogle Scholar
  70. 70.
    Paya, C. V., Hermans, P. E., Van Scoy, R. E., Ritts, R. E., Homburger, H. A. Repeatedly relapsing disseminated histoplasmosis: clinical observations during long-term follow-up. Journal of Infectious Diseases 1987, 156: 308–312.PubMedGoogle Scholar
  71. 71.
    Bradsher, R. W., Alfor, R. H., Hawkins, S. S., Spickard, W. A. Conditions associated with relapse of amphotericin B-treated disseminated histoplasmosis. Johns Hopkins Medical Journal 1982, 150: 127–131.PubMedGoogle Scholar
  72. 72.
    Slama, T. G.: Treatment of disseminated and progressive cavitary histoplasmosis with ketoconazole. American Journal of Medicine 1983, 70–73.Google Scholar
  73. 73.
    National Institute of Allergy and Infectious Diseases Mycoses Study Group, Birmingham, Alabama, and Bethesda, Maryland: Treatment of blastomycosis and histoplasmosis with ketoconazole. Annals of Internal Medicine 1985, 103: 861–872.Google Scholar
  74. 74.
    Goetz, M. B., Jones, J. M. Combined ketoconazole and amphotericin B treatment of acute disseminated histoplasmosis in renal allograft recipient. Southern Medical Journal 1985, 78: 1368–1370.PubMedGoogle Scholar
  75. 75.
    Sutliff, W. D. Histoplasmosis cooperative study 1, 2. Chronic pulmonary histoplasmosis treated with and without amphotericin B. Veterans Administration-Armed Forces Cooperative Study on Histoplasmosis 1964, 89: 641–650.Google Scholar
  76. 76.
    Parker, J. D., Sarosi, G. A., Doto, I. L., Bailey, R. E., Tosh, F. E. Treatment of chronic pulmonary histoplasmosis. A national communicable disease center cooperative mycoses study. New England Journal of Medicine 1970, 283: 225–229.PubMedGoogle Scholar
  77. 77.
    United States Public Health Service Cooperative Mycoses Study Course and prognosis of untreated histoplasmosis. A United States Public Health Service cooperative mycoses study. Journal of the American Medical Association 1961, 177: 292–296.Google Scholar
  78. 78.
    Tegeris, A. S., Smith, D. T. Acute disseminated pulmonary histoplasmosis treated with cortisone and mrd-112. Annals of Internal Medicine 1958, 48: 1414–1420.PubMedGoogle Scholar

Copyright information

© Friedr. Vieweg & Sohn Verlagsgesellschaft mbH 1989

Authors and Affiliations

  • L. J. Wheat
    • 1
    • 2
  1. 1.Indiana University School of MedicineWishard Memorial Hospital, OPW 312IndianapolisUSA
  2. 2.Department of Infectious DiseasesRichard L. Roudebush Veterans' Administration HospitalIndianapolisUSA

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