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An Unusual Presentation of Disseminated Histoplasmosis: Case Report and Review of Pediatric Immunocompetent Patients from India


Histoplasmosis is a progressive disease caused by dimorphic intracellular fungi and can prove fatal. Usually, it is present in immunocompromised individuals and immunocompetent individuals in the endemic zones. We report an unusual presentation of progressive disseminated histoplasmosis. The patient in the present case report was immunocompetent child and had fever, bone pains, gradual weight loss, lymphadenopathy and hepatosplenomegaly. Disseminated histoplasmosis (DH) was diagnosed on microscopic examination and fungal culture of bone marrow, blood, skin biopsy and lymph node aspirate. The patient died on seventh day of amphotericin B. In the absence of predisposing factors and classical clinical presentation of febrile neutropenia, lung, adrenal and oropharyngeal lesions, the disease posed a diagnostic challenge. Progressive disseminated histoplasmosis in children can be fatal despite timely diagnosis and therapy. In India, disseminated histoplasmosis is seen in immunocompetent hosts. All the pediatrics immunocompetent cases from India are also reviewed.

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  1. Reiss E, Shadomy HJ, Lyon GM III. Histoplasmosis. In: Reiss E, Shadomy HJ, Lyon III GM, editors. Fundamental medical mycology. New Jersey: Wiley-Blackwell Publication; 2012. p. 165–86.

    Google Scholar 

  2. Adderson EE. Histoplasmosis in a pediatric oncology center. J Pediatr. 2004;144(1):100–6.

    Article  PubMed  Google Scholar 

  3. Brodsky AL, Gregg MB, Lowenstein MW, Kaufman L, Mallison GF. Outbreak of histoplasmosis associated with the 1970 Earth Day activities. Am J Med. 1970;54:333–42.

    Article  Google Scholar 

  4. Kleinman MB. Histoplasma capsulatum (histoplasmosis). In: Long SS, Pickering LK, Prober CG, editors. Principle and practice of infectious diseases. Philadelphia: Churchill Livingstone (Elsevier); 2003.

    Google Scholar 

  5. Histoplasmosis KR. The Madras. Clin J. 1966;3:81.

    Google Scholar 

  6. Chakravorty SC, Damodaran VN, Abraham S. Histoplasmosis in childhood in India (a case report with family study). Indian J Chest Dis. 1968;10:204.

    Google Scholar 

  7. Mukherjee AM, Khan KP, Sanyal M, Basu N. Histoplasmosis in India with report of two cases. J Indian Med Assoc. 1971;56:121–5.

    CAS  PubMed  Google Scholar 

  8. Mukherjee AK, Mukherjee D, Mukhopadhyay M. Histoplasmosis in India: a clinicopathological review with report of a case in a child. Indian J Pathol Microbiol. 1986;29:263–70.

    CAS  PubMed  Google Scholar 

  9. Dhawan J, Verma P, Sharma A, et al. Disseminated cutaneous histoplasmosis in an immunocompetent child, relapsed with itraconazole, successfully treated with voriconazole. Pediatr Dermatol. 2010;27:549–51.

    Article  PubMed  Google Scholar 

  10. Kathuria S, Capoor MR, Yadav S, Singh A, Ramesh V. Disseminated histoplasmosis in an apparently immunocompetent individual from north India: a case report and review. Med Mycol. 2013;51:774–8.

    Article  PubMed  Google Scholar 

  11. Kathuria S, Singh Pradeep K, Meis JF, Chowdhary A. In vitro antifungal susceptibility profile and correlation of mycelia and yeast forms of molecularly characterized Histoplasma capsulatum strains from India. Antimicrobial Agents Chemother. 2014;58:5613–6.

    Article  Google Scholar 

  12. Vishwanathan R, Chakravarty SC, Randhawa HS, deMonte AJH. Pilot histoplasmosis survey in Delhi area. Br Med J. 1960;1:399–400.

    Article  Google Scholar 

  13. Subramanian S, Abraham OC, Rupali P, Zachariah A, Mathews MS, Mathai D. Disseminated histoplasmosis. JAPI. 2005;53:185–9.

    CAS  PubMed  Google Scholar 

  14. Anstead GM, Patterson TF. Endemic mycoses. In: Aaisse EJ, McGinnis MR, Pfaller MA, editors. Clinical mycology. Philadelphia: Churchill Livingstone, Elsevier; 2009. p. 355–73.

    Chapter  Google Scholar 

  15. Gurney JW, Conces DJ. Pulmonary histoplasmosis. Radiology. 1996;199:297–306.

    CAS  Article  PubMed  Google Scholar 

  16. Bradsher RW. Histoplasmosis and blastomycosis. Clin Infect Dis. 1996;22(suppl 2):S102–11.

    Article  PubMed  Google Scholar 

  17. Kurowski R, OstapchuK. Overview of histoplasmosis. Am Fam Phys. 2002;66(12):2247–52.

    Google Scholar 

  18. Tan JS, File TM Jr, Salata RA, Tan MJ, editors. Expert guide to infectious diseases. Philadelphia: ACP Press; 2008.

    Google Scholar 

  19. Elin RJ, Whitis J, Snyder J. Infectious disease diagnosis from a peripheral blood smear. Lab Med. 2000;31:324–8.

    Article  Google Scholar 

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The authors acknowledge the help of Dr (Prof.) Arunaloke Chakrabarti and Dr M. R. Shivaprakash, National Culture Collection of Pathogenic Fungi, PGIMER, Chandigarh, India, for reconfirming the isolate by DNA sequencing. The authors also acknowledge the help of Late Mrs. Kamlawati, Senior Technician, Department of Microbiology, V.M.M.C and Safdarjung Hospital, Delhi, India, for her technical expertise in the case.

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Correspondence to Malini R. Capoor.

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Agarwal, P., Capoor, M.R., Singh, M. et al. An Unusual Presentation of Disseminated Histoplasmosis: Case Report and Review of Pediatric Immunocompetent Patients from India. Mycopathologia 180, 359–364 (2015).

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  • Disseminated histoplasmosis (DH)
  • Immunocompetent hosts
  • Children
  • Complications