Exuberant mucocutaneous lesions of disseminated histoplasmosis in a human immunodeficiency virus (HIV) positive patient (original) (raw)
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Mycopathologia, 2009
Background. Mucocutaneous lesions in human immunodeficiency virus (HIV)infected patients with disseminated histoplasmosis have a wide spectrum of clinical manifestations, making its diagnosis difficult. Studies have been restricted to case reports and series with small numbers of patients not specifically focusing on the dermatological aspects of histoplasmosis. Aims. To describe the characteristics of mucocutaneous lesions of disseminated histoplasmosis in HIV-infected patients. Methods. A retrospective and prospective study was conducted on 36 HIV-infected patients with mucocutaneous histoplasmosis in a tertiary-care hospital in Brazil. Results. Mucocutaneous histoplasmosis was diagnosed by histopathology in 33 of the 36 patients (91%) and ⁄ or culture in 23 (64%). Their CD4+ cell counts ranged from 2 to 103 cells ⁄ mm 3 . The average number of different morphological types of lesions was three per patient. Despite the variability of the lesions, papules (50%), crusted papules (64%) and oral mucosal erosions and ⁄ or ulcers (58%) were the most frequent dermatological lesions. A diffuse pattern of distribution of the skin lesions was found in 58% of the cases. There was significant association between the CD4+ cell counts and the morphological variability of lesions per patient. Variation in the lesions seemed to be associated with higher CD4+ cell counts. Conclusion. Doctors caring for HIV-infected patients should be aware of the wide spectrum of dermatological lesions observed in disseminated histoplasmosis and the importance of detecting and isolating the fungus in mucocutaneous tissues.
Actas Dermo-Sifiliográficas, 2018
Histoplasmosis is a systemic mycosis caused by the dimorphous fungus Histoplasma capsulatum (H. capsulatum). The fungus enters the body through the respiratory tract in the form of microconidia, which are transformed into intracellular yeast-like structures in the lungs before disseminating hematogenously. Primary infection is usually asymptomatic and selfresolving. Some patients develop severe disease with acute or chronic respiratory involvement. Immunosuppressed patients, mainly those with altered cellular immunity, may have disseminated disease with variable mucocutaneous involvement characterized by papules, nodules, gummas, or ulcers with a granulomatous base. We report the case of 3 HIV-negative patients infected by H capsulatum in whom diagnosis based on the skin lesions proved essential for early initiation of treatment.
Histoplasmosis: An Important Mycosis of Public Health Significance
Histoplasmosis, a highly infectious fungal disease of public health concern, is caused by Histoplasma capsulatum var. capsulatum, a dimorphic fungus that occurs in mycelial and yeast form. The respiratory tract is recognized as the primary site of H. capsulatum var.capsulatum and the infection is acquired by inhalation of fungal spores from the saprobic environment. Disease can occur in sporadic as well as in epidemic form causing morbidity and mortality in susceptible individuals. Sporadic cases of histoplasmosis are reported from over 60 countries of the world including India. In USA, 25,000 cases of histoplasmosis are diagnosed every year. Certain groups of people who are associated with the soil related activities are at greater risk for developing the severe forms of disease. The fungus has the potential to infect every organ of the body including the skin, lung, brain, eye, adrenal gland, heart, liver, spleen, nose, gastrointestinal tract etc. The infection remains asymptomatic in over 90% of cases. The clinical presentation is varied and the affected person shows fever, headache, dry cough, dyspnea, chest pain, profuse sweating, lymphadenopathy, lesions in the mouth and skin etc. histoplasmosis in immune compromised patients, especially suffering from AIDS has poor prognosis. Mycological, immunological, and molecular techniques are employed to confirm an unequivocal diagnosis of disease. However, the isolation of H. capsulatum var. capsulatum from the clinical specimens still considered the gold standard of diagnosis. Antifungal drugs like liposomal amphotericin B and itraconazole are recommended for the management of disease. The disseminated histoplasmosis can be fatal if left untreated. It is imperative that immune compromised persons must avoid visiting the heavily contaminated sites that are inhabited by bats excreta and avian droppings.
An Italian Case of Disseminated Histoplasmosis Associated with HIV
Case Reports in Infectious Diseases, 2019
Histoplasma capsulatumis a dimorphic fungus, endemic in the Americas, Africa (var.duboisii), India, and Southeast Asia.H. capsulatuminfection is rarely diagnosed in Italy, while in Latin America, progressive disseminated histoplasmosis (PDH) is one of the most frequent AIDS-defining illnesses and causes of AIDS-related deaths. We report a case of PDH and new HIV infection diagnosis in a Cuban patient, who has been living in Italy for the past 10 years. Bone marrow aspirate and peripheral blood smear microscopy suggestedH. capsulatuminfection. The diagnosis was confirmed with the culture method identifying its thermal dimorphism. Liposomal amphotericin B was administered alone for 10 days and then for another 2 days, accompanied with voriconazole; the former was stopped for probable side effects (persistent fever and worsening thrombocytopenia), and voriconazole was continued to complete 4 weeks. PDH maintenance treatment consisted of itraconazole for one year. Antiretroviral therapy...
Emerging Infectious Diseases, 2007
African histoplasmosis caused by Histoplasma capsulatum var. duboisii is an invasive fungal infection endemic in central and west Africa. Most of its ecology and pathogenesis remain unknown. H. capsulatum var. capsulatum is an AIDS-defi ning opportunistic infection in HIV-infected patients who are living in or have traveled to histoplasmosis-endemic areas. In contrast, reports concerning African histoplasmosis during HIV infection are rare, although both pathogens coexist in those regions. We report 3 cases of imported African histoplasmosis diagnosed in France in HIVinfected patients and a literature review on similar cases.