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Cureus Feb 2024causes symptoms in fewer than 5% of infected people, with most recovering without treatment two to three weeks after the onset of symptoms. Progressive disseminated...
causes symptoms in fewer than 5% of infected people, with most recovering without treatment two to three weeks after the onset of symptoms. Progressive disseminated histoplasmosis in adults occurs most often in persons with underlying immunodeficiency. We present a case of a 65-year-old caucasian male without any known immune defect from North Alabama, United States, presenting with chronic tongue ulcer and constitutional symptoms. CT and positron emission tomography scans showed disseminated infection with pulmonary nodule, oral/buccal lesions, and bilateral adrenal hyperplasia. The patient's left adrenal gland and tongue were biopsied and stains confirmed the presence of histoplasmosis in both samples. The patient was treated with isavuconazole off-label as per the United States FDA. The patient tolerated the therapy well and had symptomatic improvement. A follow-up CT scan showed improvement and resolution of adrenal masses.
PubMed: 38440015
DOI: 10.7759/cureus.53495 -
Medical Mycology Case Reports Mar 2024Haemophagocytic lymphohistiocytosis secondary to infection is rare and almost always occurs in immunocompromised hosts. We report a 32-year-old immunocompetent man...
Haemophagocytic lymphohistiocytosis secondary to infection is rare and almost always occurs in immunocompromised hosts. We report a 32-year-old immunocompetent man presenting with a nonspecific febrile illness found to have disseminated histoplasmosis and associated haemophagocytic lymphohistiocytosis. The diagnosis was confirmed on histopathological examination and PCR of liver and bone marrow biopsies. He was successfully treated with steroids, intravenous immunoglobulin and itraconazole.
PubMed: 38425787
DOI: 10.1016/j.mmcr.2024.100635 -
Microbiology Spectrum Apr 2024var (HCF) is a dimorphic fungus that causes epizootic lymphangitis in equids. Current diagnostic approaches, including culture, microscopy, and clinical presentation,...
UNLABELLED
var (HCF) is a dimorphic fungus that causes epizootic lymphangitis in equids. Current diagnostic approaches, including culture, microscopy, and clinical presentation, lack speed, sensitivity, and specificity when diagnosing clinical cases. In this study, equine blood and pus samples on Whatman FTA cards from Senegal ( = 3), The Gambia ( = 19), Ethiopia ( = 16), and Mali ( = 13) were tested using a real-time PCR (qPCR) protocol. The assay was optimized and tested for its suitability to detect and quantify HCF in blood and pus loaded onto Whatman FTA cards at sampling. Whatman FTA cards were tested for their suitability for use with qPCR and were found to recover DNA more efficiently than from direct extraction. Using TaqMan fluorescent probes and specific primers, the assay demonstrated 100% analytical specificity when detecting multiple strains of and no false positives with off-target organisms. The assay's diagnostic performance was measured against an existing nested internal transcribed spacer PCR protocol using a receiver operating characteristic curve. The test was found to have a diagnostic specificity and sensitivity of 100% and 71.4%, respectively, when analyzing pus samples using a cycle threshold (Ct) cutoff determined by Youden's index (27.75). Blood sample cutoff Ct value was proposed at 34.55. Further optimization is required to improve the performance of the protocol when applied to blood samples. This study has, for the first time, demonstrated the ability to detect and quantify the DNA of spp. in equine blood and pus samples with a high degree of accuracy, providing a platform to further investigate the pathogenesis and epidemiology of this disease.
IMPORTANCE
Histoplasmosis is a neglected yet major cause of morbidity and mortality in both equids and people in resource-scarce settings. One of the major hindrances to the control of histoplasmosis is a lack of readily available diagnostic tests. Tests are needed to support clinical decision-making and to be applied in population-based research to further understand this disease . This paper reports, for the first time, the validation and application of a qPCR to detect directly from equine clinical samples, bypassing the need to culture this notoriously difficult organism. We report and comment on the performance of the qPCR in comparison with our previously developed nested PCR.
Topics: Horses; Animals; Humans; Histoplasma; Histoplasmosis; Real-Time Polymerase Chain Reaction; Nucleic Acids; DNA, Fungal; Suppuration
PubMed: 38411051
DOI: 10.1128/spectrum.03100-23 -
Journal of Fungi (Basel, Switzerland) Feb 2024, the etiological agent for histoplasmosis, is a dimorphic fungus that grows as a mold in the environment and as a yeast in human tissues. It has a broad global... (Review)
Review
, the etiological agent for histoplasmosis, is a dimorphic fungus that grows as a mold in the environment and as a yeast in human tissues. It has a broad global distribution with shifting epidemiology during recent decades. While in immunocompetent individuals infection is usually self-resolving, solid organ transplant recipients are at increased risk of symptomatic disease with dissemination to extrapulmonary tissue. Diagnosis of histoplasmosis relies on direct observation of the pathogen (histopathology, cytopathology, and culture) or detection of antigens, antibodies, or nucleic acids. All transplant recipients with histoplasmosis warrant therapy, though the agent of choice and duration of therapy depends on the severity of disease. In the present article, we describe the pathogenesis, epidemiology, clinical manifestations and management of histoplasmosis in solid organ transplant recipients.
PubMed: 38392796
DOI: 10.3390/jof10020124 -
Journal of Infection in Developing... Jan 2024Fungi play a vital role in ensuring a physiological balance in the surrounding environments, interacting closely with humans, plants, and animals. While most of the time... (Review)
Review
Fungi play a vital role in ensuring a physiological balance in the surrounding environments, interacting closely with humans, plants, and animals. While most of the time their contribution is beneficial, occasionally, they can become harmful, especially in patients with weakened immune systems. The work at hand aims to present the most common fungal pathogens involved in invasive infections, focusing on fungi that are present in the tropical and temperate areas of the world. While in the former, due to the humid climate, most fungal infections are caused by dimorphic fungi such as Coccidioides spp., Blastomyces spp., Histoplasma spp., Emergomyces spp. and Paracoccidioides spp., in the latter, after Candida spp., the most frequent fungi that are involved in disseminated mycosis are Aspergillus spp., Fusarium spp. and species from the order Mucorales. Nowadays, the etiology, severity, and number of cases of fungal diseases are starting to rise significantly. There are no exact reasons reported for this increase, but several factors are thought to be incriminated: the expansion of the range of medical conditions that constitute risk factors for developing the disease, an improvement in the available diagnostic methods, the commodity offered by modern traveling services associated with the lack of an available vaccine against fungal infections, as well as climatic influences. All the above-mentioned aspects consequently caused infections that used to be endemic to be spread worldwide. Therefore, it is of critical importance to understand the epidemiology, clinical manifestations of fungi induced diseases, virulence factors, and diagnosis for each of those pathogens.
Topics: Animals; Humans; Fungi; Mycoses; Aspergillus; Candida
PubMed: 38377080
DOI: 10.3855/jidc.18206 -
Indian Journal of Dermatology 2023Angioimmunoblastic T-cell lymphoma (AITL) is an uncommon systemic lymphoproliferative disorder that comprises approximately one-fifth of all mature peripheral T-cell...
'Generalised Pruritus with Prurigo-Like Lesions and Generalised Lymphadenopathy: Could be an Early Diagnostic Clue for Angioimmunoblastic T-Cell Lymphoma (AITL) and/or Histoplasmosis'.
Angioimmunoblastic T-cell lymphoma (AITL) is an uncommon systemic lymphoproliferative disorder that comprises approximately one-fifth of all mature peripheral T-cell lymphomas. A broad range of cutaneous manifestations include maculopapular, papulovesicular, erythrodermic, urticarial, plaque-like and nodular, and they are mentioned in 50% of patients and may precede systemic symptoms, which include lymphadenopathy, hepatosplenomegaly and constitutional symptoms. Histoplasmosis is a common granulomatous infection worldwide caused by , a dimorphic fungus. Cutaneous manifestations are reported to occur in 10% to 25% of immunosuppressed patients with disseminated histoplasmosis. Generalised pruritus as a presenting feature is rarely described in both of these entities. We report a unique case of AITL with histoplasmosis discovered during paraclinical assessment of generalised pruritus (? neurodermatitis) with prurigo-like lesions and lymphadenopathy.
PubMed: 38371550
DOI: 10.4103/ijd.ijd_974_22 -
Indian Journal of Pathology &... 2024
Topics: Humans; Antifungal Agents; Bone Marrow; Histoplasma; Histoplasmosis
PubMed: 38358230
DOI: 10.4103/ijpm.ijpm_200_22 -
Cureus Dec 2023Histoplasmosis is a systemic fungal infection caused by , known for its protean clinical manifestations that often pose diagnostic challenges. Immunocompromised...
Histoplasmosis is a systemic fungal infection caused by , known for its protean clinical manifestations that often pose diagnostic challenges. Immunocompromised patients, such as those on immunosuppressive therapies or with HIV/AIDS, are particularly susceptible to severe forms of the disease. We present a case of a 55-year-old female with a complex medical history, including a renal transplant, who developed fever, malaise, nausea, and vomiting after a month-long stay in Panama. The patient's history included exposure to a bird with apparent infection and mold in her home. Her clinical presentation featured acute kidney injury, elevated liver enzymes, acalculous cholecystitis, and lung nodules. This intricate constellation of symptoms underscores the diverse nature of histoplasmosis presentations and its potential to mimic other diseases. The patient underwent a stepwise diagnostic approach involving imaging, microbiological tests, and multidisciplinary consultations. The positive Fungitell assay, detection in urine, and identification of scattered subcentimeter lung nodules confirmed the diagnosis. This case underscores the significance of considering endemic areas, environmental exposures, and atypical clinical features in immunocompromised patients. The multidisciplinary approach facilitated appropriate management and treatment initiation with liposomal amphotericin B, highlighting the importance of collaboration among various medical specialties in complex cases. As such, this case report emphasizes the complexity of diagnosing and managing histoplasmosis in immunocompromised individuals and highlights the need for a comprehensive evaluation of atypical presentations.
PubMed: 38283423
DOI: 10.7759/cureus.51276 -
JGH Open : An Open Access Journal of... Jan 2024Disseminated histoplasmosis is a rare complication of infection due to . Typically, histoplasmosis is self-limiting and asymptomatic in infected individuals with...
Disseminated histoplasmosis is a rare complication of infection due to . Typically, histoplasmosis is self-limiting and asymptomatic in infected individuals with immunocompetence. Disseminated disease, however, can arise in high-risk populations with primary or acquired cellular immunodeficiency including HIV/AIDS, transplant recipients, and those undergoing immunosuppressive therapy. Here we describe a unique case of extrapulmonary gastrointestinal histoplasmosis by infiltrative Peyer's patch disease with bone marrow involvement in a transgender HIV-infected woman.
PubMed: 38268953
DOI: 10.1002/jgh3.13011 -
BioRxiv : the Preprint Server For... Jan 2024Histoplasmosis is an endemic mycosis that often presents as a respiratory infection in immunocompromised patients. Hundreds of thousands of new infections are reported...
Histoplasmosis is an endemic mycosis that often presents as a respiratory infection in immunocompromised patients. Hundreds of thousands of new infections are reported annually around the world. The etiological agent of the disease, , is a dimorphic fungus commonly found in the soil where it grows as mycelia. Humans can become infected by through inhalation of its spores (conidia) or mycelial particles. The fungi transitions into the yeast phase in the lungs at 37°C. Once in the lungs, yeast cells reside and proliferate inside alveolar macrophages. We have previously described that is composed of at least five cryptic species that differ genetically, and assigned new names to the lineages. Here we evaluated multiple phenotypic characteristics of 12 strains from five phylogenetic species of to identify phenotypic traits that differentiate between these species: , and an African lineage. We report diagnostic traits for two species. The other three species can be identified by a combination of traits. Our results suggest that 1) there are significant phenotypic differences among the cryptic species of , and 2) that those differences can be used to positively distinguish those species in a clinical setting and for further study of the evolution of this fungal pathogen.
PubMed: 38260643
DOI: 10.1101/2024.01.08.574719