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Histoplasmosis

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Summary of Histoplasmosis

Histoplasma is a genus of dimorphic fungi. Histoplasma capsulatum is a common disease in HIV-positive adults.

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Microbiology

Mycology

Systemic fungal infections

Coccidioidomycosis and paracoccidioidomycosis

Opportunistic fungal infections

Pneumocystis jirovecii (Pneumocystis pneumonia)

Aspergillus fumigatus

Sporothrix schenckii

Cryptococcus neoformans

Cutaneous fungal infections

Malassezia (Tinea versicolor and Seborrhoeic dermatitis)

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Histoplasmosis

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High Yield Notes

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HISTOPLASMA CAPSULATUM osms.it/histoplasma-capsulatum PATHOLOGY & CAUSES ▪ Histoplasmosis ▫ Systemic fungal infection caused by Histoplasma capsulatum; usually manifests as acute pneumonia ▪ Most frequent systemic mycoses in U.S. ▪ Microconidia inhalation → conversion to yeast form → macrophage phagocytosis → inﬂammation → pneumonia ▪ Immune response: mainly cellular, mediated by T-lymphocytes, macrophages, TNF alpha, interferon-gamma ▪ Infection sites: primarily lungs; may disseminate to other organs Histoplasma capsulatum ▪ Size: 2–3μm x 3–4μm ▪ Thermal dimorphism ▫ Mold form (< 35°C/95°F); produces microconidia (spores, 2–5μm) ▫ Yeast form (37°C/98.6°F) ▪ Infectious particles: microconidia ▪ Bird, bat fecal material promotes growth Pulmonary histoplasmosis clinical syndromes ▪ Pneumonia: acute (diffuse/localized); chronic ▪ Broncholithiasis Disseminated histoplasmosis clinical syndromes ▪ Progressive disseminated histoplasmosis: excessive reticuloendothelial infection ▪ Adrenal perivasculitis (common) ▪ Endocarditis ▪ Mediastinal granuloma ▪ Mediastinitis ▪ Meningitis ▪ Ocular histoplasmosis (e.g. retinal lesions) ▪ Lesions: intestinal (e.g. ulcers, polyps), skin (e.g. dermatitis, papules) 562 OSMOSIS.ORG RISK FACTORS ▪ Outdoor occupations (e.g. construction, excavation) ▪ Outdoor activities (e.g. camping) ▪ Immunosuppression ▪ High prevalence regions: U.S. (Ohio, Mississippi river valleys), Mexico, Central America, South America ▪ Recent travel to endemic areas ▪ Comorbid conditions ▪ Extremes of age COMPLICATIONS ▪ Fatal acute diffuse pneumonia, mediastinal granuloma, mediastinitis, chylothorax, pleural effusion SIGNS & SYMPTOMS ▪ Mostly asymptomatic Acute pulmonary histoplasmosis ▪ Systemic ▫ Fever, headaches, fatigue ▪ Chest pain (pleuritic/substernal), dry cough, myalgia, arthralgia, erythema nodosum/ multiforme Chronic pulmonary histoplasmosis ▪ Systemic ▫ Fever, fatigue, night sweats, weight loss ▪ Productive cough, hemoptysis, dyspnea ▪ Consolidation: dullness to percussion, crackles DIAGNOSIS DIAGNOSTIC IMAGING Chest X-ray ▪ Hilar/mediastinal lymphadenopathy, patchy/ nodular pulmonary inﬁltrates, occasional cavitation

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Histoplasmosis

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necrosis is seen in Histoplasma capsulatum.

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