1/23. Disseminated histoplasmosis causing reversible gaze palsy and optic neuropathy.Subacute disseminated histoplasmosis is an uncommon entity. Typical neuro-ophthalmologic manifestations are usually secondary to histoplasmomas or encephalitis. A 45-year-old man noted blurred vision while receiving empiric antituberculosis therapy for fever and diffuse granulomatous disease of unknown origin. Vertical-gaze palsy, right horizontal-gaze paresis, and mild right optic neuropathy were found on neuro-ophthalmologic examination. Further questioning revealed a history of frequent contact with fighting cocks from south america. Magnetic resonance images were consistent with multiple hemorrhagic infarcts, areas of inflammation, or both, and cerebral angiography showed changes consistent with vasculitis. A previously obtained biopsy specimen from the duodenum was restained and found to be positive for fungal elements. serum antigen titers for histoplasma capsulatum demonstrated evidence of active infection. This case is a rare example of a supranuclear ocular motility disturbance and optic neuropathy secondary to an occlusive vascular process in a patient with subacute disseminated histoplasmosis.- - - - - - - - - - ranking = 1keywords = antigen (Clic here for more details about this article) |
2/23. A case of histoplasma capsulatum causing granulomatous liver disease and Addisonian crisis.A 56-year-old man with persistently elevated liver enzyme levels, fatigue, lethargy and a 9.0 kg weight loss over six months underwent a percutaneous liver biopsy that demonstrated multiple granulomas. Screening serologies were positive for histoplasmosis, and he was started on itraconazole treatment. He returned to hospital the same night with coffee-ground emesis and in Addisonian crisis requiring parenteral steroids and intensive care unit support. An abdominal computed tomography scan revealed bilaterally enlarged, nonenhancing adrenal glands suggestive of infarcts, presumed secondary to histoplasmosis. Treatment was initiated with amphotericin b, and histoplasma capsulatum was cultured from his urine and cerebrospinal fluid. A serum immunodiffusion test was also positive for both H and M bands, indicating active infection with histoplasmosis species. His serum and urine samples were also weakly positive for the antigen. Despite complications of renal failure, pneumonia and congestive heart failure, he recovered with medical therapy and was discharged home to complete a prolonged course of itraconazole therapy. While hepatic granulomas often reflect an occult disease process, the cause may remain undiscovered in 30% to 50% of patients despite exhaustive investigations. H capsulatum is an uncommon cause of granulomatous liver disease, and with its protean clinical presentation, a high index of suspicion is needed to make the diagnosis and avoid the potentially high fatality rate associated with disseminated infection.- - - - - - - - - - ranking = 1keywords = antigen (Clic here for more details about this article) |
3/23. Disseminated histoplasmosis presenting as pyoderma gangrenosum-like lesions in a patient with acquired immunodeficiency syndrome.A 33-year-old Hispanic woman with newly diagnosed human immunodeficiency virus (hiv) infection, a CD4 T-lymphocyte count of 2, viral load of 730,000 copies/mL, candidal esophagitis, seizure disorder, a history of bacterial pneumonia, and recent weight loss was admitted with tonic clonic seizure. On admission, her vital signs were: pulse of 88, respiration rate of 18, temperature of 37.7 degrees C, and blood pressure of 126/76. Her only medication was phenytoin. On examination, the patient was found to have multiple umbilicated papules on her face, as well as painful, erythematous, large, punched-out ulcers on the nose, face, trunk, and extremities of 3 months' duration (Fig. 1). The borders of the ulcers were irregular, raised, boggy, and undermined, while the base contained hemorrhagic exudate partially covered with necrotic eschar. The largest ulcer on the left mandible was 4 cm in diameter. The oral cavity was clear. Because of her subtherapeutic phenytoin level, the medication dose was adjusted, and she was empirically treated with Unasyn for presumptive bacterial infection. Chest radiograph and head computed tomography (CT) scan were within normal limits. sputum for acid-fast bacilli (AFB) smear was negative. Serologic studies, including histoplasma antibodies, toxoplasmosis immunoglobulin m (IgM), rapid plasma reagin (RPR), hepatitis c virus (HCV), and hepatitis b virus (HBV) antibodies were all negative. Examination of the cerebrospinal fluid was within normal limits without the presence of cryptococcal antigen. Blood and cerebrospinal cultures for bacteria, mycobacteria, and fungi were all negative. Viral culture from one of the lesions was also negative. The analysis of her complete blood count showed: white blood count, 2300/microl; hemoglobin, 8.5 g/dL; hematocrit, 25.7%; and platelets, 114,000/microl. Two days after admission, the dermatology service was asked to evaluate the patient. Although the umbilicated papules on the patient's face resembled lesions of molluscum contagiosum, other infectious processes considered in the differential diagnosis included histoplasmosis, cryptococcosis, and penicillium marnefei. In addition, the morphology of the ulcers, particularly that on the left mandible, resembled lesions of pyoderma gangrenosum. A skin biopsy was performed on an ulcer on the chest. Histopathologic examination revealed granulomatous dermatitis with multiple budding yeast forms, predominantly within histiocytes, with few organisms residing extracellularly. methenamine silver stain confirmed the presence of 2-4 microm fungal spores suggestive of histoplasma capsulatum (Fig. 2). Because of the patient's deteriorating condition, intravenous amphotericin b was initiated after tissue culture was obtained. Within the first week of treatment, the skin lesions started to resolve. histoplasma capsulatum was later isolated by culture, confirming the diagnosis. The patient was continued on amphotericin b for a total of 10 weeks, and was started on lamivudine, stavudine, and nelfinavir for her hiv infection during hospitalization. After amphotericin b therapy, the patient was placed on life-long suppressive therapy with itraconazole. Follow-up at 9 months after the initial presentation revealed no evidence of relapse of histoplasmosis.- - - - - - - - - - ranking = 1keywords = antigen (Clic here for more details about this article) |
4/23. Development of an idlike reaction during treatment for acute pulmonary histoplasmosis: a new cutaneous manifestation in histoplasmosis.Id reactions often occur secondary to release of antigens after initiation of antimicrobial therapy. This reaction commonly occurs during treatment of trichophyton infections. The diagnosis is usually made clinically and is supported in the presence of an infection and/or initiation of therapy. We report an idlike reaction during therapy for pulmonary histoplasmosis.- - - - - - - - - - ranking = 1keywords = antigen (Clic here for more details about this article) |
5/23. Disseminated histoplasmosis in a nonendemic area.health care providers in the areas where histoplasmosis is not endemic can benefit greatly from understanding the clinical presentation, diagnosis and management of disseminated histoplasmosis as patients from the endemic areas may travel to and require medical attention in areas of low disease prevalence. Use of effective diagnostic tools such as histoplasma antigen detection can aid in providing timely and appropriate therapy.- - - - - - - - - - ranking = 1keywords = antigen (Clic here for more details about this article) |
6/23. histoplasma endocarditis: clinical and mycologic features and outcomes.OBJECTIVES: To define the salient clinical and microbiologic characteristics and outcome of infective endocarditis caused by histoplasma capsulatum. methods: Case report and review of 43 literature cases. RESULTS: Infection involved both native (36 cases) and prosthetic (7) heart valves, had a high rate of systemic embolization (58%), and a more delayed diagnosis than bacterial endocarditis. Cardiac involvement generally occurred on mitral and/or aortic valves, and almost always in the setting of disseminated disease. Antemortem diagnosis was best made by serology (serum antibody titers or urinary antigen) or culture of blood (positive in <20% of cases), bone marrow, excised valves, and other non-blood specimens. Other diagnostic methods included histopathology and immunofluorescent staining of tissue samples. Untreated infection was uniformly fatal. Prolonged antifungal therapy with amphotericin b, without surgical intervention, appeared more effective than for candida endocarditis. CONCLUSIONS: histoplasma endocarditis is an infrequent but important cause of left-sided, blood culture-negative endocarditis. Its true prevalence may be underestimated because of the relative difficulty in making a precise microbiologic diagnosis. amphotericin b therapy appears more effective than for candida endocarditis, while the role for azole treatment and secondary prophylaxis remains uncertain. Indications for surgical valve replacement are similar to those for bacterial endocarditis.- - - - - - - - - - ranking = 1keywords = antigen (Clic here for more details about this article) |
7/23. Disseminated cryptococcosis and histoplasmosis co-infection in a hiv-infected woman in france.We report the first case in europe of co-infection with disseminated cryptococcosis and histoplasmosis. The diagnosis of invasive histoplasmosis was confirmed by microscopic examination of the anatomic right colon specimen (hemicolectomy). histoplasma antigen detection is not yet available in france but it could have a key role in the early diagnosis of disseminated histoplasmosis co-existing with a cryptococcal infection, especially in hiv-infected African people.- - - - - - - - - - ranking = 1keywords = antigen (Clic here for more details about this article) |
8/23. Disseminated histoplasmosis in patients receiving low-dose methotrexate therapy for psoriasis.BACKGROUND--Low-dose methotrexate sodium therapy used for nonmalignant disease has been associated with a variety of opportunistic infections with pathogens occurring in patients with defective cellular immunity. This article describes the unusual development of disseminated histoplasmosis as a probable complication of immunosuppression resulting from use of methotrexate. OBSERVATIONS--We report the cases of three patients in whom disseminated histoplasmosis developed while receiving low-dose methotrexate therapy for psoriasis. disease manifestations were unusually severe in two of the three patients. All three cases were disseminated, and two cases resulted in illnesses requiring intensive medical treatment. Each patient responded appropriately to antifungal treatment, although one patient has required long-term suppressive treatment because of persistent histoplasma antigenuria. These cases illustrate the risk for opportunistic fungal infections in patients receiving low-dose methotrexate therapy for nonmalignant diseases. CONCLUSIONS--histoplasma should be added to the list of pathogens to be suspected in patients receiving such therapy.- - - - - - - - - - ranking = 1keywords = antigen (Clic here for more details about this article) |
9/23. histoplasma meningitis with hyperactive suppressor T cells in cerebrospinal fluid.histoplasma meningitis usually occurs in conjunction with disseminated histoplasmosis. We studied a patient with common variable hypogammaglobulinemia who manifested meningitis without disseminated histoplasmosis. No histoplasma antibody was detected in cerebrospinal fluid (CSF) or blood. Evaluation of lymphocyte function in the blood revealed normal numbers of T cells with increased numbers of B cells. Most blood lymphocytes were identifiable, but most lymphocytes in CSF were null cells. Lymphocyte proliferative response to phytohemagglutinin or pokeweed mitogen was poor. T cells in CSF suppressed proliferative responses to histoplasma antigen by cells from blood or CSF, whereas T cells from blood did not. This difference suggested compartmentalization of T-cell function. The lack of humoral and cellular response to histoplasma in CSF may have allowed meningitis to develop, while the cellular response to histoplasma elsewhere prevented development of disseminated histoplasmosis.- - - - - - - - - - ranking = 1keywords = antigen (Clic here for more details about this article) |
10/23. Presumed chronic ocular histoplasmosis syndrome: a clinical-pathologic case report.An eye of a patient with clinically typical presumed ocular histoplasmosis was studied by light microscopy, electron microscopy and immuno-fluorescence techniques. There was clinical and pathological evidence of anterior segment involvement. The posterior segment showed granulomatous and nongranulomatous chorioretinal lesions with and without subretinal neovascularization. Immunohistopathological staining for histoplasma antigens revealed positive staining at sites of lymphoid inflammation. Organisms were not identified.- - - - - - - - - - ranking = 1keywords = antigen (Clic here for more details about this article) |
| | Next -> |