Article

Disseminated Histoplasmosis

Department of General Medicine, Unit 1 Christian Medical College, Ida Scudder Road, PB No. 3, Vellore, Tamil Nadu, India.
The Journal of the Association of Physicians of India 04/2005; 53:185-9.
Source: PubMed

ABSTRACT

To study the clinical features and natural history of disseminated histoplasmosis(DH) in India.
We retrospectively analyzed the data obtained from the in-patient medical records of adults (age > 13 years) diagnosed to have DH during the period from January 1989 to December 1999. DH was diagnosed when histologically compatible intracellular organisms were present or Histoplasma capsulatum was obtained in culture from the extrapulmonary sites.
Nineteen patients (18 male and 1 female) were diagnosed to have DH. Diabetes mellitus and HIV infection were the most common co-morbid conditions. Weight loss, fever and oropharyngeal ulcers were the commonest symptoms. Physical signs included hepatosplenomegaly, oropharyngeal ulcers and lymphadenopathy. The diagnosis was confirmed by histopathology and/or culture from the following sites: bone marrow, adrenal gland, lymph node, oropharyngeal ulcers, rectal mucosa and skin. Two patients were treated with Amphotericin B, 6 with various azoles and 3 had Amphotericin B followed by various azoles. Among the eleven treated, 7 were cured, 2 improved, 1 had a relapse and 1 patient died.
DH is not uncommon in India and should be considered in the diagnosis of patients with prolonged fever, weight loss, oropharyngeal ulcers, hepatosplenomegaly, lymphadenopathy and adrenal enlargement. Correct diagnosis and treatment leads to a favourable outcome.

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Available from: Priscilla Rupali, Dec 23, 2013
    • "The diagnosis rests upon histopathology of affected areas most often with demonstration of intracellular yeasts, the presence of budding and a distinct capsule seen best on the PAS or Gomori's Silver stain, all of which were seen in our patient. The value of direct demonstration of the organisms on smear or tissue was stressed in two studies both of which found the sensitivity to be 100%,[19] in contrast to culture, which was positive in 20.8%[1] and 16%[9] respectively. As in our case, all studies reporting positive cultures noted a period of 3-4 weeks on special media to develop the mold form with the presence of microconidia.[168] "
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