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Disseminated histoplasmosis due to histoplasma capsulatum in two Nigerian children
Abstract:
Two cases of disseminated histoplasmosis caused by H. capsulatum in Nigerian children are reported. This is a rare infection in this part of the world. The main clinical features were fever, weight loss, lassitude, lymphadenopathy, hepatosplenomegaly and severe anaemia, features indistinguishable from those of tuberculosis, Hodgkins and other reticuloses. Recognition of this infection in this environment is possible if it is considered in the differential diagnosis of pyrexia of undetermined origin and appropriate laboratory tests carried out on suitable specimens such as bone marrow, splenic aspirate or biopsy material. Treatment of choice is amphotericin B given intravenously, starting with 0-25 mg/kg. and increasing slowly to 1 mg/kg. Other useful drugs are Septrin and rifampicin which can be given concurrently. Subcutaneous abscesses and multiple bone lesions occurred in both our cases presumably as a result of blood stream infection, or embolisation from endocarditis.
Insights
Disseminated histoplasmosis, a rare fungal infection caused by Histoplasma capsulatum, was identified in Nigerian children. Early recognition and treatment with amphotericin B are crucial for managing this severe disease.
Area of Science:
- Mycology
- Infectious Diseases
- Pediatrics
Background:
- Disseminated histoplasmosis is a rare fungal infection caused by Histoplasma capsulatum.
- This infection is uncommon in Nigeria and surrounding regions.
Observation:
- Two Nigerian children presented with disseminated histoplasmosis.
- Clinical features included fever, weight loss, fatigue, lymphadenopathy, enlarged liver and spleen, and severe anemia.
- These symptoms were clinically indistinguishable from tuberculosis, Hodgkin's disease, and other reticuloses.
Findings:
- Histoplasma capsulatum infection can mimic other serious conditions in children.
- Subcutaneous abscesses and multiple bone lesions were observed in both cases, likely due to bloodstream dissemination or endocardial embolization.
- Prompt laboratory investigation of pyrexia of unknown origin is essential for diagnosis.
Implications:
- Histoplasmosis should be considered in the differential diagnosis of febrile illnesses in children in endemic and non-endemic areas.
- Intravenous amphotericin B is the primary treatment, with Septrin and rifampicin as potential concurrent therapies.
- Early diagnosis and appropriate management are critical for improving outcomes in pediatric disseminated histoplasmosis.