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Pericarditis caused by Histoplasma capsulatum
Abstract:
Sixteen patients with pericarditis caused by Histoplasma capsulatum were studied. Fourteen were less than 30 years old, and no patient had an underlying illness or was receiving immunosuppressive therapy. All patients experienced a flu-like prodromal illness lasting from 2 weeks to 4 months. Pneumonitis or hilar adenopathy, or both, was found in 12; pleural effusion, uncommon in primary pulmonary histoplasmosis, was found in seven patients. Pericardial fluid, pleural fluid and bone marrow cultures yielded no growth. All patients demonstrated a fourfold or greater change in complement-fixing antibody titers. No patient had disseminated disease, and only one required treatment with ampholericin B. The illness ran a protracted course, and in six patients symptomatic pericarditis recurred. Ultimately all recovered. Ten patients were restudied 6 months to 12 years after recover. Only one patient had pericardial calcification, and none had constrictive pericarditis. This form of granulomatous pericarditis, unlike that caused by Mycobacterium tuberculosis, appears to carry a good prognosis.
Insights
Histoplasma capsulatum can cause pericarditis, often in young, healthy individuals. This granulomatous pericarditis typically resolves without long-term complications, unlike tuberculosis-related cases.
Area of Science:
- Infectious Diseases
- Cardiology
- Mycology
Background:
- Pericarditis is inflammation of the pericardium, the sac surrounding the heart.
- Histoplasma capsulatum is a fungus endemic in certain regions, primarily causing pulmonary infections.
- Fungal infections, including histoplasmosis, can rarely manifest with cardiac involvement.
Purpose of the Study:
- To investigate the clinical presentation, course, and prognosis of pericarditis caused by Histoplasma capsulatum.
- To differentiate Histoplasma capsulatum-induced pericarditis from other causes, particularly tuberculosis.
- To assess long-term outcomes in patients with fungal pericarditis.
Main Methods:
- Retrospective case series of sixteen patients diagnosed with pericarditis due to Histoplasma capsulatum.
- Clinical data collection including prodromal symptoms, associated pulmonary findings, and treatment.
- Serological testing for Histoplasma capsulatum antibodies and long-term follow-up assessments.
Main Results:
- Most patients were young (<30 years) and immunocompetent, presenting with flu-like illness and sometimes pneumonitis or pleural effusion.
- Cultures were typically negative, but serological evidence confirmed Histoplasma capsulatum infection.
- While protracted and recurrent in some, all patients recovered, with minimal long-term sequelae like pericardial calcification; no constrictive pericarditis was observed.
Conclusions:
- Histoplasma capsulatum pericarditis is an uncommon but generally benign condition in immunocompetent hosts.
- It differs from tuberculous pericarditis in its favorable prognosis and lower likelihood of causing constrictive pericarditis.
- Early recognition and supportive care are key, with a good long-term outlook for affected individuals.