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Disseminated histoplasmosis.

S Subramanian1, O C Abraham, Priscilla Rupali

  • 1Department 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
|June 2, 2005
PubMed
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Disseminated histoplasmosis (DH) is a significant fungal infection in India, often presenting with fever, weight loss, and ulcers. Early diagnosis and treatment of DH are crucial for favorable patient outcomes.

Area of Science:

  • Medical Mycology
  • Infectious Diseases
  • Clinical Medicine

Background:

  • Disseminated histoplasmosis (DH) is a systemic fungal infection caused by Histoplasma capsulatum.
  • While endemic in some regions, its prevalence and clinical spectrum in India require further elucidation.

Purpose of the Study:

  • To investigate the clinical characteristics and natural progression of disseminated histoplasmosis in India.
  • To identify key diagnostic features and treatment outcomes for DH in the Indian subcontinent.

Main Methods:

  • Retrospective analysis of inpatient medical records of adult patients diagnosed with DH between January 1989 and December 1999.
  • Diagnosis confirmed by histological evidence of intracellular organisms or culture of Histoplasma capsulatum from extrapulmonary sites.

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Main Results:

  • Nineteen cases of DH were identified, predominantly in males (18/19).
  • Common comorbidities included diabetes mellitus and HIV infection. Presenting symptoms were weight loss, fever, and oropharyngeal ulcers. Physical findings included hepatosplenomegaly, oropharyngeal ulcers, and lymphadenopathy.
  • Histopathology and/or culture confirmed DH from bone marrow, adrenal glands, lymph nodes, oropharyngeal ulcers, rectal mucosa, and skin. Treatment with Amphotericin B, azoles, or combination therapy resulted in 7 cures, 2 improvements, 1 relapse, and 1 death among 11 treated patients.

Conclusions:

  • Disseminated histoplasmosis is an important consideration in India for patients presenting with prolonged fever, weight loss, oropharyngeal ulcers, hepatosplenomegaly, lymphadenopathy, and adrenal enlargement.
  • Prompt and accurate diagnosis, coupled with appropriate antifungal therapy, can lead to favorable clinical outcomes in patients with DH.