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Chronic Cavitary Histoplasmosis of the Lung

H E Pugsley, A S Brown, O T Cheung

    Canadian Medical Association Journal
    |March 24, 2010
    PubMed

    Insights

    Chronic cavitary histoplasmosis, a lung infection, mimics tuberculosis but is identifiable by specific tests. Treatment involves amphotericin B and potentially surgery, with a high mortality rate.

    Area of Science:

    • Mycology
    • Infectious Diseases
    • Pulmonology

    Background:

    • Histoplasma capsulatum causes four distinct clinical forms of disease.
    • Chronic cavitary histoplasmosis presents similarly to pulmonary tuberculosis.
    • This form has a mortality rate exceeding 30%.

    Purpose of the Study:

    • To highlight the clinical and diagnostic features of chronic cavitary histoplasmosis.
    • To emphasize the importance of specific diagnostic tests for Histoplasma capsulatum.
    • To discuss current treatment modalities for this severe fungal infection.

    Main Methods:

    • Clinical case review of two patients with chronic cavitary histoplasmosis.
    • Diagnostic evaluation including histoplasmin skin tests, complement fixation tests, and sputum cultures.
    • Radiographic and clinical comparison with pulmonary tuberculosis.

    Main Results:

    • Both patients presented with chronic cavitary histoplasmosis.
    • Diagnostic tests for Histoplasma capsulatum were positive in over 80% of cases.
    • The condition was clinically and radiographically indistinguishable from pulmonary tuberculosis.

    Conclusions:

    • Chronic cavitary histoplasmosis requires specific diagnostic approaches due to its similarity to tuberculosis.
    • Amphotericin B is the primary treatment, with surgical resection as a preferred option when feasible.
    • Prompt diagnosis and treatment are crucial given the high mortality rate.

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