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Disseminated pulmonary histoplasmosis in immunocompetent patients: a common epidemiological exposure

Michael Klein1, Mirza Khan2, Jorge L Salinas3

  • 1Department of Medicine - Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA.

BMJ Case Reports
|March 23, 2019
PubMed

Insights

Acute respiratory distress syndrome in immunocompetent adults can be caused by histoplasmosis. Occupational exposure to bat droppings during building remodelling led to severe fungal infections in three men.

Area of Science:

  • Infectious Diseases
  • Pulmonology
  • Environmental Health

Background:

  • Histoplasmosis is a fungal infection typically associated with specific geographic regions.
  • Severe cases can lead to acute respiratory distress syndrome (ARDS), particularly with high-dose exposures.
  • Immunocompetent individuals can develop severe histoplasmosis under certain exposure conditions.

Observation:

  • Three immunocompetent adult men presented with ARDS within a short period.
  • The common exposure source was identified as remodelling a building infested with bat droppings.

Findings:

  • The patients' ARDS was attributed to a large inoculum of Histoplasma capsulatum.
  • Diagnostic work-up and treatment strategies for severe histoplasmosis were employed.

Implications:

  • Highlights the importance of detailed exposure history in diagnosing unexplained respiratory failure.
  • Emphasizes the need for respiratory protection in occupational settings with potential fungal spore exposure.
  • Underscores Histoplasma as a potential cause of ARDS in immunocompetent individuals following significant environmental exposure.
Keywords:
occupational and environmental medicinepneumonia (respiratory medicine)public health

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