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Histoplasmosis in patients at risk for the acquired immunodeficiency syndrome in a nonendemic setting

S H Salzman1, R L Smith, C P Aranda

  • 1Bellevue Chest Service, New York Veterans Administration Medical Center, New York.

Chest
|May 1, 1988
PubMed

Insights

Histoplasmosis in individuals at risk for acquired immunodeficiency syndrome (AIDS) presents subtly, often mimicking other conditions. Early diagnosis and treatment are crucial for managing this opportunistic infection in immunocompromised patients.

Area of Science:

  • Infectious Diseases
  • Pulmonology
  • Immunology

Background:

  • Histoplasmosis is an opportunistic fungal infection that can affect individuals with compromised immune systems.
  • Patients at risk for acquired immunodeficiency syndrome (AIDS) are particularly susceptible to disseminated histoplasmosis.
  • Understanding the clinical presentation and diagnostic challenges of histoplasmosis in this population is critical.

Purpose of the Study:

  • To review cases of histoplasmosis in patients at risk for AIDS.
  • To describe the clinical presentation, diagnostic methods, and treatment outcomes.
  • To highlight the association between histoplasmosis and altered host immunity in AIDS.

Main Methods:

  • Retrospective review of 18 histoplasmosis cases in patients at risk for AIDS.
  • Analysis of clinical data, chest roentgenograms, and diagnostic test results.
  • Evaluation of concurrent infections and treatment responses.

Main Results:

  • Seventeen of 18 patients were Hispanic, with many from Puerto Rico or South America.
  • Subacute presentation with fever, weight loss, and mild respiratory symptoms.
  • Common chest X-ray finding: diffuse small nodules; five patients had normal X-rays.
  • Histological diagnosis in 72% (transbronchial biopsy); cultures positive in 94%.
  • Concurrent Mycobacterium tuberculosis infection in six cases.
  • Most patients responded to amphotericin B therapy.

Conclusions:

  • Histoplasmosis in patients at risk for AIDS often presents with subtle respiratory symptoms and may have normal chest X-rays.
  • Rapid diagnosis is achievable through histology and cultures.
  • Concurrent tuberculosis is a significant co-infection.
  • Histoplasmosis can be an early indicator of altered immunity in AIDS.

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