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Histoplasmosis: the otolaryngologist's perspective

M E Gerber1, J D Rosdeutscher, A M Seiden

  • 1Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati, OH 45267-0528, USA.

The Laryngoscope
|September 1, 1995
PubMed
Summary

Disseminated histoplasmosis can affect the head and neck, mimicking cancer. This fungal infection is increasingly seen in immunocompromised individuals and requires prompt diagnosis and treatment.

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Area of Science:

  • Infectious Diseases
  • Otolaryngology
  • Mycology

Background:

  • Histoplasmosis, a fungal infection caused by Histoplasma capsulatum, can present with symptoms mimicking upper aerodigestive tract carcinoma.
  • Increasing numbers of immunocompromised patients, including those with human immunodeficiency virus (HIV), diabetes, and organ transplants, are at higher risk for severe disseminated histoplasmosis.
  • Prompt and accurate diagnosis is crucial for managing histoplasmosis, especially when it affects the head and neck region.

Observation:

  • A review of 115 hospitalized patients with disseminated histoplasmosis identified 9 with otolaryngologic manifestations.
  • These 9 patients included individuals with HIV (4), diabetes (1), and renal transplants (3).
  • Otolaryngologic sites involved were the larynx (2 cases) and the oral cavity/oral pharynx (7 cases).

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Findings:

  • Diagnosis was confirmed via positive biopsy results in 8 patients and positive culture in 1 patient.
  • Treatment with amphotericin B was generally effective for these cases.
  • Newer azole antifungal agents showed less efficacy compared to amphotericin B.

Implications:

  • The rising prevalence of immunocompromised patients suggests an increased incidence of head and neck histoplasmosis in clinical practice.
  • Otolaryngologists must be aware of histoplasmosis as a differential diagnosis for upper aerodigestive tract lesions, particularly in at-risk populations.
  • Effective management strategies, including appropriate antifungal therapy, are essential for improving outcomes in patients with disseminated histoplasmosis affecting the head and neck.