1/48. Potential association between calcified thoracic lymphadenopathy due to previous histoplasma capsulatum infection and pulmonary mycobacterium avium complex disease.BACKGROUND: Among patients with pulmonary disease due to mycobacterium avium complex (MAC) seen recently at our center, a substantial number have had extensive calcified mediastinal, hilar, and peribronchial lymphadenopathy, a finding historically inconsistent with pulmonary MAC disease. METHOD: We retrospectively studied the frequency of calcified lymphadenopathy in the chest and prevalence of known risk factors for MAC infection in 79 patients with pulmonary MAC disease who were referred to our hospital over a 1-year period. RESULTS: Calcified intrathoracic adenopathy was present in 25 of the 79 patients (32%). Residential histories revealed that 20 of the 25 patients (80%) with such calcified chest adenopathy reported living for substantial periods in the regions indigenous for histoplasma capsulatum. In contrast, the residences of patients without calcified chest adenopathy were more evenly distributed throughout the country. Nineteen of these 25 patients (76%) with calcified chest adenopathy had no known predisposing risk factor for the infection; in contrast, the proportion of patients with no calcified adenopathy who also had no identifiable classic risk factor tended to be lower (32/54, 59%). CONCLUSION: In this retrospective study, we observed that (1) a large number of patients with pulmonary MAC disease had no identifiable risk factor, (2) calcified chest adenopathy was present in one third of the patients, (3) the residential history of those with calcified adenopathy mirrored the endemic region of histoplasmosis, and, (4) conversely, those patients with pulmonary MAC who lived outside the histoplasmosis belt had no such adenopathy. Thus, we hypothesize that previous fungal infection may predispose the lungs of certain patients to subsequent invasion by MAC, presumably by airway distortion and/or parenchymal damage.- - - - - - - - - - ranking = 1keywords = count (Clic here for more details about this article) |
2/48. Acute disseminated histoplasmosis complicated with hypercalcaemia.A case of acute progressive disseminated histoplasmosis complicated with hypercalcemia is reported and the literature is reviewed. This and the previously reported cases imply that physicians should have a higher index of suspicion for this infection and the probable underlying diseases resulting from impaired cellular-mediated immunity when encountering patients with hypercalcaemia.- - - - - - - - - - ranking = 1keywords = count (Clic here for more details about this article) |
3/48. Endogenous endophthalmitis caused by histoplasma capsulatum var. capsulatum: a case report and literature review.OBJECTIVE: We report the first case of clinically diagnosed endogenous endophthalmitis caused by histoplasma capsulatum var. capsulatum in a patient with the acquired immune deficiency syndrome. DESIGN: Interventional case report and literature review. INTERVENTION: Pars plana vitrectomy and scleral buckling procedure in the left eye with intravenous and intravitreal amphotericin in both eyes. MAIN OUTCOME MEASURES: The clinical features, culture results, visual outcome, and complications were studied. RESULTS: This case demonstrates a bilateral endophthalmitis with severe subretinal exudation, choroidal granulomas, and intraretinal hemorrhage leading to exudative bilateral retinal detachments. Vitreous cultures grew H. capsulatum var. capsulatum. Treatment consisted of intravenous amphotericin, intravitreal amphotericin (both eyes), pars plana vitrectomy (left eye), and scleral buckling procedure (left eye) with resulting counting fingers vision (right eye) and 20/300 (left eye). Four cases of histoplasma endophthalmitis have been reported previously, all of which had a documented history of disseminated histoplasmosis and resulted in enucleation. CONCLUSIONS: H. capsulatum should be considered a possible etiologic agent of endophthalmitis, especially in patients with a history of disseminated histoplasmosis and/or immune deficiency.- - - - - - - - - - ranking = 1keywords = count (Clic here for more details about this article) |
4/48. Gastrointestinal histoplasmosis in patients with AIDS: case report and review.histoplasmosis is the most common endemic mycosis in individuals with AIDS, occurring in 2%-5% of this population. infection is more likely to be disseminated than in immunocompetent individuals and generally presents insidiously with nonspecific symptoms. The gastrointestinal tract is involved in 70%-90% of cases of disseminated histoplasmosis, yet gastrointestinal histoplasmosis per se is infrequently encountered in patients with AIDS. The diagnosis of gastrointestinal histoplasmosis is often not suspected, particularly in areas of nonendemicity, and a delay in diagnosis may lead to increased morbidity and risk of death. Since antifungal therapy improves outcome for >80% of AIDS patients with histoplasmosis, it is essential that caregivers be aware of the varied presentations of gastrointestinal histoplasmosis in order to diagnose and to treat this potentially life-threatening infection effectively.- - - - - - - - - - ranking = 1keywords = count (Clic here for more details about this article) |
5/48. Disseminated histoplasmosis presenting as pyoderma gangrenosum-like lesions in a patient with acquired immunodeficiency syndrome.A 33-year-old Hispanic woman with newly diagnosed human immunodeficiency virus (hiv) infection, a CD4 T-lymphocyte count of 2, viral load of 730,000 copies/mL, candidal esophagitis, seizure disorder, a history of bacterial pneumonia, and recent weight loss was admitted with tonic clonic seizure. On admission, her vital signs were: pulse of 88, respiration rate of 18, temperature of 37.7 degrees C, and blood pressure of 126/76. Her only medication was phenytoin. On examination, the patient was found to have multiple umbilicated papules on her face, as well as painful, erythematous, large, punched-out ulcers on the nose, face, trunk, and extremities of 3 months' duration (Fig. 1). The borders of the ulcers were irregular, raised, boggy, and undermined, while the base contained hemorrhagic exudate partially covered with necrotic eschar. The largest ulcer on the left mandible was 4 cm in diameter. The oral cavity was clear. Because of her subtherapeutic phenytoin level, the medication dose was adjusted, and she was empirically treated with Unasyn for presumptive bacterial infection. Chest radiograph and head computed tomography (CT) scan were within normal limits. sputum for acid-fast bacilli (AFB) smear was negative. Serologic studies, including histoplasma antibodies, toxoplasmosis immunoglobulin m (IgM), rapid plasma reagin (RPR), hepatitis c virus (HCV), and hepatitis b virus (HBV) antibodies were all negative. Examination of the cerebrospinal fluid was within normal limits without the presence of cryptococcal antigen. Blood and cerebrospinal cultures for bacteria, mycobacteria, and fungi were all negative. Viral culture from one of the lesions was also negative. The analysis of her complete blood count showed: white blood count, 2300/microl; hemoglobin, 8.5 g/dL; hematocrit, 25.7%; and platelets, 114,000/microl. Two days after admission, the dermatology service was asked to evaluate the patient. Although the umbilicated papules on the patient's face resembled lesions of molluscum contagiosum, other infectious processes considered in the differential diagnosis included histoplasmosis, cryptococcosis, and penicillium marnefei. In addition, the morphology of the ulcers, particularly that on the left mandible, resembled lesions of pyoderma gangrenosum. A skin biopsy was performed on an ulcer on the chest. Histopathologic examination revealed granulomatous dermatitis with multiple budding yeast forms, predominantly within histiocytes, with few organisms residing extracellularly. methenamine silver stain confirmed the presence of 2-4 microm fungal spores suggestive of histoplasma capsulatum (Fig. 2). Because of the patient's deteriorating condition, intravenous amphotericin b was initiated after tissue culture was obtained. Within the first week of treatment, the skin lesions started to resolve. histoplasma capsulatum was later isolated by culture, confirming the diagnosis. The patient was continued on amphotericin b for a total of 10 weeks, and was started on lamivudine, stavudine, and nelfinavir for her hiv infection during hospitalization. After amphotericin b therapy, the patient was placed on life-long suppressive therapy with itraconazole. Follow-up at 9 months after the initial presentation revealed no evidence of relapse of histoplasmosis.- - - - - - - - - - ranking = 3keywords = count (Clic here for more details about this article) |
6/48. Subretinal, viscoelastic-assisted, endoscope-guided photothermal ablation of choroidal neovascular membranes by erbium:YAG laser.BACKGROUND AND OBJECTIVE: The efficacy of endoscope-guided erbium:YAG laser, assisted by viscoelastic macular detachment, in subretinal ablation of choroidal neovascular membranes (CNVs) is evaluated. patients AND methods: A high-repetition, midinfrared erbium:YAG laser was used subretinally to ablate CNVs in 2 patients. Ablation followed pars plana vitrectomy and macular retinal detachment using a viscoelastic substance, and was guided by a high resolution endoscope. RESULTS: visual acuity improved from 6/90 to 6/20, six months after treatment in 1 patient, and from finger counting from 1 meter to 6/30, three months after treatment in the other. The membranes showed no angiographic signs of activity postoperatively. However, a zone of stippled hyperfluorescence appeared in both patients, corresponding with the macular detachment area. This gradually diminished in size in both patients. CONCLUSIONS: The surgical procedure was found effective in our preliminary research. The use of viscoelastic substance and endoscope is felt to contribute to the favorable outcome. The cause and significance of the retinal pigment epithelium damage are yet to be determined.- - - - - - - - - - ranking = 1keywords = count (Clic here for more details about this article) |
7/48. Hemophagocytosis in a patient with chronic lymphocytic leukemia and histoplasmosis.We present a case of hemophagocytosis in the setting of a disseminated histoplasma infection in a patient with B-cell chronic lymphocytic leukemia (CLL). A 68-year-old man with CLL presented with progressive pancytopenia and fevers after therapy with cyclophosphamide and fludarabine phosphate. Extensive evaluation for a source of infection revealed a pulmonary nodule. A biopsy specimen taken from the nodule showed granulomas containing histoplasma organisms. A bone marrow biopsy specimen demonstrated disseminated histoplasmosis and intense hemophagocytosis. Antifungal therapy with amphotericin b was initiated, and the fevers and cytopenias resolved. Hemophagocytic syndrome is an uncommon condition with many origins. It is characterized by a proliferation of histiocytes with phagocytosis of formed elements of blood. Clinical manifestations include signs and symptoms of immune activation and decreased peripheral blood cell counts. This condition is often underdiagnosed because clinicians are unfamiliar with it.- - - - - - - - - - ranking = 1keywords = count (Clic here for more details about this article) |
8/48. histoplasma capsulatum var. capsulatum occurring in an hiv-positive Ghanaian immigrant to italy. Identification of H. capsulatum dna by PCR from paraffin sample.histoplasmosis, which is highly endemic in the united states, is rare in europe, usually imported but sometimes autochthonous. In africa, histoplasmosis capsulati coexists with "African histoplasmosis", a characteristic skin infection caused by H. capsulatum var. duboisii. Histoplamosis due to H. capsulatum is one of the 12 secondary infections listed in the surveillance definitions of AIDS. We report the case of a 36-year-old black man with acquired immunodeficiency syndrome (AIDS) who was living in italy but originally came from ghana. histoplasmosis was disseminated with fever and cutaneous manifestations. The diagnosis was demonstrated morphologically based on the presence of yeast, observed by light microscopy, in skin lesions and by identification of H. capsulatum var. capsulatum dna by nested PCR from a paraffin sample. No clinical reports of histoplamosis capsulati in ghana have been published until now. The present case stresses the role of immigration of subjects from outside europe who have been infected in their native country.- - - - - - - - - - ranking = 1keywords = count (Clic here for more details about this article) |
9/48. Rapid PCR-based diagnosis of disseminated histoplasmosis in an AIDS patient.Disseminated histoplasmosis is an unusual opportunistic infection in patients with advanced hiv infection living outside endemic areas. diagnosis usually is made on the basis of isolation of histoplasma capsulatum from clinical specimens or histologic examination. Reported is the case of an hiv-infected Columbian individual in whom the diagnosis of histoplasmosis was established within 24 h of collection of an adequate bronchoalveolar lavage specimen. The diagnosis was made by detection of specific fungal dna and confirmed by isolation of histoplasma capsulatum from blood, bone marrow and respiratory specimens 10 days later. The patient recovered under antifungal treatment and remained asymptomatic up to the last follow-up visit 6 months later. The polymerase chain reaction assay might be a powerful and rapid diagnostic tool for the diagnosis of non-European invasive fungal infections and should be further evaluated.- - - - - - - - - - ranking = 0.010764170760066keywords = assay (Clic here for more details about this article) |
10/48. pleural effusion due to histoplasma capsulatum and idiopathic CD4 lymphocytopenia.Acute histoplasmosis is usually a benign, self-limited infection in endemic areas. Since protection against histoplasma capsulatum infection requires specific, cell-mediated immunity, histoplasmosis is well documented in patients with acquired T cell deficiencies e.g. due to hiv infection. We report here for the first time a case of pleural effusion due to H. capsulatum infection in a patient with idiopathic CD4 lymphocytopenia (ICL). A 25-year-old woman presented with chest pain, dyspnea on exertion and a moderate weight loss. Chest X-ray showed a large left pleural effusion, and thoracentesis yielded an exudate. Histologic examination of pleural biopsies identified H. capsulatum. Laboratory tests revealed lymphocytopenia with low CD4 T cell counts (<100/microl) and a decreased CD4/CD8 ratio. serology, including hiv, was repeatedly negative. The diagnosis of pleural effusion due to H. capsulatum infection in a patient with idiophatic ICL was established. There was no evidence of any other opportunistic infection. Treatment with itraconazole was initiated and pleural effusion resolved within 2 weeks of treatment. Moreover, the patient was found to have idiopathic thrombocytopenic purpura, as confirmed by the detection of autoantibodies against thrombocytes. In a 1-year follow-up, the patient remained asymptomatic without relapse or any new infection. Treatment with itraconazole was given for 12 months. Because of persistent CD4 T cell counts below 100/microl, prophylactic antibiotic treatment is continued.- - - - - - - - - - ranking = 2keywords = count (Clic here for more details about this article) |
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