1/229. Severe anal ulceration secondary to histoplasma capsulatum in a patient with hiv disease.Severe fungal infections have become increasingly common in the immunocompromised patient, including those infected with human immunodeficiency virus. histoplasma capsulatum occurs in about five per cent of acquired immunodeficiency syndrome patients in the endemic areas of the mississippi and ohio River Valley. Immunocompromised patients who present with severe ulceration and suppuration of the anus require exam under anesthesia and thorough laboratory evaluation for opportunistic infections. Thus, surgeons play a critical role in diagnosis and initiation of treatment. A case of infiltrating H. capsulatum of the anus is presented, including the natural history, presentation, diagnosis, and treatment.- - - - - - - - - - ranking = 1keywords = infection (Clic here for more details about this article) |
2/229. 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 = 3.5keywords = infection (Clic here for more details about this article) |
3/229. Disseminated histoplasmosis causing reversible gaze palsy and optic neuropathy.Subacute disseminated histoplasmosis is an uncommon entity. Typical neuro-ophthalmologic manifestations are usually secondary to histoplasmomas or encephalitis. A 45-year-old man noted blurred vision while receiving empiric antituberculosis therapy for fever and diffuse granulomatous disease of unknown origin. Vertical-gaze palsy, right horizontal-gaze paresis, and mild right optic neuropathy were found on neuro-ophthalmologic examination. Further questioning revealed a history of frequent contact with fighting cocks from south america. Magnetic resonance images were consistent with multiple hemorrhagic infarcts, areas of inflammation, or both, and cerebral angiography showed changes consistent with vasculitis. A previously obtained biopsy specimen from the duodenum was restained and found to be positive for fungal elements. serum antigen titers for histoplasma capsulatum demonstrated evidence of active infection. This case is a rare example of a supranuclear ocular motility disturbance and optic neuropathy secondary to an occlusive vascular process in a patient with subacute disseminated histoplasmosis.- - - - - - - - - - ranking = 0.5keywords = infection (Clic here for more details about this article) |
4/229. Case report. Successful therapy of disseminated histoplasmosis in AIDS with liposomal amphotericin b.A 36-year-old hiv-infected male patient presented with relapsing fever episodes to 39 degrees C, night sweats and weight loss. Computerized tomography of the abdomen showed enlarged multiple lymph nodes. After surgical resection of multiple lymph nodes, disseminated infection with histoplasma capsulatum was diagnosed. amphotericin b desoxycholate was initiated for 24 days. Fourteen days after therapy was discontinued, the patient suffered similar symptoms again. Subsequent treatment with liposomal amphotericin b led to rapid improvement within 3 days. Upon discharge, maintenance therapy with 600-mg itraconazole capsules was initiated and decreased to 400-mg 14-days later. itraconazole therapy was continued until the patient died more than 2 years later because of complications of the underlying disease. At autopsy there were no signs of histoplasmosis.- - - - - - - - - - ranking = 0.5keywords = infection (Clic here for more details about this article) |
5/229. Disseminated histoplasmosis presenting as bilateral adrenal masses.histoplasma capsulatum is a universal dimorphic fungus found mainly in soil contaminated with excrement of birds and bats. Bilateral adrenal masses with massive tissue destruction are a rare primary presentation of disseminated histoplasmosis. As it behaves as an opportunistic pathogen there is a higher susceptibility for dissemination on those patients with immunodeficiency or immunosuppression. We report a case in an elderly diabetic patient with bilateral adrenal enlargement, diagnosed as histoplasmosis only after surgical exploration, with symptoms probably occurring at least 60 years after the original infection. She was successfully treated with itraconazole.- - - - - - - - - - ranking = 0.5keywords = infection (Clic here for more details about this article) |
6/229. 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 = 0.5keywords = infection (Clic here for more details about this article) |
7/229. central nervous system histoplasmosis mimicking a brain tumor: difficulties in diagnosis and treatment.Neurologic involvement occurs in 10% to 20% of patients with disseminated histoplasmosis. We describe a 20-year-old woman who had headache and diplopia but no evidence of systemic infection. magnetic resonance imaging showed an enhancing mass in the thalamomesencephalic and third ventricular region. After subtotal resection of what was presumed to be a glioma, the patient had symptoms and signs of meningitis. Subsequent pathological review demonstrated noncaseating granulomas, and serologic tests and cultures confirmed the diagnosis of histoplasmosis. Initiation of antifungal therapy and removal of an infected shunt system resulted in clinical improvement. Clinicians should maintain a high index of suspicion in patients who are from any area endemic for histoplasmosis.- - - - - - - - - - ranking = 0.5keywords = infection (Clic here for more details about this article) |
8/229. A case of disseminated histoplasmosis likely due to infection from a liver allograft.Disseminated histoplasmosis in immunosuppressed patients rarely occurs in nonendemic areas. Reported here is a case of disseminated histoplasmosis in a patient who had undergone orthotopic liver transplantation and had never traveled outside of france. The infection was most likely transmitted via the liver allograft, since the organ donor had lived in an area highly endemic for the disease (french guiana) 20 years earlier. Two years post-transplantation, none of the other patients who received allografts (heart, cornea, kidneys) from the same donor had developed signs of infection.- - - - - - - - - - ranking = 3keywords = infection (Clic here for more details about this article) |
9/229. histoplasmosis of the wrist.We present a case of synovitis of the wrist due to histoplasmosis, diagnosed only after extensive surgery and culturing. Treatment with amphotericin b in combination with radical surgery was effective in curing the disease. This manifestation was probably an exacerbation of a latent chronic infection with histoplasma capsulatum, although it was unclear why the exacerbation occurred. synovitis resistant to treatment should be assessed with great care, especially in view of the growing number of immunocompromised patients. Close collaboration between surgeon, rheumatologist, pathologist and microbiologist is paramount in such cases.- - - - - - - - - - ranking = 0.5keywords = infection (Clic here for more details about this article) |
10/229. Chronic pulmonary histoplasmosis in the State of Rio de Janeiro, brazil.Three cases of chronic pulmonary histoplasmosis affecting aged patients with chronic obstructive pulmonary disease are reported. They had a history of recurrent episodes of respiratory infection and presented radiological lung lesions inducing a misdiagnosis of chronic pulmonary tuberculosis of the adults. The diagnosis of histoplasmosis, suggested by the immunodiffusion test and the detection of yeastlike cells in smeared and stained sputum, was confirmed by the isolation and identification of histoplasma capsulatum var. capsulatum in selective media. The treatment was carried out with amphothericin B and ketoconazole or itraconazole. Clinical, radiologic, mycologic and serologic improvement was obtained in all the patients. However, relapses occurred within a period of 1 to 18 months after the interruption of the treatment. Mycological diagnosis and the difficulties observed in the treatment were discussed. In addition data on the epidemiology of histoplasmosis in the state of Rio de Janeiro, brazil, were presented.- - - - - - - - - - ranking = 0.5keywords = infection (Clic here for more details about this article) |
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