Histoplasmosis - chronic pulmonary
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Definition
Chronic pulmonary histoplasmosis is a long-term respiratory infection caused by breathing the spores of the fungus, Histoplasma capsulatum.
See also:
Alternative Names
Chronic cavitary histoplasmosis
Causes, incidence, and risk factors
Histoplasma capsulatum is a fungus found in the soil of the central and eastern United States (especially Mississippi and Ohio river valleys), eastern Canada, Mexico, Central America, and South America.
The infection occurs when a person breathes in the reproducing parts of the fungus, called spores. Those who have a healthy immune system usually do not have symptoms, or only mild ones.
This "acute" infection does not last, but can leave a person with small scars (granulomas). These scars can be difficult to distinguish from tumors in the lung.
However, the infection can cause severe illness right away, or redevelop years after the first exposure, if a person's immune system is weakened by:
Cancer
Chemotherapy
Immune-suppressing drugs
Risk factors for chronic pulmonary histoplasmosis include:
Living in or traveling to central or eastern United States
Exposure to soil or particles contaminated with droppings of chickens, bats, or blackbirds
Weakened immune system, such as in people who have
AIDS
References
Kauffman CA. Histoplasmosis. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 353.
What LJ, Freifeld AG, Kleiman MB, Baddley JW, McKinsey DS, Loyd JE, Kauffman CA. Clinical practice guidelines for the management of patients with histoplasmosis: 2007 update by the Infectious Diseases Society of America. Clin Infect Dis, 2007;45(7):807-825.
Review Date: 12/1/2009
Reviewed By: David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine; Jatin M. Vyas, MD, PhD, Assistant Professor in Medicine, Harvard Medical School, Assistant in Medicine, Division of Infectious Disease, Department of Medicine, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. Copyright 2004 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
Alternative Names
Chronic cavitary histoplasmosis
Symptoms
- Chills
- Cough that brings up blood, mucus, or pus
- Fever
- Shortness of breath
- Unintentional weight loss
Signs and tests
Tests that may be used to diagnose chronic pulmonary histoplasmosis include:
- Biopsy of infected tissue, such as open lung biopsy
- Bronchoscopy with transbronchial biopsy or bronchoalveolar lavage
- CBC
- Chest CT scan
- Chest x-ray
- Histoplasma complement fixation titer
- Histoplasma urinary antigen test (positive only if the person also has disseminated histoplasmosis)
- Immunodiffusion test
- Sputum culture and stain
References
Kauffman CA. Histoplasmosis. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 353.
What LJ, Freifeld AG, Kleiman MB, Baddley JW, McKinsey DS, Loyd JE, Kauffman CA. Clinical practice guidelines for the management of patients with histoplasmosis: 2007 update by the Infectious Diseases Society of America. Clin Infect Dis, 2007;45(7):807-825.
Review Date: 12/1/2009
Reviewed By: David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine; Jatin M. Vyas, MD, PhD, Assistant Professor in Medicine, Harvard Medical School, Assistant in Medicine, Division of Infectious Disease, Department of Medicine, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. Copyright 2004 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
Alternative Names
Chronic cavitary histoplasmosis
Treatment
The doctor will prescribe antifungal medications to control the infection within the lung. These medications must be taken for 1 to 2 years.
Expectations (prognosis)
The infection usually goes away with antifungal medication, but scarring inside the lung often remains. Histoplasmosis is unusual enough that if you develop it, your health care provider should check to find out whether another disease is weakening your immune system.
Often, those who have had chronic pulmonary histoplasmosis must follow up with their doctor, who will check for signs of relapse.
In rare cases, a pulmonary histoplasmosis infection can spread through the blood to other organs. This is called disseminated histoplasmosis. People who have a suppressed immune system and very young children are more likely to develop this condition. If this occurs, the prognosis is less favorable.
Complications
- Arthritis
- Disseminated histoplasmosis
- Lung scarring (fibrosis)
- Pericarditis
- Respiratory insufficiency
Patients who breathe in a large amount of fungus can develop a severe and potentially deadly and sudden type of lung infection.
Calling your health care provider
Call for an appointment with your health care provider if you develop symptoms of chronic pulmonary histoplasmosis.
Call your health care provider if your symptoms continue despite treatment, or if you have breathing difficulty or symptoms of disseminated histoplasmosis.
References
Kauffman CA. Histoplasmosis. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 353.
What LJ, Freifeld AG, Kleiman MB, Baddley JW, McKinsey DS, Loyd JE, Kauffman CA. Clinical practice guidelines for the management of patients with histoplasmosis: 2007 update by the Infectious Diseases Society of America. Clin Infect Dis, 2007;45(7):807-825.
Review Date: 12/1/2009
Reviewed By: David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine; Jatin M. Vyas, MD, PhD, Assistant Professor in Medicine, Harvard Medical School, Assistant in Medicine, Division of Infectious Disease, Department of Medicine, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. Copyright 2004 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
Alternative Names
Chronic cavitary histoplasmosis
Prevention
Be aware of your surroundings, especially if you are in a weakened state from another medical condition, or from immune-suppressing medications.
References
Kauffman CA. Histoplasmosis. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 353.
What LJ, Freifeld AG, Kleiman MB, Baddley JW, McKinsey DS, Loyd JE, Kauffman CA. Clinical practice guidelines for the management of patients with histoplasmosis: 2007 update by the Infectious Diseases Society of America. Clin Infect Dis, 2007;45(7):807-825.
Review Date: 12/1/2009
Reviewed By: David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine; Jatin M. Vyas, MD, PhD, Assistant Professor in Medicine, Harvard Medical School, Assistant in Medicine, Division of Infectious Disease, Department of Medicine, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. Copyright 2004 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
Review Date: 12/1/2009
Reviewed By: David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine; Jatin M. Vyas, MD, PhD, Assistant Professor in Medicine, Harvard Medical School, Assistant in Medicine, Division of Infectious Disease, Department of Medicine, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. Copyright 2004 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.