Acute Pulmonary Histoplasmosis Following COVID-19: Novel Laboratorial Methods Aiding Diagnosis

The acute form of histoplasmosis usually occurs after the exposition of more than one individual to a common environmental source harboring Histoplasma capsulatum. Here, we present two cases of acute pulmonary histoplasmosis seen within two weeks at a reference center for infectious diseases at Rio de Janeiro, Brazil. The patients did not present a common epidemiologic history for histoplasmosis, however both presented COVID-19 before the onset of histoplasmosis symptoms. Due to the difficulties in the diagnosis of acute histoplasmosis, novel laboratory methods such as Western Blot and PCR were included in the investigation of these cases. Both patients presented negative cultures for H. capsulatum and negative urinary galactomannan. However, they presented H and M bands in the Western blot as well as a positive H. capsulatum DNA detection in sputum. These results were available approximately 36 h after sample collection, fastening the beginning of treatment of one patient. Both patients progressed well with itraconazole treatment. These cases suggest that COVID-19 may facilitate the development of acute pulmonary histoplasmosis and, therefore, clinicians must be aware of this differential diagnosis in patients from endemic areas with fever and coughing after recovery from COVID-19.

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Pulmonary histoplasmosis: A case report

International Journal of Family & Community Medicine ◽

10.15406/ijfcm.2021.05.00237 ◽

2021 ◽

Vol 5 (5) ◽

pp. 148-150

Author(s):

Sunzida Arina

Keyword(s):

Case Report ◽

Fungal Infection ◽

Lung Biopsy ◽

Alcoholic Hepatitis ◽

Histoplasma Capsulatum ◽

Dimorphic Fungus ◽

Systemic Fungal Infection ◽

Pulmonary Histoplasmosis ◽

The World ◽

Itraconazole Treatment

Histoplasmosis is a systemic fungal infection caused by dimorphic fungus Histoplasma capsulatum. It is widely distributed throughout the world. In present study, the case of a 50-year-old male patient diagnosed as pulmonary histoplasmosis. Initially, the patient was suspected as a case of alcoholic hepatitis but subsequently the diagnosis of pulmonary histoplasmosis was confirmed by lung biopsy. The symptoms were dissuaded following amphotericin B and itraconazole treatment.

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Reintroduction of immunosuppressive medications in pediatric rheumatology patients with histoplasmosis: a case series

Pediatric Rheumatology ◽

10.1186/s12969-021-00581-7 ◽

2021 ◽

Vol 19 (1) ◽

Author(s):

Rachel A. Brown ◽

Fatima Barbar-Smiley ◽

Cagri Yildirim-Toruner ◽

Monica I. Ardura ◽

Stacy P. Ardoin ◽

...

Keyword(s):

Rheumatic Disease ◽

Lupus Erythematosus ◽

Histoplasma Capsulatum ◽

Case Series ◽

Organ Damage ◽

Necrosis Factor Alpha ◽

Pulmonary Histoplasmosis ◽

Immunosuppressive Medications ◽

Biologic Dmard ◽

Factor Alpha

Abstract Background Children with rheumatic diseases (cRD) receiving immunosuppressive medications (IM) are at a higher risk for acquiring potentially lethal pathogens, including Histoplasma capsulatum (histoplasmosis), a fungal infection that can lead to prolonged hospitalization, organ damage, and death. Withholding IM during serious infections is recommended yet poses risk of rheumatic disease flares. Conversely, reinitiating IM increases risk for infection recurrence. Tumor necrosis factor alpha inhibitor (TNFai) biologic therapy carries the highest risk for histoplasmosis infection after epidemiological exposure, so other IM are preferred during active histoplasmosis infection. There is limited guidance as to when and how IM can be reinitiated in cRD with histoplasmosis. This case series chronicles resumption of IM, including non-TNFai biologics, disease-modifying anti-rheumatic drugs (DMARDs), and corticosteroids, following histoplasmosis among cRD. Case presentation We examine clinical characteristics and outcomes of 9 patients with disseminated or pulmonary histoplasmosis and underlying rheumatic disease [juvenile idiopathic arthritis (JIA), childhood-onset systemic lupus erythematosus (cSLE), and mixed connective tissue disease (MCTD)] after reintroduction of IM. All DMARDs and biologics were halted at histoplasmosis diagnosis, except hydroxychloroquine (HCQ), and patients began antifungals. Following IM discontinuation, all patients required systemic or intra-articular steroids during histoplasmosis treatment, with 4/9 showing Cushingoid features. Four patients began new IM regimens [2 abatacept (ABA), 1 HCQ, and 1 methotrexate (MTX)] while still positive for histoplasmosis, with 3/4 (ABA, MTX, HCQ) later clearing their histoplasmosis and 1 (ABA) showing decreasing antigenemia. Collectively, 8/9 patients initiated or continued DMARDs and/or non-TNFai biologic use (5 ABA, 1 tocilizumab, 1 ustekinumab, 3 MTX, 4 HCQ, 1 leflunomide). No fatalities, exacerbations, or recurrences of histoplasmosis occurred during follow-up (median 33 months). Conclusions In our cohort of cRD, histoplasmosis course following reintroduction of non-TNFai IM was favorable, but additional studies are needed to evaluate optimal IM management during acute histoplasmosis and recovery. In this case series, non-TNFai biologic, DMARD, and steroid treatments did not appear to cause histoplasmosis recurrence. Adverse events from corticosteroid use were common. Further research is needed to implement guidelines for optimal use of non-TNFai (like ABA), DMARDs, and corticosteroids in cRD following histoplasmosis presentation.

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Global Infectious Diseases: Four Steps Toward a Differential Diagnosis

Field Guide to Global Health & Disaster Medicine ◽

10.1016/b978-0-323-79412-1.00002-3 ◽

2023 ◽

pp. 19-50

Author(s):

Saif Al-Bedwawi ◽

Amanda Huston

Keyword(s):

Differential Diagnosis ◽

Infectious Diseases

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Human serum antibody reactivity towards Paracoccidioides brasiliensis antigens treated with sodium metaperiodate

Revista da Sociedade Brasileira de Medicina Tropical ◽

10.1590/s0037-86822008000400001 ◽

2008 ◽

Vol 41 (4) ◽

pp. 325-329 ◽

Cited By ~ 9

Author(s):

Ana Paula Ferreira ◽

Thadeu Côrrea ◽

Rosângela Cunha ◽

Marcos José Marques ◽

Maria Angela Montesano ◽

...

Keyword(s):

Western Blot ◽

Human Serum ◽

Paracoccidioides Brasiliensis ◽

Serum Antibody ◽

Parasitic Infections ◽

Sodium Metaperiodate ◽

Chronic Form ◽

Western Blot Test ◽

Immunoglobulin Isotypes ◽

Acute Form

In this study, we evaluated the profile of anti-Paracoccidioides brasiliensis immunoglobulin isotypes in serum from patients with the acute and chronic forms of paracoccidioidomycosis, using the whole Paracoccidioides brasiliensis antigen and the antigen treated with sodium metaperiodate. All the immunoglobulin isotypes present in the serum from patients with the acute and chronic forms of paracoccidioidomycosis presented higher reactivity towards the whole antigen than to the antigen treated with metaperiodate (P < 0.05). The reactivity of IgG and IgM to the antigen treated with metaperiodate was greater in serum from patients with the acute form of the disease (P < 0.05), while IgA was more reactive in serum from patients with the chronic form (P < 0.05). There was greater reactivity of IgG1 and IgG2 to the whole antigen and the antigen treated with metaperiodate in the serum from patients with paracoccidioidomycosis than there was in serum from patients with other parasitic infections (P < 0.05). Furthermore, IgG1 from patients with the acute form recognized the 19kDa, 27kDa and 31kDa antigens in the western blot test. Thus, the results suggest that modifications to the epitopes of Paracoccidioides brasiliensis antigens may help to improve the immunodiagnosis of paracoccidioidomycosis.

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Acute Pulmonary Histoplasmosis Outbreak in A Documentary Film Crew Travelling from Guatemala to Australia

Tropical Medicine and Infectious Disease ◽

10.3390/tropicalmed4010025 ◽

2019 ◽

Vol 4 (1) ◽

pp. 25 ◽

Cited By ~ 1

Author(s):

Stephen Muhi ◽

Amy Crowe ◽

John Daffy

Keyword(s):

Medical Care ◽

Documentary Film ◽

Histoplasma Capsulatum ◽

Febrile Illness ◽

Acute Febrile Illness ◽

Widespread Distribution ◽

Endemic Mycosis ◽

Pulmonary Histoplasmosis ◽

Vampire Bats

Histoplasma capsulatum is an endemic mycosis with a widespread distribution, although it is infrequently reported in travellers. In April 2018, five television crew members developed an acute febrile illness after filming a documentary about vampire bats in Guatemala. Patients developed symptoms after travelling to Australia, where they presented for medical care.

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Clinical and evolutionary characteristics of four patients with pulmonary histoplasmosis reported in the Paraíba Paulista Valley region

Revista da Sociedade Brasileira de Medicina Tropical ◽

10.1590/s0037-86822010000500028 ◽

2010 ◽

Vol 43 (5) ◽

pp. 599-601 ◽

Cited By ~ 8

Author(s):

Maria Stella Amorim da Costa Zöllner ◽

Karla Mayra Pinto e Carvalho Rezende ◽

Simone Birman ◽

Chelna Paolichi Ferro Elias ◽

Emília Ângela Loschiavo Arisawa ◽

...

Keyword(s):

Differential Diagnosis ◽

Pulmonary Tuberculosis ◽

Clinical Features ◽

Clinical Status ◽

Disease Onset ◽

Oral Medication ◽

Pulmonary Histoplasmosis ◽

Reducing Potential

The type of pulmonary histoplasmosis presents limited lesions to the lungs, with symptoms that are clinically and radiological similar to chronic pulmonary tuberculosis. This paper describes the clinical features of four cases of pulmonary histoplasmosis. Aspects of diagnostic and clinical, epidemiological, laboratorial and imaging exams are discussed, in addition to the clinical status of the individuals five years after disease onset. The treatment of choice was oral medication, following which all the patients improved. It is important to understand the clinical status and the difficulties concerning the differential diagnosis of histoplasmosis, to assist the proper indication of cases, thus reducing potential confusion with other diseases.

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Assessment of a portable clinical blood analyzer during space flight

Clinical Chemistry ◽

10.1093/clinchem/43.6.1056 ◽

1997 ◽

Vol 43 (6) ◽

pp. 1056-1065 ◽

Cited By ~ 32

Author(s):

Scott M Smith ◽

Janis E Davis-Street ◽

Tina B Fontenot ◽

Helen W Lane

Keyword(s):

Space Shuttle ◽

Medical Data ◽

Ionized Calcium ◽

Sample Collection ◽

Laboratory Methods ◽

Remote Locations ◽

Fluid Redistribution ◽

Reliable Instrument ◽

Orbiting Spacecraft ◽

Control Samples

Abstract This study was designed to validate the utility of a commercial portable clinical blood analyzer (PCBA) in ground-based studies and on the space shuttle. Ionized calcium, pH, electrolytes, glucose, and hematocrit were determined. Results agreed well with those from traditional laboratory methods, and the PCBA demonstrated good between-day precision for all analytes. In-flight analysis of control samples revealed differences in one analyte (sodium). There were few changes in crew members’ results during flight, and these were expected. Potassium increased in flight compared with before flight, and potassium, pH, and hematocrit decreased after flight. Ionized calcium was decreased in flight and on landing day. Changes during flight were likely related to sample collection technique. Postflight changes likely reflected the fluid redistribution that occurs after exposure to weightlessness. These data confirm that the PCBA is a reliable instrument for most analytes, and can provide important medical data in remote locations, such as orbiting spacecraft.

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