Histoplasmosis classification: Difference between revisions

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Latest revision as of 20:56, 14 June 2017

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Prince Tano Djan, BSc, MBChB [2], Usama Talib, BSc, MD [3], Aravind Kuchkuntla, M.B.B.S [4]

Overview

Histoplasmosis can be classified with respect to the involved organ system. This can include pulmonary, nervous system, cardiovascular system and mediastinum. Histoplasmosis can also be classified according to the severity in to mild, moderate and severe, according to disease duration into acute, subacute, chronic and recurrent and according to the progression of the disease into localized or disseminated histoplasmosis.^[1]^[2]

Classification

A. Organ system classification

1. Pulmonary histoplasmosis

This may manifest in the following forms:
- Acute pulmonary histoplasmosis
- Chronic cavitary pulmonary histoplasmosis
- Broncholithiasis
- Pulmonary nodules (Histoplasmomas)

2. CNS histoplasmosis

3. Histoplasma pericarditis

4. Rheumatologic histoplasmosis

5. Mediastinal histoplasmosis

This may manifest in the following forms:

B. Severity of disease

On the basis of disease severity, histoplasmosis may be as follows:


According to severity of the disease
Mild	Early diagnosis and treatment Responds to medical treatment Typical clinical presentation Good prognosis
Moderate	May present late with typical or atypical symptoms May present with complications Variable response to treatment
Severe	Presents with complications or prolonged illness Immunocompromised Common in extremes of age Delayed diagnosis and treatment Surgical treatment may be required in addition to medical treatment Increased morbidity and mortality

C. According to the duration of disease


According to the duration of disease
Acute	Lasts few weeks Patient acutely ill Mostly in HIV-associated patients Impaired consciousness Seeks medical treatment early due to sudden deterioration
Subacute	Lasts less than 4 weeks Patient acutely ill Mostly in HIV-associated patients Impaired consciousness Seeks medical treatment early due to sudden deterioration
Chronic	Lasts more than 4 weeks Gradual deterioration of patient Prolonged history of atypical symptoms Common in older patients
Recurrent	Multiple episodes which lasts less than 4 weeks History of incompliance to medication Immunosuppression may be the underlying cause

D. Progression of disease

Localised histoplasmosis
Disseminated histoplasmosis

References

↑ Untanu RV, Akbar S, Graziano S, Vajpayee N (2016). "Histoplasmosis-Induced Hemophagocytic Lymphohistiocytosis in an Adult Patient: A Case Report and Review of the Literature". Case Rep Infect Dis. 2016: 1358742. doi:10.1155/2016/1358742. PMC 5088313. PMID 27830097.
↑ Wheat LJ, Azar MM, Bahr NC, Spec A, Relich RF, Hage C (2016). "Histoplasmosis". Infect Dis Clin North Am. 30 (1): 207–27. doi:10.1016/j.idc.2015.10.009. PMID 26897068.

[pmid27830097-1] Untanu RV, Akbar S, Graziano S, Vajpayee N (2016). "Histoplasmosis-Induced Hemophagocytic Lymphohistiocytosis in an Adult Patient: A Case Report and Review of the Literature". Case Rep Infect Dis. 2016: 1358742. doi:10.1155/2016/1358742. PMC 5088313. PMID 27830097.

[pmid26897068-2] Wheat LJ, Azar MM, Bahr NC, Spec A, Relich RF, Hage C (2016). "Histoplasmosis". Infect Dis Clin North Am. 30 (1): 207–27. doi:10.1016/j.idc.2015.10.009. PMID 26897068.

[1]

[2]

@@ Line 2: / Line 2: @@
 {{Histoplasmosis}}
-{{CMG}} {{AE}} {{PTD}}
+{{CMG}} {{AE}} {{PTD}}, {{USAMA}}, {{AKI}}
 ==Overview==
+[[Histoplasmosis]] can be classified with respect to the involved organ system. This can include [[pulmonary]], [[nervous system]], [[cardiovascular system]] and [[mediastinum]]. [[Histoplasmosis]] can also be classified according to the '''severity''' in to mild, moderate and severe, according to '''disease duration''' into [[acute]], [[subacute]], [[chronic]] and recurrent and according to the '''progression of the disease''' into localized or [[Disseminated disease|disseminated]] [[histoplasmosis]].<ref name="pmid27830097">{{cite journal| author=Untanu RV, Akbar S, Graziano S, Vajpayee N| title=Histoplasmosis-Induced Hemophagocytic Lymphohistiocytosis in an Adult Patient: A Case Report and Review of the Literature. | journal=Case Rep Infect Dis | year= 2016 | volume= 2016 | issue=  | pages= 1358742 | pmid=27830097 | doi=10.1155/2016/1358742 | pmc=5088313 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27830097  }} </ref><ref name="pmid26897068">{{cite journal| author=Wheat LJ, Azar MM, Bahr NC, Spec A, Relich RF, Hage C| title=Histoplasmosis. | journal=Infect Dis Clin North Am | year= 2016 | volume= 30 | issue= 1 | pages= 207-27 | pmid=26897068 | doi=10.1016/j.idc.2015.10.009 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26897068  }} </ref>
 ==Classification==
+===A. Organ system classification===
+*1. '''Pulmonary histoplasmosis'''
+:*This may manifest in the following forms:
+:**Acute pulmonary [[histoplasmosis]]
+:**Chronic cavitary pulmonary [[histoplasmosis]]
+:**Broncholithiasis
+:**Pulmonary nodules (Histoplasmomas)
+*2. '''CNS histoplasmosis'''
+*3. '''Histoplasma pericarditis'''
+*4. '''Rheumatologic histoplasmosis'''
+*5. '''Mediastinal histoplasmosis'''
+:*This may manifest in the following forms:
+:**[[Mediastinal]] [[lymphadenitis]]
+:**[[Mediastinal]] [[granuloma]]
+:**[[Mediastinal fibrosis]]
+===B. Severity of disease===
+On the basis of disease severity, histoplasmosis may be as follows:
+{| style="border: 0px; font-size: 90%; margin: 3px;" align="center"
+|+
+|-
+| colspan="3" style="background: #4479BA; text-align: center;" | {{fontcolor|#FFF|'''According to severity of the disease'''}}
+|-
+| style="padding: 5px 5px; background: #DCDCDC;" |Mild
+| colspan="2" style="padding: 5px 5px; background: #F5F5F5;" |
+*Early diagnosis and treatment
+*Responds to medical treatment
+*Typical clinical presentation
+*Good [[prognosis]]
+|-
+| style="padding: 5px 5px; background: #DCDCDC;" |Moderate
+| colspan="2" style="padding: 5px 5px; background: #F5F5F5;" |
+*May present late with typical or atypical symptoms
+*May present with complications
+*Variable response to treatment
+|-
+| style="padding: 5px 5px; background: #DCDCDC;" |Severe
+| colspan="2" style="padding: 5px 5px; background: #F5F5F5;" |
+*Presents with complications or prolonged illness
+*[[Immunocompromised]]
+*Common in extremes of age
+*Delayed diagnosis and treatment
+*Surgical treatment may be required in addition to medical treatment
+*Increased [[morbidity]] and [[mortality]]
+|-
+|}
+===C. According to the duration of disease===
+{| style="border: 0px; font-size: 90%; margin: 3px;" align="center"
+|+
+|-
+| colspan="4" style="background: #4479BA; text-align: center;" | {{fontcolor|#FFF|'''According to the duration of disease'''}}
+|-
+| style="padding: 5px 5px; background: #DCDCDC;" |Acute
+| colspan="2" style="padding: 5px 5px; background: #F5F5F5;" |
+* Lasts few weeks
+* Patient acutely ill
+*Mostly in [[HIV]]-associated patients
+* Impaired consciousness
+* Seeks medical treatment early due to sudden deterioration
+|-
+| style="padding: 5px 5px; background: #DCDCDC;" |Subacute
+| colspan="2" style="padding: 5px 5px; background: #F5F5F5;" |
+* Lasts less than 4 weeks
+* Patient acutely ill
+*Mostly in [[HIV]]-associated patients
+* Impaired consciousness
+* Seeks medical treatment early due to sudden deterioration
+|-
+| style="padding: 5px 5px; background: #DCDCDC;" |Chronic
+| colspan="2" style="padding: 5px 5px; background: #F5F5F5;" |
+* Lasts more than 4 weeks
+* Gradual deterioration of patient
+* Prolonged history of atypical symptoms
+* Common in older patients
+|-
+| style="padding: 5px 5px; background: #DCDCDC;" |Recurrent
+| colspan="2" style="padding: 5px 5px; background: #F5F5F5;" |
+* Multiple episodes which lasts less than 4 weeks
+* History of incompliance to medication
+* [[Immunosuppression]] may be the underlying cause
+|-
+|}
+===D. Progression of disease===
+* Localised [[histoplasmosis]]
+* Disseminated [[histoplasmosis]]
 ==References==
 {{Reflist|2}}