Histoplasmosis classification: Difference between revisions

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{{Histoplasmosis}}
{{Histoplasmosis}}


{{CMG}} {{AE}} {{PTD}}
{{CMG}} {{AE}} {{PTD}}, {{USAMA}}, {{AKI}}


==Overview==
==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==
==Classification==


===Organ system classification===
===A. Organ system classification===


*1. '''Pulmonary histoplasmosis'''
*1. '''Pulmonary histoplasmosis'''
:*Acute pulmonary histoplasmosis'''
:*This may manifest in the following forms:
:*Chronic cavitary pulmonary histoplasmosis
:**Acute pulmonary [[histoplasmosis]]
:*Broncholithiasis
:**Chronic cavitary pulmonary [[histoplasmosis]]
:*Pulmonary Nodules (Histoplasmomas)
:**Broncholithiasis
:**Pulmonary nodules (Histoplasmomas)


*2. '''CNS histoplasmosis'''
*2. '''CNS histoplasmosis'''
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*5. '''Mediastinal histoplasmosis'''
*5. '''Mediastinal histoplasmosis'''
:*This may manifest in the following forms:
:**[[Mediastinal]] [[lymphadenitis]]
:**[[Mediastinal]] [[granuloma]]
:**[[Mediastinal fibrosis]]


:*Mediastinal lymphadenitis'''
===B. Severity of disease===
:*Mediastinal granuloma'''
On the basis of disease severity, histoplasmosis may be as follows:
:*Mediastinal fibrosis''


 
{| style="border: 0px; font-size: 90%; margin: 3px;" align="center"
 
*'''Progressive disseminated histoplasmosis''
 
 
 
 
{| style="border: 0px; font-size: 90%; margin: 3px;" align=center
|+  
|+  
|-
|-
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|-
|-
| style="padding: 5px 5px; background: #DCDCDC;" |Mild
| style="padding: 5px 5px; background: #DCDCDC;" |Mild
| style="padding: 5px 5px; background: #F5F5F5;" colspan="2" |
| colspan="2" style="padding: 5px 5px; background: #F5F5F5;" |
*Early diagnosis and treatment
*Early diagnosis and treatment
*Responds to medical treatment
*Responds to medical treatment
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|-
|-
| style="padding: 5px 5px; background: #DCDCDC;" |Moderate
| style="padding: 5px 5px; background: #DCDCDC;" |Moderate
| style="padding: 5px 5px; background: #F5F5F5;" colspan="2" |
| colspan="2" style="padding: 5px 5px; background: #F5F5F5;" |
*May present late with typical or atypical symptoms
*May present late with typical or atypical symptoms
*May present with complications  
*May present with complications  
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|-
|-
| style="padding: 5px 5px; background: #DCDCDC;" |Severe
| style="padding: 5px 5px; background: #DCDCDC;" |Severe
| style="padding: 5px 5px; background: #F5F5F5;" colspan="2" |
| colspan="2" style="padding: 5px 5px; background: #F5F5F5;" |
*Presents with complications or prolonged illness
*Presents with complications or prolonged illness
*[[Immunocompromised]]
*[[Immunocompromised]]
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*Surgical treatment may be required in addition to medical treatment
*Surgical treatment may be required in addition to medical treatment
*Increased [[morbidity]] and [[mortality]]
*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'''}}
| colspan="4" style="background: #4479BA; text-align: center;" | {{fontcolor|#FFF|'''According to the duration of disease'''}}
|-
|-
| style="padding: 5px 5px; background: #DCDCDC;" |Acute
| style="padding: 5px 5px; background: #DCDCDC;" |Acute
| style="padding: 5px 5px; background: #F5F5F5;" colspan="2" |
| colspan="2" style="padding: 5px 5px; background: #F5F5F5;" |
* Lasts few weeks  
* Lasts few weeks  
* Patient acutely ill
* Patient acutely ill
*Mostly in HIV-associated patients
*Mostly in [[HIV]]-associated patients
* Impaired consciousness  
* Impaired consciousness  
* Seeks medical treatment early due to sudden deterioration
* Seeks medical treatment early due to sudden deterioration
|-
|-
| style="padding: 5px 5px; background: #DCDCDC;" |Subacute  
| style="padding: 5px 5px; background: #DCDCDC;" |Subacute  
| style="padding: 5px 5px; background: #F5F5F5;" colspan="2" |
| colspan="2" style="padding: 5px 5px; background: #F5F5F5;" |
* Lasts less than 4 weeks  
* Lasts less than 4 weeks  
* Patient acutely ill
* Patient acutely ill
*Mostly in HIV-associated patients
*Mostly in [[HIV]]-associated patients
* Impaired consciousness  
* Impaired consciousness  
* Seeks medical treatment early due to sudden deterioration
* Seeks medical treatment early due to sudden deterioration
|-
|-
| style="padding: 5px 5px; background: #DCDCDC;" |Chronic  
| style="padding: 5px 5px; background: #DCDCDC;" |Chronic  
| style="padding: 5px 5px; background: #F5F5F5;" colspan="2" |
| colspan="2" style="padding: 5px 5px; background: #F5F5F5;" |
* Lasts more than 4 weeks
* Lasts more than 4 weeks
* Gradual deterioration of patient
* Gradual deterioration of patient
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|-
|-
| style="padding: 5px 5px; background: #DCDCDC;" |Recurrent
| style="padding: 5px 5px; background: #DCDCDC;" |Recurrent
| style="padding: 5px 5px; background: #F5F5F5;" colspan="2" |
| colspan="2" style="padding: 5px 5px; background: #F5F5F5;" |
* Multiple episodes which lasts less than 4 weeks
* Multiple episodes which lasts less than 4 weeks
* History of incompliance to medication
* History of incompliance to medication
* [[immunosuppression]] may be the underlying cause
* [[Immunosuppression]] may be the underlying cause
|-
|-
|}
|}
===D. Progression of disease===
* Localised [[histoplasmosis]] 
* Disseminated [[histoplasmosis]]


==References==
==References==
{{Reflist|2}}
{{Reflist|2}}

Latest revision as of 20:56, 14 June 2017

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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:
  • 2. CNS histoplasmosis
  • 3. Histoplasma pericarditis
  • 4. Rheumatologic histoplasmosis
  • 5. Mediastinal histoplasmosis

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


References

  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.
  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.
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