Histoplasmosis physical examination: Difference between revisions

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{{Histoplasmosis}}
{{Histoplasmosis}}


{{CMG}} {{AE}} {{SSK}}
{{CMG}} {{AE}} {{SSK}}, {{AKI}}


==Overview==
==Overview==
Physical examination findings in pulmonary [[histoplasmosis]] include [[erythema nodosum]] and [[rales]] on auscultation. In patients with [[Disseminated disease|disseminated]] [[histoplasmosis]] features similar to sepsis such as [[hypotension]], [[altered mental status]] will be present.


==Physical Examination==
==Physical Examination==
Physical examination findings vary in patients with histoplasma infection and it depends on stage of the disease and extent of the spread of infection.
Physical examination findings vary in patients with [[Histoplasma capsulatum|histoplasma]] infection and it depends on stage of the disease and extent of the spread of infection.
Patients with acute or chronic pulmonary histoplasmosis present with features similar to pneumonia. The following physical examination findings can be demonstrated:  
Patients with acute or chronic pulmonary histoplasmosis present with features similar to [[pneumonia]].<br> <ref name="pmid20463244">{{cite journal| author=Knox KS, Hage CA| title=Histoplasmosis. | journal=Proc Am Thorac Soc | year= 2010 | volume= 7 | issue= 3 | pages= 169-72 | pmid=20463244 | doi=10.1513/pats.200907-069AL | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20463244  }} </ref>
The following physical examination findings can be demonstrated:
===General Appearance===
Patient will appear ill with [[fever]] and [[dyspnea]].
 
===Skin===
*[[Erythema nodosum]]
 
===Lungs===
===Lungs===
In patients with acute or chronic pulmonary histoplasmosis occasional [[wheezing]] and [[rales]] are a common finding.
====Palpation====
====Palpation====
* Increased tactile fremitus
* Increased [[tactile fremitus]]
 
=====Percussion=====
====Percussion====
* Dullness on [[percussion]]
* Dullness on percussion
=====Auscultation=====
 
* [[Decreased breath sounds]]
====Auscultation====
* Decreased breath sounds
* Bronchial breath sounds
* Bronchial breath sounds
* [[Rhonchi]]
* [[Rhonchi]]
* Crackles, [[Rales]]
* Crackles, [[Rales]]
* Increased [[vocal fremitus]]
* Increased [[vocal fremitus]]
Patients with disseminated histoplasma infection have similar features as sepsis. The following physical examination findings can be demonstrated in a patient with disseminated infection:  
 
===Vital Signs===
===Disseminated Histoplasmosis===
Patients with disseminated histoplasma infection have similar features as [[sepsis]]. The following physical examination findings can be demonstrated in a patient with disseminated infection:<ref name="pmid19375629">{{cite journal| author=Kauffman CA| title=Histoplasmosis. | journal=Clin Chest Med | year= 2009 | volume= 30 | issue= 2 | pages= 217-25, v | pmid=19375629 | doi=10.1016/j.ccm.2009.02.002 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19375629  }} </ref>
====Vital Signs====
* [[Hypotension]]
* [[Hypotension]]
Sepsis is considered present if infection is highly suspected or proven and two or more of the following [[systemic inflammatory response syndrome]] (SIRS) criteria are met:<ref name="pmid18158437">{{cite journal |author=Dellinger RP, Levy MM, Carlet JM, Bion J, Parker MM, Jaeschke R, Reinhart K, Angus DC, Brun-Buisson C, Beale R, Calandra T, Dhainaut JF, Gerlach H, Harvey M, Marini JJ, Marshall J, Ranieri M, Ramsay G, Sevransky J, Thompson BT, Townsend S, Vender JS, Zimmerman JL, Vincent JL |title=Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock: 2008 |journal=[[Critical Care Medicine]] |volume=36 |issue=1 |pages=296–327 |year=2008 |month=January |pmid=18158437 |doi=10.1097/01.CCM.0000298158.12101.41 |url=http://meta.wkhealth.com/pt/pt-core/template-journal/lwwgateway/media/landingpage.htm?issn=0090-3493&volume=36&issue=1&spage=296 |accessdate=2012-09-16}}</ref><ref>Bone RC, Balk RA, Cerra FB, Dellinger RP, Fein AM, Knaus WA, Schein RM, Sibbald WJ. Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. The ACCP/SCCM Consensus Conference Committee. American College of Chest Physicians/Society of Critical Care Medicine. Chest. 1992 Jun;101(6):1644-55. PMID 1303622.</ref>
[[Sepsis]] is considered present if infection is highly suspected or proven and two or more of the following [[systemic inflammatory response syndrome]] ([[SIRS]]) criteria are met:<ref name="pmid18158437">{{cite journal |author=Dellinger RP, Levy MM, Carlet JM, Bion J, Parker MM, Jaeschke R, Reinhart K, Angus DC, Brun-Buisson C, Beale R, Calandra T, Dhainaut JF, Gerlach H, Harvey M, Marini JJ, Marshall J, Ranieri M, Ramsay G, Sevransky J, Thompson BT, Townsend S, Vender JS, Zimmerman JL, Vincent JL |title=Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock: 2008 |journal=[[Critical Care Medicine]] |volume=36 |issue=1 |pages=296–327 |year=2008 |month=January |pmid=18158437 |doi=10.1097/01.CCM.0000298158.12101.41 |url=http://meta.wkhealth.com/pt/pt-core/template-journal/lwwgateway/media/landingpage.htm?issn=0090-3493&volume=36&issue=1&spage=296 |accessdate=2012-09-16}}</ref><ref>Bone RC, Balk RA, Cerra FB, Dellinger RP, Fein AM, Knaus WA, Schein RM, Sibbald WJ. Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. The ACCP/SCCM Consensus Conference Committee. American College of Chest Physicians/Society of Critical Care Medicine. Chest. 1992 Jun;101(6):1644-55. PMID 1303622.</ref>
* [[Heart rate]] > 90 beats per minute
* [[Heart rate]] > 90 beats per minute
* [[Temperature]] < 36 (96.8 °F) or > 38 °C (100.4 °F)
* [[Temperature]] < 36 (96.8 °F) or > 38 °C (100.4 °F)
* [[Tachypnea]] > 20 breaths per minute or, on [[blood gas]], a P<sub>a</sub>CO<sub>2</sub> < 32 mm Hg
* [[Tachypnea]] > 20 breaths per minute or, on [[blood gas]], a P<sub>a</sub>CO<sub>2</sub> < 32 mm Hg
===Skin===
====Skin====
*[[Cyanosis]]
*[[Cyanosis]]
===HEENT===
====HEENT====
*Cervical [[Lymphadenopathy]]
*Cervical [[Lymphadenopathy]]
===Extremities===
====Extremities====
*Decreased peripheral [[pulse]]s
*Decreased peripheral [[pulse]]s
===Neurologic===
====Neurologic====
*Altered sensorium, lethargy, and [[coma]]
*[[Altered mental status|Altered sensorium]]
*[[Lethargy]]
*[[Neck stiffness]]


==Gallery==
===Gallery===


<gallery>
<gallery>
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[[Category:Fungal diseases]]
[[Category:Fungal diseases]]
[[Category:Rat carried diseases]]
[[Category:Rat carried diseases]]
[[Category:Emergency mdicine]]
[[Category:Disease]]
[[Category:Up-To-Date]]
[[Category:Infectious disease]]
[[Category:Pulmonology]]
[[Category:Gastroenterology]]

Latest revision as of 22:11, 29 July 2020

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Serge Korjian M.D., Aravind Kuchkuntla, M.B.B.S[2]

Overview

Physical examination findings in pulmonary histoplasmosis include erythema nodosum and rales on auscultation. In patients with disseminated histoplasmosis features similar to sepsis such as hypotension, altered mental status will be present.

Physical Examination

Physical examination findings vary in patients with histoplasma infection and it depends on stage of the disease and extent of the spread of infection. Patients with acute or chronic pulmonary histoplasmosis present with features similar to pneumonia.
[1] The following physical examination findings can be demonstrated:

General Appearance

Patient will appear ill with fever and dyspnea.

Skin

Lungs

In patients with acute or chronic pulmonary histoplasmosis occasional wheezing and rales are a common finding.

Palpation

Percussion
Auscultation

Disseminated Histoplasmosis

Patients with disseminated histoplasma infection have similar features as sepsis. The following physical examination findings can be demonstrated in a patient with disseminated infection:[2]

Vital Signs

Sepsis is considered present if infection is highly suspected or proven and two or more of the following systemic inflammatory response syndrome (SIRS) criteria are met:[3][4]

Skin

HEENT

Extremities

Neurologic

Gallery

  • Skin lesion on the upper lip due to Histoplasma capsulatum infection.

    Skin lesion on the upper lip due to Histoplasma capsulatum infection.

  • Interior view of an elderly man’s oral cavity. A histoplasmosis infection induced inflammatory response on right inferior gingival tissues. From Public Health Image Library (PHIL). [5]

    Interior view of an elderly man’s oral cavity. A histoplasmosis infection induced inflammatory response on right inferior gingival tissues. From Public Health Image Library (PHIL). [5]

  • This image depicts the perianal region of a male patient afflicted with a disease known as histoplasmosis, which is caused by the fungal organism, Histoplasma capsulatum. From Public Health Image Library (PHIL). [5]

    This image depicts the perianal region of a male patient afflicted with a disease known as histoplasmosis, which is caused by the fungal organism, Histoplasma capsulatum. From Public Health Image Library (PHIL). [5]

  • This image depicts an intraoral view, which reveals a lesion of the patient’s maxillary gingival mucosa that had been diagnosed as histoplasmosis, caused by the fungal pathogen, Histoplasma capsulatum. From Public Health Image Library (PHIL). [5]

    This image depicts an intraoral view, which reveals a lesion of the patient’s maxillary gingival mucosa that had been diagnosed as histoplasmosis, caused by the fungal pathogen, Histoplasma capsulatum. From Public Health Image Library (PHIL). [5]

References

  1. ↑ Knox KS, Hage CA (2010). "Histoplasmosis". Proc Am Thorac Soc. 7 (3): 169–72. doi:10.1513/pats.200907-069AL. PMID 20463244.
  2. ↑ Kauffman CA (2009). "Histoplasmosis". Clin Chest Med. 30 (2): 217–25, v. doi:10.1016/j.ccm.2009.02.002. PMID 19375629.
  3. ↑ Dellinger RP, Levy MM, Carlet JM, Bion J, Parker MM, Jaeschke R, Reinhart K, Angus DC, Brun-Buisson C, Beale R, Calandra T, Dhainaut JF, Gerlach H, Harvey M, Marini JJ, Marshall J, Ranieri M, Ramsay G, Sevransky J, Thompson BT, Townsend S, Vender JS, Zimmerman JL, Vincent JL (2008). "Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock: 2008". Critical Care Medicine. 36 (1): 296–327. doi:10.1097/01.CCM.0000298158.12101.41. PMID 18158437. Retrieved 2012-09-16. Unknown parameter |month= ignored (help)
  4. ↑ Bone RC, Balk RA, Cerra FB, Dellinger RP, Fein AM, Knaus WA, Schein RM, Sibbald WJ. Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. The ACCP/SCCM Consensus Conference Committee. American College of Chest Physicians/Society of Critical Care Medicine. Chest. 1992 Jun;101(6):1644-55. PMID 1303622.
  5. ↑ 5.0 5.1 5.2 "Public Health Image Library (PHIL)".
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