Histoplasmosis history and symptoms: Difference between revisions
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*These patients present with features of: dyspnea, cough and hemoptysis. | *These patients present with features of: dyspnea, cough and hemoptysis. | ||
===Disseminated Histoplasmosis=== | ===Disseminated Histoplasmosis=== | ||
It is seen in patients with risk factors | It is seen in patients with risk factors resulting in a weakened immune system. Clinical features of disseminated histoplasmosis include the following: | ||
*Fever | *Fever | ||
*Malaise | *Malaise | ||
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*'''Adrenal gland involvement:''' Infection of the adrenal gland presents with symptoms of fever, malaise, orthostatic hypotension, nausea, and vomiting. | *'''Adrenal gland involvement:''' Infection of the adrenal gland presents with symptoms of fever, malaise, orthostatic hypotension, nausea, and vomiting. | ||
*'''Mucosal Involvement:''' Superficial and deep ulcerations with nodules and verrucous lesions involving the tongue, buccal mucosa, lips, pharynx and larynx can be present. | *'''Mucosal Involvement:''' Superficial and deep ulcerations with nodules and verrucous lesions involving the tongue, buccal mucosa, lips, pharynx and larynx can be present. | ||
*'''Genitourinary involvement:''' Histoplasma infection of the genitourinary involvement can result in testicular abscess, prostatic abscess, epididymitis, penile lesions, and bladder ulcerations. Patients present with scrotal pain, swelling, dysuria, pyuria and hematuria. | |||
*'''Articular involvement:''' The infection usually involves the tendons and joints, patients present with features of joint pain and reduced range of motion. | |||
*'''Endocarditis:''' Histoplasma infection can occur in the valves, prosthetic valves and atrial myxomas. Patients present with features of distal embolization. | |||
*'''Meningitis:''' Histoplamsmosis causes chronic meningitis and is characterized by affecting the basilar meninges resulting in a communicating hydrocephalus. Symptoms include headache, mental status | |||
changes, and features of cranial nerve palsies. | |||
==References== | ==References== | ||
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Symptoms
Acute Pulmonary Histoplasmosis
It is an acute self limiting illness in patients exposed to the organism for the first time. The symptoms of an acute infection include the following:[1][2]
- The incubation period of histoplasmosis is typically 3–17 days for the acute disease.
- A positive history for exposure to H.capsulatum and close contacts with similar complaints is hellpful to diagnose pulmonary histoplasmosis.
- Fever
- Malaise
- Headache
- Weakness
- Substernal chest discomfort
- Dry cough
- Myalgias and arthralgias with symmetrical joint involvement
- Most people spontaneously recover 2–3 weeks after onset of symptoms, although fatigue may persist longer.
Chronic Cavitatory Pulmonary Histoplasmosis
It is usually seen in elderly patients with emphysema and these patients present with the following symptoms:
- Fatigue
- Fever
- Night sweats
- Anorexia and weight loss
- Cough,
- Sputum production
- Hemoptysis
- Dyspnea
Granulomatous Mediastinitis
Majority of patients with mediastinal lymph node involvement are asymptomatic but few patients present with symptoms resulting from compression on the esophagus, superior vena cava and bronchus:
- Dysphagia
- Congestion of the face
- Distended veins in the neck
- Dyspnea
Mediastinal Fibrosis
It is a complication of histoplasma infection of the mediastinal structures resulting in fibrosis and causing compression of surrounding structures in the mediastinum. The symptoms of fibrosis include the following:
- It is seen in patients between the ages of 20 to 40 years of age.
- It follows a gradual progression of symptoms with compression of the superior vena cava, the pulmonary arteries, pulmomary veins, bronchi, thoracic duct, recurrent laryngeal nerve, and right atrium.
- Patients present with increasing dyspnea, cough, hemoptysis, and chest pain.
- Superior vena cava compression presents with features of distended neck veins and facial congestion.
- Right heart failure presents with pedal edema and dyspnea.
Brocholithiasis
In patients with calcified nodules bursting into the bronchus present with features of brochial obstruction and inflammation. The features include the following:
- Lithoptysis: Spitting of tiny pieces of gravel like particles
- Dyspnea
- Hemoptysis
- Cough
- Occasional wheezing can be present with significant airway obstruction
Chronic Progressive Disseminated Histoplasmosis
- It is defined as a chronic gradually progressive infection in adults with an intact immune system.
- These patients present with features of: dyspnea, cough and hemoptysis.
Disseminated Histoplasmosis
It is seen in patients with risk factors resulting in a weakened immune system. Clinical features of disseminated histoplasmosis include the following:
- Fever
- Malaise
- Anorexia
- Weight loss
- Abdominal distension due to hepatosplenomegaly
- Severe form of disseminated histoplasmosi presents with features of sepsis, acute respiratory distress syndrome and disseminated intravascular coagulation.
- Gastrointestinal involvement: Infection of the gastrointestinal tract is seen in patients with AIDS and presents with symptoms of bloody diarrhea, abdominal distension and pain.
- Adrenal gland involvement: Infection of the adrenal gland presents with symptoms of fever, malaise, orthostatic hypotension, nausea, and vomiting.
- Mucosal Involvement: Superficial and deep ulcerations with nodules and verrucous lesions involving the tongue, buccal mucosa, lips, pharynx and larynx can be present.
- Genitourinary involvement: Histoplasma infection of the genitourinary involvement can result in testicular abscess, prostatic abscess, epididymitis, penile lesions, and bladder ulcerations. Patients present with scrotal pain, swelling, dysuria, pyuria and hematuria.
- Articular involvement: The infection usually involves the tendons and joints, patients present with features of joint pain and reduced range of motion.
- Endocarditis: Histoplasma infection can occur in the valves, prosthetic valves and atrial myxomas. Patients present with features of distal embolization.
- Meningitis: Histoplamsmosis causes chronic meningitis and is characterized by affecting the basilar meninges resulting in a communicating hydrocephalus. Symptoms include headache, mental status
changes, and features of cranial nerve palsies.
References
- ↑ Goodwin RA, Owens FT, Snell JD, Hubbard WW, Buchanan RD, Terry RT; et al. (1976). "Chronic pulmonary histoplasmosis". Medicine (Baltimore). 55 (6): 413–52. PMID 792626.
- ↑ Chiller, TM. Chapter 3 Infectious Diseases Related to Travel. Histoplasmosis. Available at: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseases-related-to-travel/histoplasmosis. Accessed February 2, 2016.