Histoplasmosis classification

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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]

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.

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:

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