Histoplasmosis

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Overview

Histoplasmosis is an endemic infection in most of the United States and can be found worldwide. The spectrum of this illness ranges from asymptomatic infection to severe disseminated disease. Life-threatening illness is usually associated with an immunocompromised state; however, 20 percent of severe illnesses result from a heavy inoculum in healthy persons. Culture remains the gold standard for diagnosis but requires a lengthy incubation period. Fungal staining produces quicker results than culture but is less sensitive. Testing for antigen and antibodies is rapid and sensitive when used for particular disease presentations. An advantage of antigen detection is its usefulness in monitoring disease therapy. Antifungal therapy is indicated in chronic or disseminated disease and severe, acute infection. Amphotericin B is the agent of choice in severe cases; however, patients must be monitored for nephrotoxicity and hypokalemia. Itraconazole is effective in moderate disease and is well tolerated, even with long-term use. Hepatotoxicity, the most severe adverse effect of itraconazole, is uncommon and usually transient.

Symptoms

Fever.

Cough.

Fatigue (extreme tiredness)

Chills.

Headache.

Chest pain.

Body aches.

Causes

 A disease caused by the fungus Histoplasma capsulatum. Most people with histoplasmosis have no symptoms. However, histoplasma can cause acute or chronic lung disease and progressive disseminated histoplasmosis affecting a number of organs. It can be fatal if untreated.

Histoplasmosis is caused by the reproductive cells (spores) of the fungus Histoplasma capsulatum. They float into the air when dirt or other material is disturbed. The fungus thrives in damp soil that's rich in organic material, especially the droppings from birds and bats.

Risk factors

Histoplasmosis is often associated with activities that disturb soil, particularly soil that contains bird or bat droppings. Certain groups of people are at higher risk for developing the severe forms of histoplasmosis: People who have weakened immune systems, for example, people who: Have HIV/AIDS.

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Complications

Histoplasmosis can cause many serious complications, even in otherwise healthy people. For infants, older adults and people with weakened immune systems, the potential problems are often life-threatening.


Complications can include:


Acute respiratory distress syndrome. Histoplasmosis can damage lungs to the point that the air sacs begin filling with fluid. This prevents good air exchange and can deplete the oxygen in your blood.

Heart problems. Inflammation of the sac that surrounds your heart (pericardium) is called pericarditis. When the fluid in this sac increases, it can interfere with the heart's ability to pump blood.

Adrenal insufficiency. Histoplasmosis can harm your adrenal glands, which produce hormones that give instructions to virtually every organ and tissue in your body.

Meningitis. In some cases, histoplasmosis can cause this inflammation of the membranes surrounding your brain and spinal cord.


Prevention

It's difficult to prevent exposure to the fungus that causes histoplasmosis, especially in areas where the disease is widespread. But taking the following steps might help reduce the risk of infection:


Avoid exposure. Avoid projects and activities that might expose you to the fungus, such as cave exploring and raising birds, such as pigeons or chickens.

Spray contaminated surfaces. Before you dig soil or work in an area that could harbor the fungus that causes histoplasmosis, soak it with water. This can help prevent spores from being released into the air. Spraying chicken coops and barns before cleaning them also can reduce your risk.

Wear a respirator mask. Consult the National Institute for Occupational Safety and Health to determine which type of mask will provide protection for your level of exposure.