Internal Medicine

0521779407-09 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:13

718 Hirsutism (Endocrinology) Histoplasma Capsulatum

complications and prognosis

■PCOS increased risk of uterine, ovarian cancer, type 2 diabetes, dys-

lipidemia, hypertension, atherosclerosis

■Unrecognized, tumor can grow, and malignancy can spread

■Cushing syndrome can be subtle, worsening if not diagnosed and

cured

■Hirsutism can be psychologically scarring

Histoplasma Capsulatum..............................

RICHARD A. JACOBS, MD, PhD

history & physical

History

■Inhalation of mycelial fragments and microconidia

■Endemic in Ohio and Mississippi River valleys, soil-based fungus

■Strong association between bird and bat guano and presence of

histoplasma

■Disruption of soil by excavation or construction is associated with

organism release.

■People exposed to disrupted soil through recreation or work activities

are most at risk.

■Disease develops in men > women by 4:1 ratio.

■No differences in racial or ethnic groups

Signs & Symptoms

■Acute Primary Infection:

➣>90% unrecognized

➣Asymptomatic or mild influenza-like illness

➣In those ill, incubation 7–21 days. Fever (up to 42C), HA, nonpro-

ductive cough, chills, chest pain

➣Arthralgias, E. nodosum, E. multiforme 6% pts, mostly women

➣Physical findings minimal – rales, rarely organomegaly

➣6% acute pericarditis – precordial chest pain, fever – pericardial

friction rub, pulsus paradoxus, enlarged cardiac silhouette

■Acute Reinfection: milder influenza-like illness

■Histoplasmoma: mass lesion resembling fibroma, can enlarge over

years to form calcified mass

■Mediastinal Granuloma: massive enlargement of mediastinal lymph

nodes by granulomatous inflammation. Asymptomatic or can affect

major airways; fibrosis in healing can cause retraction.