0521779407-09 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:13
Histoplasma Capsulatum 719■Mediastinal Fibrosis: rare but grave consequence of mediastinal
involvement – massive fibrotic deposition within mediastinum – can
cause hypoxemia, SVC syndrome, dysphagia, can encroach on all
major structures
■Chronic Pulmonary Histoplasmosis
➣Cavitary pulmonary histoplasmosis
➣Cavitary lesions in upper lobes in >90% of cases
➣Males >50 years old, preexisting chronic lung disease (emphy-
sema), unusual in <40 group
➣Symptoms: low-grade fever, productive cough, dyspnea, weight
loss; night sweats, chest pain, hemoptysis, malaise less common
■Progressive Disseminated Histoplasmosis (PDH)
➣Relentless growth in multiple organ systems
➣Acute form: severely immunosuppressed (AIDS, Hodgkins,
NHL), infants/young children. Abrupt onset, fever/malaise, hep-
atosplenomegaly, lymphadenopathy, rales.
➣HIV: CD4 <200, exposure to chicken coops. Fever, weight loss,
rales, hepatosplenomegaly, lymphadenopathy. Cutaneous: mac-
ulopapular eruption, petechiae, ecchymosis.
➣Subacute: more prolonged nature of symptoms, hepatosp-
lenomegaly and oropharyngeal ulcers (deeper), focal lesions of
various organ systems (GI, CNS, adrenal glands), endocarditis.
CNS: chronic meningitis, mass lesions, cerebritis.
➣Chronic: Chronic, mild symptoms, almost all in adults. Malaise
and lethargy most frequent, fever less common and low-grade.
Most common finding (50%) is deep and painless oropharyn-
geal ulcer. Hepatosplenomegaly in 1/3, absence of other organ
involvement.
➣Ocular: Uveitis or panophthalmitis in association with active
histo; also ocular histoplasmosis syndrome – posterior uveitis
or choroiditis in skin-test positive individualstests
Laboratory
■Acute Pulmonary: WBC nl, 30% leukocytosis or leukopenia, transient
increase in serum alkaline phosphatase
■Chronic Pulmonary: leukocytosis and elevated alk phos in 1/3, ane-
mia in 1/2
■Acute PDH: anemia 90% (often <20), leukopenia, thrombocytopenia,
ALT and alk phos elevation
■Subacute PDH: less striking than in acute PDH