Histoplasmosis history and symptoms

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Aravind Kuchkuntla, M.B.B.S[2]

Majority of the patients are asymptomatic and few develop acute pulmonary histoplasmosis presenting with fever, cough and dyspnea. Few patients develop rheumatological symptoms such as erythema nodosum and symmetrical joint pain. Severe form of disseminated histoplasmosis presents with features of sepsis, acute respiratory distress syndrome and disseminated intravascular coagulation.

It is an acute self-limiting illness in patients exposed to the organism for the first time or the patient is exposed to a large amount of inoculum or is exposed to virulent strains of histoplasma. The symptoms of an acute infection include the following:^[1][2][3]

• The incubation period of histoplasmosis is typically 3–17 days for the acute disease.
• A positive history for exposure to Histoplasma capsulatum and close contacts with similar complaints is helpful to diagnose pulmonary histoplasmosis.
• Fever
• Malaise
• Headache
• Weakness
• Substernal chest discomfort
• Dry cough
• Myalgias and arthralgias with symmetrical joint involvement

It is usually seen in elderly patients with emphysema and presents with the following symptoms:

• Fatigue
• Fever
• Night sweats
• Anorexia and weight loss
• Cough
• Sputum production
• Hemoptysis
• Dyspnea

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, which include:

• Dysphagia
• Congestion of the face
• Distended veins in the neck
• Dyspnea

It is a complication of histoplasma infection of the mediastinal structures resulting in fibrosis and causing compression of the surrounding structures in the mediastinum. The symptoms of fibrosis include the following:

• It is seen in patients between 20 to 40 years of age.
• It follows a gradual progression of symptoms with compression of the superior vena cava, the pulmonary arteries, pulmonary 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.

In patients with calcified nodules bursting into the bronchus present with features of bronchial 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.

• It is defined as a gradually progressive chronic infection in adults with an intact immune system.
• These patients present with features of: dyspnea, cough and hemoptysis.

It is seen in patients with risk factors resulting in a weakened immune system. Clinical features of disseminated histoplasmosis include the following: ^[4]

• Fever
• Malaise
• Anorexia
• Weight loss
• Abdominal distension due to hepatosplenomegaly
• Severe form of disseminated histoplasmosis 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.^[5]
• Adrenal gland involvement: Infection of the adrenal gland presents with symptoms of fever, malaise, orthostatic hypotension, nausea, and vomiting.^[6]
• 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 urinary bladder ulcerations. Patients present with scrotal pain, swelling, dysuria, pyuria and hematuria.^[7]
• 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: Histoplasmosis 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.^[8]