Histoplasmosis physical examination

Physical examination findings in pulmonary histoplasmosis include erythema nodosum and rales on auscultation. In patients with disseminated histoplasmosis features similar to sepsis such as hypotension, altered mental status will be present.

Physical examination findings vary in patients with histoplasma infection and it depends on stage of the disease and extent of the spread of infection. Patients with acute or chronic pulmonary histoplasmosis present with features similar to pneumonia.
^[1] The following physical examination findings can be demonstrated:

Patient will appear ill with fever and dyspnea.

• Erythema nodosum

In patients with acute or chronic pulmonary histoplasmosis occasional wheezing and rales are a common finding.

• Increased tactile fremitus

• Dullness on percussion

• Decreased breath sounds
• Bronchial breath sounds
• Rhonchi
• Crackles, Rales
• Increased vocal fremitus

Patients with disseminated histoplasma infection have similar features as sepsis. The following physical examination findings can be demonstrated in a patient with disseminated infection:^[2]

• Hypotension

Sepsis is considered present if infection is highly suspected or proven and two or more of the following systemic inflammatory response syndrome (SIRS) criteria are met:^[3][4]

• Heart rate > 90 beats per minute
• Temperature < 36 (96.8 °F) or > 38 °C (100.4 °F)
• Tachypnea > 20 breaths per minute or, on blood gas, a P_aCO₂ < 32 mm Hg

• Cyanosis

• Cervical Lymphadenopathy

• Decreased peripheral pulses

• Altered sensorium
• Lethargy
• Neck stiffness

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  Skin lesion on the upper lip due to Histoplasma capsulatum infection.
• 
  Interior view of an elderly man’s oral cavity. A histoplasmosis infection induced inflammatory response on right inferior gingival tissues. From Public Health Image Library (PHIL). ^[5]
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  This image depicts the perianal region of a male patient afflicted with a disease known as histoplasmosis, which is caused by the fungal organism, Histoplasma capsulatum. From Public Health Image Library (PHIL). ^[5]
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  This image depicts an intraoral view, which reveals a lesion of the patient’s maxillary gingival mucosa that had been diagnosed as histoplasmosis, caused by the fungal pathogen, Histoplasma capsulatum. From Public Health Image Library (PHIL). ^[5]