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Histoplasmosis - acute (primary) pulmonary

Acute pulmonary histoplasmosis is a respiratory infection that is caused by inhaling the spores of the fungus Histoplasma capsulatum.

Causes

Histoplasma capsulatum is the name of the fungus that causes histoplasmosis. It is found in the central and eastern United States, eastern Canada, Mexico, Central America, South America, Africa, and Southeast Asia. It is commonly found in the soil in river valleys. It gets into the soil mostly from bird and bat droppings.

You can get sick when you breathe in spores that the fungus produces. Every year, thousands of people with a normal immune system worldwide are infected, but most do not become seriously sick. Most have no symptoms or have only a mild flu-like illness and recover without any treatment.

Acute pulmonary histoplasmosis may happen as an epidemic, with many people in 1 region becoming sick at the same time. People with weakened immune systems (see Symptoms section below) are more likely to:

  • Get the disease if exposed to the fungus spores
  • Have the disease come back
  • Have more symptoms, and more serious symptoms, than others who get the disease

Risk factors include traveling to or living in the central or eastern United States near the Ohio and Mississippi river valleys, and being exposed to the droppings of birds and bats. This threat is greatest after an old building is torn down and the spores get into the air, or when exploring caves.

Symptoms

Most people with acute pulmonary histoplasmosis have no symptoms or only mild symptoms. The most common symptoms are:

  • Chest pain
  • Chills
  • Cough
  • Fever
  • Joint pain and stiffness
  • Muscle aches and stiffness
  • Rash (usually small sores on the lower legs)
  • Shortness of breath

Acute pulmonary histoplasmosis can be a serious illness in the very young, older people, and people with a weakened immune system, including those who:

  • Have HIV/AIDS
  • Have had bone marrow or solid organ transplants
  • Take medicines that suppress their immune system

Symptoms in these people may include:

  • Inflammation around the heart (called pericarditis)
  • Serious lung infections
  • Severe joint pain

Exams and Tests

To diagnose histoplasmosis, you must have the fungus or signs of the fungus in your body. Or your immune system must show that it is reacting to the fungus.

Tests include:

  • Antibody tests for histoplasmosis
  • Biopsy of infection site
  • Bronchoscopy (usually only done if symptoms are severe or you have an abnormal immune system)
  • Complete blood count (CBC) with differential
  • Chest CT scan
  • Chest x-ray (might show a lung infection or pneumonia)
  • Sputum culture (this test often does not show the fungus, even if you are infected)
  • Urine test for Histoplasma capsulatum antigen

Treatment

Most cases of histoplasmosis clear up without specific treatment. People are advised to rest and take medicine to control fever.

Your health care provider may prescribe medicine if you are sick for more than 4 weeks, have a weakened immune system, or are having breathing problems.

Outlook (Prognosis)

When histoplasmosis infection is severe or gets worse, the illness may last up to 6 months. Even then, it is rarely fatal.

Possible Complications

Acute pulmonary histoplasmosis can get worse over time, or can become long-term (chronic) pulmonary histoplasmosis (which doesn't go away).

Histoplasmosis can spread to other organs through the bloodstream (dissemination). This is often seen in infants, young children, and people with a suppressed immune system.

When to Contact a Medical Professional

Call your provider if:

  • You have symptoms of histoplasmosis, especially if you have a weakened immune system or have recently been exposed to bird or bat droppings
  • You are being treated for histoplasmosis and develop new symptoms

Prevention

Avoid contact with bird or bat droppings if you are in an area where the spore is common, especially if you have a weakened immune system.

References

Deepe GS. Histoplasma capsulatum (histoplasmosis). In: Bennett JE, Dolin R, Blaser MJ, eds. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. 8th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 265.

Kauffman CA. Histoplasmosis. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 332.

Schmitt BH, Rosenblatt JE, Pritt BS. Laboratory diagnosis of tropical infections. Infec Dis Clin N Am. 2012;26(2):513-554. PMID: 22632652 www.ncbi.nlm.nih.gov/pubmed/22632652.

Update Date 3/13/2016

Updated by: Jatin M. Vyas, MD, PhD, Assistant Professor in Medicine, Harvard Medical School; Assistant in Medicine, Division of Infectious Disease, Department of Medicine, Massachusetts General Hospital, Boston, MA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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