Disseminated Histoplasmosis: Case Report and Review
Dr. Anita Shoba Flynn,
Senior Pathologist, Department of Pathology,
St.Marthas Hospital Nrupatunga road Bengaluru-560001,
Bengaluru, Karnataka, India.
Histoplasmosis is a systemic fungal disease. It is also called
as Darling’s disease, as it was first described by an American
physician named Samuel Taylor Darling, in Panama. It is caused
by the dimorphic fungus Histoplasma capsulatum. It is usually
self-limiting or localized in immunocompetent individuals
whereas in immunocompromised patients, it presents in
disseminated forms. This infection is endemic to central and
South-central United States.
Histoplasmosis infection is acquired by inhalation of fungal
microconidia present in the contaminated soil. Asymptomatic
dissemination of infection beyond the lungs is common.
Infection heals spontaneously in most of the cases and
in some cases it develops into pulmonary disease similar
to tuberculosis. Dissemination and systemic involvement
occurs in patients suffering from debilitating diseases and
immunocompromised conditions. It is relatively uncommon in
India with few sporadic cases getting reported and it is endemic
in eastern part of India. In non-endemic parts, disseminated
histoplasmosis is rarely suspected and there have been very
few case reports. Awareness is required, as its presentation is
similar to tuberculosis, especially when we have patients with
compromised immune status. We are reporting with consent one
such rare case of disseminated histoplasmosis in a 36-year-old
male farmer from South India with acquired immunodeficiency
syndrome and very low CD4 count of 17cells/µl with lymph node
and bone marrow involvement. Awareness of this infection is
essential in these cases as it is potentially lethal and adequately
treated patients with antifungal agents carry better prognosis.
In non-endemic areas Disseminated Histoplasmosis has to be
differentiated from more common disease like tuberculosis,
leishmaniasis or systemic malignancies.
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