Ocular Histoplasmosis

Case reports of three residents of Ontario with clinical histoplasmic chorioretinitis are presented. The diagnosis was made on the basis of the clinical appearance, the presence of calcified lesions in the chest, a negative skin test to tuberculin, and a positive skin test to toxoplasmin. All patients were treated with intravenous amphotericin B. Except for transitory elevation of blood urea nitrogen, there were no serious complications from the drug and in all cases the lesions in the eyes were improved. Histologic or cultural proof of the presence of fungus in the eye is not available, but clinical and laboratory findings can combine to point to the diagnosis of histoplasmosis. In such cases, since vision is at stake, treatment with amphotericin B should be considered.     

Coexistent Coccidioidomycosis of the Meninges and Pulmonary Cavitation Due to Coccidioides

A clinical study was undertaken to evaluate the effectiveness of concentrated cabbage juice in the treatment of peptic ulcers. Patients at San Quentin Prison with a diagnosed ulcer crater were treated in a double blind control experiment. They were given either concentrated cabbage juice or placebo facsimile. The evaluation of the merit of this treatment was based upon repeated x-ray examinations of the ulcer crater. A period of 22 days was allowed for ulcer crater healing time.The results of this experiment indicated concentrated cabbage juice to be effective in healing of peptic ulcer.     

Histoplasmosis in India

The article gives a critical review of the available publications pertaining to Histoplasmosis in India. Evidence on hand indicates that this fungus infection is not endemic in India.

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Zusammenfassung Der Artikel gibt einen kritischen Überblick über die verfügbaren Veröffentlichungen, die die Histoplasmose in Indien betreffen. Daraus geht hervor, daß diese Pilzerkrankung in Indien nicht endemisch ist.

     

Antibodies in Histoplasmosis

Production of precipitating and complement-fixing antibody in rabbits and other animals was induced by immunization with live yeast-phase cells of Histoplasma capsulatum. Results of studies of polysaccharide antigens from three strains of H. capsulatum, by quantitative complement-fixation with human and rabbit antisera, strongly suggest the presence of type specificity. The variations of titer during 11 weeks in one patient with histoplasmosis and the variations of titer among a group of patients with histoplasmosis were studied by use of quantitative complement-fixation tests.     

Histoplasmosis in Europe

After reviewing the reports ofHistoplasma capsulatum in man, animal and soil, and the results of histoplasmin sensitivity tests in Europe, we have concluded that autochthonous histoplasmosis is present but rare in Europe.Only the European parts of Turkey and of U.S.S.R. are considered in this report.Paper read at the Eighth International Congresses for Tropical Medicine and Malaria, September 1968, Teheran (Iran).     

Epidemiology of Histoplasmosis

Purpose of Review

Histoplasma capsulatum is an environmental fungus that contributes significant morbidity and mortality throughout the globe, especially in immunocompromised hosts. This review presents current data on the understanding of histoplasmosis epidemiology, including changing incidence among geographic regions and patient populations with increased risk.

Recent Findings

Global cases are more frequently identified due to the HIV epidemic, an increasing number of immunocompromised patients, and improved diagnostic capabilities. The global distribution of histoplasmosis extends to several countries in Central and South America and the Caribbean, as well as southern and sub-Saharan Africa, India, China, and Southeast Asia. Cases are also seen throughout Europe and non-endemic regions of the USA often due to migration and travelers.

Summary

The changing epidemiology of histoplasmosis underlines the importance of continued surveillance and reporting to better understand the regions which place patients at a higher risk for infection.

     

How I Treat Histoplasmosis

Histoplasmosis is an endemic mycosis caused by the dimorphic fungus Histoplasma capsulatum. Some important manifestations of infection include acute or chronic pulmonary disease, histoplasmomas, progressive disseminated histoplasmosis, and central nervous system infection. Depending on the clinical presentation, site of infection and severity of disease, either amphotericin B preparations followed by itraconazole, or itraconazole alone have become the preferred treatments. Because prolonged therapy (6 weeks to 24 months) may be required, careful monitoring for nephrotoxicity in patients on amphotericin B preparations is necessary. In addition, in patients receiving itraconazole, vigilance for drug interactions and pharmacokinetic properties is warranted. Histoplasma antigen testing has improved rapidity of diagnosis and the ability of long-term monitoring for clinical response in patients with histoplasmosis.