Histoplasmosis

Infectious Agent

Histoplasma capsulatum, a dimorphic fungus that grows as a mold in soil and as a yeast in animal and human hosts.

Transmission

Through inhalation of spores (conidia) from soil (often soil contaminated with bat guano or bird droppings); not transmitted from person to person.

Epidemiology

Distributed worldwide, except in Antarctica, but most often associated with river valleys. Activities that expose people to soil disruption or areas where bats live and birds roost, such as construction, excavation, demolition, farming, gardening, and caving, can increase risk of histoplasmosis. Outbreaks have been reported associated with travel to many countries in Central and South America, most often associated with visiting caves.

Clinical Presentation

Incubation period is typically 3–17 days for acute disease. Ninety percent of infections are asymptomatic or result in a mild influenzalike illness. Some infections may cause acute pulmonary histoplasmosis, manifested by high fever, headache, nonproductive cough, chills, weakness, pleuritic chest pain, and fatigue. Most people spontaneously recover 2–3 weeks after onset of symptoms, although fatigue may persist longer. High-dose exposure can lead to severe pulmonary disease. Dissemination, especially to the gastrointestinal tract and central nervous system, can occur in people who are immunocompromised.

Diagnosis

Several methods are available to diagnose histoplasmosis.

  • Culture of H. capsulatum from bone marrow, blood, sputum, and tissue specimens is the definitive method but may take weeks to grow.
  • Demonstration of the typical intracellular yeast forms in tissue by microscopic examination strongly supports the diagnosis of histoplasmosis when clinical, epidemiologic, and other laboratory studies are compatible. Molecular diagnostics, such as PCR on tissue specimens, are increasingly available to support microscopic findings.
  • EIA on urine, serum, plasma, bronchoalveolar lavage, or cerebrospinal fluid is a rapid diagnostic test commercially available in the United States.
  • Antibody tests are available for histoplasmosis. Testing a single serum specimen can aid in diagnosis, but testing serial specimens offers greater specificity (detection of seroconversion and increases in antibody titer).
  • Other endemic mycoses (such as blastomycosis, paracoccidioidomycosis, and penicilliosis) can lead to false-positive EIA and antibody tests for H. capsulatum .

Treatment

Treatment is not usually indicated for immunocompetent people with acute, localized pulmonary infection. People with more extensive disease or persistent symptoms beyond 1 month are generally treated with an azole drug, such as itraconazole, for mild to moderate illness or amphotericin B for severe infection.

Prevention

People at increased risk for severe disease should avoid high-risk areas, such as bat-inhabited caves.

CDC website: www.cdc.gov/fungal/diseases/histoplasmosis

Bibliography

  1. CDC. Outbreak of histoplasmosis among travelers returning from El Salvador—Pennsylvania and Virginia, 2008. MMWR Morb Mortal Wkly Rep. 2008 Dec 19;57(50):1349–53.  [PMID:19092757]
  2. Hage CA, Azar MM, Bahr N, Loyd J, Wheat LJ. Histoplasmosis: up-to-date evidence-based approach to diagnosis and management. Semin Respir Crit Care Med. 2015 Oct;36(5):729–45.  [PMID:26398539]
  3. Kauffman CA. Histoplasmosis: a clinical and laboratory update. Clin Microbiol Rev. 2007 Jan;20(1):115–32.  [PMID:17223625]
  4. Morgan J, Cano MV, Feikin DR, Phelan M, Monroy OV, Morales PK, et al. A large outbreak of histoplasmosis among American travelers associated with a hotel in Acapulco, Mexico, spring 2001. Am J Trop Med Hyg. 2003 Dec;69(6):663–9.  [PMID:14740886]
  5. Weinberg M, Weeks J, Lance-Parker S, Traeger M, Wiersma S, Phan Q, et al. Severe histoplasmosis in travelers to Nicaragua. Emerg Infect Dis. 2003 Oct;9(10):1322–5.  [PMID:14609473]
  6. Wheat LJ. Histoplasmosis: a review for clinicians from non-endemic areas. Mycoses. 2006 Jul;49(4):274–82.  [PMID:16784440]

Authors

Brendan R. Jackson, Tom M. Chiller