Histoplasmosis Health Article

Signs and tests

How histoplasmosis is diagnosed depends on the body parts involved. Tests may look at the sputum, lung tissue, blood, cerebrospinal fluid (CSF), or bone marrow for signs of the fungus. An antigen test may be done on blood, urine, or CSF.

In addition, x-rays may show abnormalities in the lungs or lymph nodes of the chest. These are signs of histoplasmosis.

Treatment

The main treatment for histoplasmosis is antifungal drugs. In the case of pulmonary histoplasmosis, this may include oral (taken by mouth) medicines such as itraconazole or ketoconazole.

Sometimes, especially in immunosuppressed people, long-term treatment with anti-fungal drugs are used after treatment with amphotericin.

Expectations (prognosis)

What happens depends on the extent of the infection and the overall health of the individual. The death rate is fairly high for people with untreated widespread (disseminated) histoplasmosis, but is reduced significantly with treatment.

Complications

• Fibrosing mediastinitis -- scarring in the chest that may entrap the following body parts:
  • Great vessels (the major blood vessels carrying blood to and from the heart)
  • Esophagus (food pipe)
  • Heart
  • Lymph nodes
• Inflammatory syndromes involving:
  • Heart lining (pericarditis)
  • Joints (arthritis)
  • Rashes (erythema nodosum, erythema multiforme)
  • Skin nodules
• Mediastinal granuloma -- enlarged chest-cavity lymph nodes, which may compress body parts such as the esophagus and blood vessels of the lungs
• Medication side effects (for example, amphotericin can have severe side effects)

In addition, people who have a weakened immune system may develop disseminated disease, which can infect the meninges of the brain (causing meningitis).

Calling your health care provider

Notify your health care provider if you live in an area where histoplasmosis is common, and you develop flu-like symptoms, chest pain, cough and shortness of breath. While there are many other illnesses that have similar symptoms, you may need to be tested for the possibility of histoplasmosis.

Prevention

Minimize exposure to dust in contaminated environments such as chicken coops and bat caves. Wear protective equipment such as masks if you work in these environments.

References

Kauffman CA. Histoplasmosis. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007: chap 353.