An Epidemic of Erythema Multiforme and Erythema Nodosum Caused by Histoplasmosis

Sellers, T. F.

doi:10.7326/0003-4819-62-6-1244

Cited by 68 publications

(13 citation statements)

References 13 publications

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“…Nearly half of patients with rheumatologic manifestations exhibit erythema nodosum and/or erythema multiforme [45,46]. The joint symptoms usually resolve in response to treatment with nonsteroidal anti-inflammatory agents.…”

Section: Rheumatologic Syndromesmentioning

confidence: 98%

Practice Guidelines for the Management of Patients with Histoplasmosis

Wheat

Sarosi

McKinsey

et al. 2000

Clinical Infectious Diseases

345

196

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Section: Rheumatologic Syndromesmentioning

confidence: 98%

Practice Guidelines for the Management of Patients with Histoplasmosis

Wheat

Sarosi

McKinsey

et al. 2000

Clinical Infectious Diseases

345

196

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“…Erythema nodosum and erythema multiforme are the most common skin manifestations; they occur most frequently in young women and are thought to be associated with a hypersensitivity response to the antigens of H. capsulatum (88,94,115). Myalgias and arthralgias are common symptoms during acute infection; however, a minority of patients may develop self-limited, polyarticular, symmetrical arthritis (108).…”

Section: Pulmonary Histoplasmosismentioning

confidence: 99%

Histoplasmosis: a Clinical and Laboratory Update

2007

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SUMMARY Infection with Histoplasma capsulatum occurs commonly in areas in the Midwestern United States and Central America, but symptomatic disease requiring medical care is manifest in very few patients. The extent of disease depends on the number of conidia inhaled and the function of the host's cellular immune system. Pulmonary infection is the primary manifestation of histoplasmosis, varying from mild pneumonitis to severe acute respiratory distress syndrome. In those with emphysema, a chronic progressive form of histoplasmosis can ensue. Dissemination of H. capsulatum within macrophages is common and becomes symptomatic primarily in patients with defects in cellular immunity. The spectrum of disseminated infection includes acute, severe, life-threatening sepsis and chronic, slowly progressive infection. Diagnostic accuracy has improved greatly with the use of an assay for Histoplasma antigen in the urine; serology remains useful for certain forms of histoplasmosis, and culture is the ultimate confirming diagnostic test. Classically, histoplasmosis has been treated with long courses of amphotericin B. Today, amphotericin B is rarely used except for severe infection and then only for a few weeks, followed by azole therapy. Itraconazole is the azole of choice following initial amphotericin B treatment and for primary treatment of mild to moderate histoplasmosis.

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“…Prior infection provides partial imnmnity against reinfection. Similarly, outbreaks at the fringe of the endemic areas of histoplasmosis are likely to result in higher attack rates, since a larger non-immune population is exposed (13)(14)(15)22 (26)(27)(28)(29)(30). T suppressor cells appear to be responsible for this suppression.…”

Section: Historymentioning

confidence: 99%

Diagnosis and management of Histoplasmosis

1989

Eur. J. Clin. Microbiol. Infect. Dis.

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Histoplasmosis occurs throughout the world but is more common within the endemic areas of North America, particularly in fertile river valleys. Disease manifestations range from asymptomatic infection in the normal host with low-inoculum exposure to rapidly fatal, disseminated infection in the severely immunocompromised host, emphasizing the importance of cellular immunity in defense against Histoplasma capsulatum. Diagnosis depends on a high index of suspicion, knowledge of the clinical and epidemiologic features of the infection, and a thorough understanding of the uses and limitations of fungal cultural and serological laboratory procedures. Recently, a method has been developed for rapid diagnosis based on detection of a polysaccharide antigen in body fluids of patients with histoplasmosis. Amphotericin B remains the preferred treatment for more severe forms of histoplasmosis, particularly in the immunocompromised host, but oral treatment with ketoconazole or newer imidozoles appears to be effective in less severe infections in non-immunocompromised individuals.

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An Epidemic of Erythema Multiforme and Erythema Nodosum Caused by Histoplasmosis

Cited by 68 publications

References 13 publications

Practice Guidelines for the Management of Patients with Histoplasmosis

Practice Guidelines for the Management of Patients with Histoplasmosis

Histoplasmosis: a Clinical and Laboratory Update

Diagnosis and management of Histoplasmosis

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