Chronic Pulmonary Histoplasmosis—A Scoping Literature Review

Abstract

Chronic pulmonary histoplasmosis (CPH) is an uncommon manifestation of Histoplasma infection with features similar to pulmonary tuberculosis (TB). In endemic areas, it may be misdiagnosed as smear-negative pulmonary TB. Historical case series mainly from patients with presumed TB described a high frequency of cavitation and poor prognosis, likely resulting from delayed presentation. More recent reports suggest that CPH can present with nodules, lymphadenopathy, or infiltrates, with cavities being a less common feature. Emphysema is the main risk factor for cavitary CPH. CPH is therefore an umbrella term, with chronic cavitary pulmonary histoplasmosis and Histoplasma nodules being the main long-term manifestations in nonimmunocompromised individuals. Diagnosis relies on a high index of suspicion, use of fungal culture of respiratory samples, antibody testing, and compatible radiological picture. Treatment with itraconazole for at least 12 months is recommended. Morbidity from CPH results from slow progression of cavities and gradual loss of lung function, especially if not recognized and treated. Studies on the epidemiology of CPH are needed in order to improve understanding of the disease.

Post-tuberculosis chronic pulmonary aspergillosis: An emerging public health concern

“…In addition, the lack of awareness and low index of suspicion for CPA among clinicians, as well as the non-availability of essential diagnostics for CPA, are associated with misdiagnosis of CPA [24]. Other differential diagnoses such as chronic cavitary pulmonary histoplasmosis [25], coccidioidomycosis, paracoccidioidomycosis in endemic areas, non-tuberculous mycobacterial (NTM) infection, and other cavitary lung diseases should be considered and evaluated if indicated.…”

Introductory Chapter: The Global Distribution of Human Histoplasmosis - An Overview

“…Haemoptysis is common among patients with chronic pulmonary histoplasmosis, noted in up to a third of the cases. Chest radiography reveals calcified mediastinal and hilar lymph nodes of normal size along with infiltrates that evolve over time, first from focal or diffuse infiltrated to consolidations, cavitations, interstitial fibrosis, and pleural thickening, similar to patients chronic pulmonary aspergillosis and pulmonary tuberculosis [23]. Uncommon complication of pulmonary histoplasmosis includes mediastinitis, manifesting as adenitis, granulomatosis, and fibrosing [5].…”

“…Likewise in Africa, microfoci of histoplasmosis exist with reported large and small outbreaks have been attributed to histoplasmosis, but most infections are sporadic and imported cases from endemic areas have also been described [15,22]. In review of literature of recently published data, chronic cavitary histoplasmosis is described as a common entity in endemic areas and commonly misdiagnosed as smear-negative tuberculosis [23].…”

“…Chronic pulmonary histoplasmosis includes chronic cavitary pulmonary histoplasmosis and Histoplasma nodule (histoplasmoma) [23]. It is a progressive disease occurring over a period of months to years.…”

Diagnosis of Pulmonary Infections Due to Endemic Fungi

“…duboisii [ 7 ]. Classically, H capsulatum is thought of as endemic to the Ohio and Mississippi River Valleys in the United States, as well as parts of Central and South America [ 2 , 7 , 8 , 9 , 10 ]. More recently it has become clear that Histoplasma occurs frequently in many parts of the world including: Central and Eastern North America, the majority of Central and South America, much of sub-Saharan Africa, large portions of southeast Asia and small areas within Australia and Europe [ 7 ].…”