Histoplasma capsulatum Recovery from the Urine and a Short Review of Genitourinary Histoplasmosis

Abstract

Although virtually any organ can be involved in disseminated histoplasmosis, the recovery of Histoplasma capsulatum from the urine is a rare finding. Here we describe that a renal transplant recipient had H. capsulatum recovered from urinary sediment. The organism was also recovered from urine cultures. The potential implications of this finding are discussed, and the literature on genitourinary histoplasmosis is reviewed.

Cutaneous histoplasmosis in renal transplant recipients

“…As described above, there are cases of relapse noted in the literature, albeit in a minority of patients. In our report, case 11 initially presented with subcutaneous nodules two yr after transplantation, was treated with amphotericin B and discharged on oral ketoconazole then readmitted four yr later with chronic organ rejection (14). He was treated with increasing doses of immunosuppressants, and H. capsulatum was subsequently recovered from a urine culture.…”

“…In two patients, direct transmission of histoplasmosis through cadaveric renal transplantation was implicated, and these patients presented in the early post-transplantation period at around two months (4,9). The other patients presented out of this one-yr window, with a wide range including up to 29 yr after transplant ( Seventeen of these 22 cutaneous histoplasmosis cases, including our patient, occurred in the setting of confirmed disseminated disease (2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18). Table 1 displays the demographic data, time from transplantation to clinical presentation, maintenance immunosuppressants, characteristics of cutaneous findings, other organs with confirmed involvement, treatment medications, and final outcome of these 17 cases.…”

“…Seventeen of these 22 cutaneous histoplasmosis cases, including our patient, occurred in the setting of confirmed disseminated disease . Table displays the demographic data, time from transplantation to clinical presentation, maintenance immunosuppressants, characteristics of cutaneous findings, other organs with confirmed involvement, treatment medications, and final outcome of these 17 cases.…”

“…Our literature review yielded 22 cases of cutaneous histoplasmosis in renal transplant patients, including a patient seen on our inpatient consult service (2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21). The median age in this series was 38 yr, and the majority of cases were reported in males (68%).…”

Epididymo-orchitis caused by Histoplasma capsulatum

“…The genitourinary tract is uncommonly involved in disseminated histoplasmosis. Testicular involvement is infrequent, however, the incidence of the genitourinary diseases might be underdiagnosed due to some cases may remain asymptomatic and given the fact that this system is less frequently to be examined - as occurred for our patient, only examined in the ICU due to absence of symptoms [ 9 ]. Up to this date there are few cases of orchitis and/or epididymitis caused by H. capsulatum reported in the literature.…”