Histoplasmosis in Sri Lanka - a masquerader in a strange land: A Case Report

Abstract

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Histoplasmosis in Sri Lanka – barely recognized, yet present

“…Consequently, approximately 80% were probably indigenous cases, supporting a likely local environmental niche for H. capsulatum. Histoplasmosis was reported in the Central province (Karunanayaka et al 2009, Jayathilake et al 2020, Southern province (Vidanagama et al 2010, Dhammika et al 2017, Eastern province (Jayaweera et al 1975) and Sabaragamuwa province (Jayawardena et al 2019) (Figure 1). It is noteworthy that most of the reported cases have occurred in Central province where the previous skin positivity for histoplasmin was documented.…”

“…Occupation-related exposure was observed among five patients of whom three were farmers (Jayaweera et al 1975, Vidanagama et al 2010, Dhammika et al 2017) and two were labourers (Jayawardena et al 2019, Keragala et al 2020. Interestingly, four out of five patients with oral lesions were betel chewers (Vidanagama et al 2010, Dhammika et al 2017, Jayawardena et al 2019) and three of them were smokers (Jayawardena et al 2019, Jayathilake et al 2020. Although this cannot be clearly related to histoplasmosis, unwashed betel leaves and other local ingredients might have been contaminated with infectious propagules.…”

“…However, the authors infer that her infection was probably acquired during her visit to Sri Lanka, as there was a long interval after visiting those countries. Three of the patients had never traveled outside Sri Lanka (Jayaweera et al 1975, Jayathilake et al 2020, and four were unlikely to have traveled outside Sri Lanka (Vidanagama et al 2010, Dhammika et al 2017, Jayawardena et al 2019, Keragala et al 2020. Consequently, approximately 80% were probably indigenous cases, supporting a likely local environmental niche for H. capsulatum.…”

“…Adrenal gland involvement can be seen on imaging and hepatosplenomegaly may be detected in physical examination. Based on clinical presentation, physical findings, and investigation findings, five out of ten cases reported in Sri Lanka were diagnosed as disseminated histoplasmosis (Harten et al 1994, Dhammika et al 2017, Jayawardena et al 2019, Jayathilake et al 2020, Keragala et al 2020. No cases of asymptomatic, acute pulmonary or chronic pulmonary histoplasmosis were observed among the reported patients in Sri Lanka.…”

“…Non-healing oral ulcers were the most frequent presenting complaint among the patients and the appearance of these oral lesions ranged from mucosal thickening and multinodular swelling to granulomatous ulcerative lesions (Table 2). These lesions were observed in the cheek, tongue, buccal sulcus, and palate (Jayaweera et al 1975, Karunanayaka et al 2009, Vidanagama et al 2010, Dhammika et al 2017, Jayawardena et al 2019). Oral lesions are frequently observed with disseminated histoplasmosis and these are rarely seen as localized lesions without any systemic involvement (Kumar et al 2020).…”