Rheumatologic manifestations of histoplasmosis in the recent indianapolis epidemic

Rosenthal, Jerome; Brandt, Kenneth D.; Wheat, L. Joseph; Slama, Thomas G.

doi:10.1002/art.1780260902

Cited by 80 publications

(26 citation statements)

References 17 publications

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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). Joint symptoms usually resolve over several weeks and respond to nonsteroidal anti-inflammatory agents.…”

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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Section: Pulmonary Histoplasmosismentioning

confidence: 99%

Histoplasmosis: a Clinical and Laboratory Update

2007

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“…panied by erythema nodosum (44). These manifestations often last for months and are best managed by treatment with anti-inflammatory agents without antifungal therapy (44,45). Pericarditis is another inflammatory complication of acute self-limited histoplasmosis (46).…”

Section: Self-limited Histoplasmosis With Low-inoculummentioning

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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“…Rheumatologic manifestations were noted in 6% (24 of 381) of patients with histoplasmosis during 1 epidemic 6 . In 3 patients these were the main presenting complaints.…”

Section: To the Editormentioning

confidence: 99%