Semin Respir Crit Care Med 2011; 32(6): 735-744
DOI: 10.1055/s-0031-1295721
© Thieme Medical Publishers

Pulmonary Histoplasmosis

David S. McKinsey1 , 2 , Joel P. McKinsey1 , 2
  • 1Infectious Disease Associates of Kansas City, Kansas City, Missouri
  • 2University of Kansas Medical Center, Kansas City, Kansas
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Publikationsdatum:
13. Dezember 2011 (online)

ABSTRACT

Pulmonary histoplasmosis is an important cause of morbidity in the United States. Several outbreaks of acute pulmonary histoplasmosis have been linked to potentially preventable environmental exposures. Progressive disseminated histoplasmosis, which is seen frequently in the growing population of immunocompromised hosts, often presents with prominent pulmonary manifestations and is more commonly encountered in hospitalized patients than acute, subacute, or chronic pulmonary histoplasmosis. A battery of diagnostic studies including serology, antigen, cytology/histopathology, and culture should be obtained in suspected cases of histoplasmosis. The yield of antigenuria detection is highest when the multiple body fluids are tested; the level of antigenuria correlates with severity of disease. Amphotericin B is the treatment of choice for severe pulmonary or disseminated histoplasmosis, and itraconazole is effective for mild to moderately severe infection. Posaconazole exhibits promise as a salvage agent. Antifungal prophylaxis is not routinely recommended for at-risk populations. Measures to minimize environmental contamination may reduce the risk of epidemic-type acute pulmonary histoplasmosis related to high-risk exposures.

REFERENCES

  • 1 Darling S T. A protozoan general infection producing pseudotubercles in the lungs and fatal necroses in the liver, spleen, and lymph nodes.  JAMA. 1906;  46 1283-1285
  • 2 Dodd K, Tompkins E. A case of histoplasmosis of Darling in an infant.  Am J Trop Med Hyg. 1934;  14 127-137
  • 3 DeMonbreun W A. The cultivation and cultural characteristics of Darling’s Histoplasma capsulatum .  Am J Trop Med Hyg. 1934;  14 93-125
  • 4 Christie A, Peterson J C. Pulmonary calcification and sensitivity to histoplasmin, tuberculin and haplosporangin.  J Am Med Assoc. 1946;  131 658-660
  • 5 Palmer C E. Geographic differences in sensitivity to histoplasmin among student nurses.  Public Health Rep. 1946;  61 475-487
  • 6 McKinsey D S, Smith D L, Driks M R, O’Connor M C. Histoplasmosis in Missouri: historical review and current clinical concepts.  Mo Med. 1994;  91 (1) 27-32
  • 7 Furcolow M L, Grayston J T. Occurrence of histoplasmosis in epidemics; etiologic studies.  Am Rev Tuberc. 1953;  68 (3) 307-320
  • 8 Huhn G D, Austin C, Carr M et al.. Two outbreaks of occupationally acquired histoplasmosis: more than workers at risk.  Environ Health Perspect. 2005;  113 (5) 585-589
  • 9 Luby J P, Southern Jr P M, Haley C E, Vahle K L, Munford R S, Haley R W. Recurrent exposure to Histoplasma capsulatum in modern air-conditioned buildings.  Clin Infect Dis. 2005;  41 (2) 170-176
  • 10 Lemhart S, Shafer M, Singal M, Hajjeh R. Histoplasmosis: Protecting Workers at Risk. Bethesda, MD: U.S. Department of Health and Human Services; 1997. DHHS (NIOSH) publication no. 97–146
  • 11 Kauffman C A. Histoplasmosis: a clinical and laboratory update.  Clin Microbiol Rev. 2007;  20 (1) 115-132
  • 12 Connolly P A, Durkin M M, Lemonte A M, Hackett E J, Wheat L J. Detection of histoplasma antigen by a quantitative enzyme immunoassay.  Clin Vaccine Immunol. 2007;  14 (12) 1587-1591
  • 13 Wheat L J, Freifield A G, Kleiman M B Infectious Diseases Society of America et al. Clinical practice guidelines for the management of patients with histoplasmosis: 2007 update by the Infectious Diseases Society of America.  Clin Infect Dis. 2007;  45 (7) 807-825
  • 14 Limper A H, Knox K S, Sarosi G A American Thoracic Society Fungal Working Group et al. An official American Thoracic Society statement: treatment of fungal infections in adult pulmonary and critical care patients.  Am J Respir Crit Care Med. 2011;  183 (1) 96-128
  • 15 Ajello L. Distribution of Histoplasma capsulatum in the United States. In: Ajello L, Chick W, Furculow M F, eds. Histoplasmosis. Springfield, IL: Charles C. Thomas; 1971: 103-122
  • 16 Chamany S, Mirza S A, Fleming J W et al.. A large histoplasmosis outbreak among high school students in Indiana, 2001.  Pediatr Infect Dis J. 2004;  23 (10) 909-914
  • 17 Furcolow M L, Tosh F E, Larsh H W, Lynch Jr H J, Shaw G. The emerging pattern of urban histoplasmosis. Studies on an epidemic in Mexico. Missouri.  N Engl J Med. 1961;  264 1226-1230
  • 18 Mirsky S. Shakespeare to blame for introduction of European starlings to US. Scientific American. June 2008. http://www.scientificamerican.com/article.com/article.cfm?id=call-of-the-reviled Accessed June 30, 2011
  • 19 Assi M A, Sandid M S, Baddour L M, Roberts G D, Walker R C. Systemic histoplasmosis: a 15-year retrospective institutional review of 111 patients.  Medicine (Baltimore). 2007;  86 (3) 162-169
  • 20 Wynne J W, Olsen G N. Acute histoplasmosis presenting as the adult respiratory distress syndrome.  Chest. 1974;  66 (2) 158-161
  • 21 Hage C A, Ribes J A, Wengenack N L et al.. A multicenter evaluation of tests for diagnosis of histoplasmosis.  Clin Infect Dis. 2011;  53 (5) 448-454
  • 22 McKinsey D, Waxman M, Idstrom M. Differentiation of disseminated histoplasmosis from Pneumocystis pneumonia in AIDS.  Infect Med. 1993;  10 30-38
  • 23 Conces Jr D J, Stockberger S M, Tarver R D, Wheat L J. Disseminated histoplasmosis in AIDS: findings on chest radiographs.  AJR Am J Roentgenol. 1993;  160 (1) 15-19
  • 24 Goodwin R A, Nickell J A, Des Prez R M. Mediastinal fibrosis complicating healed primary histoplasmosis and tuberculosis.  Medicine (Baltimore). 1972;  51 (3) 227-246
  • 25 Goodwin Jr R A, Snell Jr J D. The enlarging histoplasmoma. Concept of a tumor-like phenomenon encompassing the tuberculoma and coccidioidoma.  Am Rev Respir Dis. 1969;  100 (1) 1-12
  • 26 McKinsey D S. Histoplasmosis in AIDS: advances in management.  AIDS Patient Care STDS. 1998;  12 (10) 775-781
  • 27 Wheat L J, Connolly-Stringfield P A, Baker R L et al.. Disseminated histoplasmosis in the acquired immune deficiency syndrome: clinical findings, diagnosis and treatment, and review of the literature.  Medicine (Baltimore). 1990;  69 (6) 361-374
  • 28 Vail G M, Young R S, Wheat L J, Filo R S, Cornetta K, Goldman M. Incidence of histoplasmosis following allogeneic bone marrow transplant or solid organ transplant in a hyperendemic area.  Transpl Infect Dis. 2002;  4 (3) 148-151
  • 29 Freifeld A G, Iwen P C, Lesiak B L, Gilroy R K, Stevens R B, Kalil A C. Histoplasmosis in solid organ transplant recipients at a large midwestern university transplant center.  Transpl Infect Dis. 2005;  7 (3-4) 109-115
  • 30 Wallis R S, Broder M, Wong J, Lee A, Hoq L. Reactivation of latent granulomatous infections by infliximab.  Clin Infect Dis. 2005;  41 (Suppl 3) S194-S198
  • 31 Allendoerfer R, Deepe Jr G S. Blockade of endogenous TNF-alpha exacerbates primary and secondary pulmonary histoplasmosis by differential mechanisms.  J Immunol. 1998;  160 (12) 6072-6082
  • 32 Lee J H, Slifman N R, Gershon S K et al.. Life-threatening histoplasmosis complicating immunotherapy with tumor necrosis factor alpha antagonists infliximab and etanercept.  Arthritis Rheum. 2002;  46 (10) 2565-2570
  • 33 McKinsey D S, Spiegel R A, Hutwagner L et al.. Prospective study of histoplasmosis in patients infected with human immunodeficiency virus: incidence, risk factors, and pathophysiology.  Clin Infect Dis. 1997;  24 (6) 1195-1203
  • 34 Jones J L, Hanson D L, Dworkin M S et al.. Surveillance for AIDS-defining opportunistic illnesses, 1992-1997.  MMWR CDC Surveill Summ. 1999;  48 (2, SS-2) 1-22
  • 35 Anderson A M, Mehta A K, Wang Y F, Jing Qian , Easley K, Nguyen M L. HIV-associated histoplasmosis in a nonendemic area of the United States during the HAART era: role of migration from endemic areas and lack of antiretroviral therapy.  J Int Assoc Physicians AIDS Care (Chic). 2010;  9 (5) 296-300
  • 36 Cuellar-Rodriguez J, Avery R K, Lard M et al.. Histoplasmosis in solid organ transplant recipients: 10 years of experience at a large transplant center in an endemic area.  Clin Infect Dis. 2009;  49 (5) 710-716
  • 37 Hage C A, Bowyer S, Tarvin S E, Helper D, Kleiman M B, Joseph Wheat L. Recognition, diagnosis, and treatment of histoplasmosis complicating tumor necrosis factor blocker therapy.  Clin Infect Dis. 2010;  50 (1) 85-92
  • 38 US Food and Drug Administration .Information for healthcare professionals: Cimzia (certolizumab pegol), Enbrel (etanercept), Humira (adalimumab), and Remicade (infliximab). September 4, 2008. http://www.fda.gov/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsandProviders/ucm124185.htm Accessed June 28, 2011
  • 39 McKinsey D S, McKinsey J P, Brune P R. Diagnosis and management of histoplasmosis.  Curr Fungal Infect Rep. 2008;  2 94-102
  • 40 Davies S F. Serodiagnosis of histoplasmosis.  Semin Respir Infect. 1986;  1 (1) 9-15
  • 41 Wheat L J. Nonculture diagnostic methods for invasive fungal infections.  Curr Infect Dis Rep. 2007;  9 (6) 465-471
  • 42 Swartzentruber S, Rhodes L, Kurkjian K et al.. Diagnosis of acute pulmonary histoplasmosis by antigen detection.  Clin Infect Dis. 2009;  49 (12) 1878-1882
  • 43 Wheat L J, Kohler R B, Tewari R P. Diagnosis of disseminated histoplasmosis by detection of Histoplasma capsulatum antigen in serum and urine specimens.  N Engl J Med. 1986;  314 (2) 83-88
  • 44 Wheat J, Wheat H, Connolly P et al.. Cross-reactivity in Histoplasma capsulatum variety capsulatum antigen assays of urine samples from patients with endemic mycoses.  Clin Infect Dis. 1997;  24 (6) 1169-1171
  • 45 McKinsey D S, McKinsey J P, Northcutt N, Sarria J C. Interlaboratory discrepancy of antigenuria results in 2 patients with AIDS and histoplasmosis.  Diagn Microbiol Infect Dis. 2009;  63 (1) 111-114
  • 46 Hage C A, Davis T E, Fuller D et al.. Diagnosis of histoplasmosis by antigen detection in BAL fluid.  Chest. 2010;  137 (3) 623-628
  • 47 Tang Y W, Li H, Durkin M M et al.. Urine polymerase chain reaction is not as sensitive as urine antigen for the diagnosis of disseminated histoplasmosis.  Diagn Microbiol Infect Dis. 2006;  54 (4) 283-287
  • 48 Kohler S, Wheat L J, Connolly P et al.. Comparison of the echinocandin caspofungin with amphotericin B for treatment of histoplasmosis following pulmonary challenge in a murine model.  Antimicrob Agents Chemother. 2000;  44 (7) 1850-1854
  • 49 McKinsey D S, Kauffman C A, Pappas P G The National Institute of Allergy and Infectious Diseases Mycoses Study Group et al. Fluconazole therapy for histoplasmosis.  Clin Infect Dis. 1996;  23 (5) 996-1001
  • 50 Wheat J, MaWhinney S, Hafner R National Institute of Allergy and Infectious Diseases Acquired Immunodeficiency Syndrome Clinical Trials Group and Mycoses Study Group et al. Treatment of histoplasmosis with fluconazole in patients with acquired immunodeficiency syndrome.  Am J Med. 1997;  103 (3) 223-232
  • 51 Parker J D, Sarosi G A, Doto I L, Bailey R E, Tosh F E. Treatment of chronic pulmonary histoplasmosis.  N Engl J Med. 1970;  283 (5) 225-229
  • 52 Wheat L J, Connolly P, Smedema M et al.. Activity of newer triazoles against Histoplasma capsulatum from patients with AIDS who failed fluconazole.  J Antimicrob Chemother. 2006;  57 (6) 1235-1239
  • 53 Connolly P, Wheat L J, Schnizlein-Bick C et al.. Comparison of a new triazole, posaconazole, with itraconazole and amphotericin B for treatment of histoplasmosis following pulmonary challenge in immunocompromised mice.  Antimicrob Agents Chemother. 2000;  44 (10) 2604-2608
  • 54 Restrepo A, Tobón A, Clark B et al.. Salvage treatment of histoplasmosis with posaconazole.  J Infect. 2007;  54 (4) 319-327
  • 55 Freifeld A, Proia L, Andes D et al.. Voriconazole use for endemic fungal infections.  Antimicrob Agents Chemother. 2009;  53 (4) 1648-1651
  • 56 McKinsey D S, Wheat L J, Cloud G A National Institute of Allergy and Infectious Diseases Mycoses Study Group et al. Itraconazole prophylaxis for fungal infections in patients with advanced human immunodeficiency virus infection: randomized, placebo-controlled, double-blind study.  Clin Infect Dis. 1999;  28 (5) 1049-1056
  • 57 Kaplan J E, Benson C, Holmes K H, Brooks J T, Pau A, Masur H. Centers for Disease Control and Prevention (CDC); National Institutes of Health; HIV Medicine Association of the Infectious Diseases Society of America . Guidelines for prevention and treatment of opportunistic infections in HIV-infected adults and adolescents: recommendations from CDC, the National Institutes of Health, and the HIV Medicine Association of the Infectious Diseases Society of America.  MMWR Recomm Rep. 2009;  58 (RR-4) 1-207
  • 58 Hajjeh R A, Pappas P G, Henderson H National Institute of Allergy and Infectious Diseases Mycoses Study Group et al. Multicenter case-control study of risk factors for histoplasmosis in human immunodeficiency virus-infected persons.  Clin Infect Dis. 2001;  32 (8) 1215-1220

David S. McKinseyM.D. 

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Kansas City, MO 64132

eMail: david.mckinsey@hcamidwest.com

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