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. 2020 Apr 6;7(5):ofaa119.
doi: 10.1093/ofid/ofaa119. eCollection 2020 May.

Chronic Pulmonary Histoplasmosis-A Scoping Literature Review

Jacob Baker  1 , Chris Kosmidis  1   2 , Anna Rozaliyani  3 , Retno Wahyuningsih  3   4 , David W Denning  1   2
Affiliations

Chronic Pulmonary Histoplasmosis-A Scoping Literature Review

Jacob Baker et al. Open Forum Infect Dis. .

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.

Keywords: Histoplasma; cavitation; chronic pulmonary histoplasmosis; nodule; tuberculosis.

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Figures

Figure 1.
Figure 1.
A male truck driver from Argentina who drank and smoke excessively presented with cough and hoarseness. A laryngeal biopsy showed granulomas. He was treated for tuberculosis for 6 months without improvement. A second laryngeal biopsy also showed granulomas, and he was treated for tuberculosis again. He deteriorated and required a tracheostomy. Antibody against Histoplasma capsulatum was detected in serum, and culture grew this organism. He responded well to itraconazole. Source: Image from Dr. Iris Nora Tiraboschi, Hospital de Clínicas, Universidad de Buenos Aires.
Figure 2.
Figure 2.
Characteristic appearances of intracellular Histoplasma capsulatum var. capsulatum organisms from a percutaneous biopsy. Source: Image from Dr. Anna Rozaliyani, Universitas Indonesia, Jakarta.
Figure 3.
Figure 3.
Frequency of disease progression in relation to time since initial x-ray in 87 cases of chronic cavitary pulmonary histoplasmosis [20].
See this image and copyright information in PMC

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