Progressive disseminated histoplasmosis as seen in adults
TL;DR: Of 530 patients with a diagnosis of active histoplasmosis, twenty-five had progressive disseminated disease and the efficacy of treatment with amphotericin B is attested to by the fact that mortality in the untreated group was 100% and in the adequately treated group only 7 per cent.
About: This article is published in The American Journal of Medicine.The article was published on 1970-05-01. It has received 128 citations till now. The article focuses on the topics: Progressive disseminated histoplasmosis & Histoplasmosis.
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TL;DR: 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.
Abstract: 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.
954 citations
Cites background from "Progressive disseminated histoplasm..."
...reported that 100% of untreated patients died, compared with 7% for those who were deemed to have received an adequate amount of amphotericin B (104)....
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...For the next 30 years, patients generally received a total dosage of 25 to 35 mg/kg amphotericin B over several months, often with resultant serious toxicity (39, 96, 104)....
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...Mucous membrane lesions are also more frequently seen in disseminated histoplasmosis than in other endemic mycoses, with the exception of paracoccidioidomycosis (50, 104, 119)....
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...In the same time period, investigators at the National Institutes of Health and the Missouri State Sanitorium reported on their experiences with treatment of disseminated histoplasmosis with amphotericin B (104, 119)....
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...capsulatum that occurs mostly in older adults who are not overtly immunosuppressed (50, 104, 119)....
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TL;DR: Treatment is clearly beneficial and cost-effective for patients with progressive forms of histoplasmosis, such as chronic pulmonary or disseminated infection, and it remains unknown whether treatment improves the outcome for patientswith the self-limited manifestations.
Abstract: Objective The objective of this guideline is to provide recommendations for treating patients with the more common forms of histoplasmosis. PARTICIPANTS AND CONSENSUS PROCESS: A working group of 8 experts in this field was convened to develop this guideline. The working group developed and refined the guideline through a series of conference calls. Outcomes The goal of treatment is to eradicate the infection when possible, although chronic suppression may be adequate for patients with AIDS and other serious immunosuppressive disorders. Other important outcomes are resolution of clinical abnormalities and prevention of relapse. Evidence The published literature on the management of histoplasmosis was reviewed. Controlled trials have been conducted that address the treatment of chronic pulmonary and disseminated histoplasmosis, but clinical experience and descriptive studies provide the basis for recommendations for other forms of histoplasmosis. VALUE: Value was assigned on the basis of the strength of the evidence supporting treatment recommendations, with the highest value assigned to controlled trials, according to conventions established for developing practice guidelines. BENEFITS AND COSTS: Certain forms of histoplasmosis cause life-threatening illnesses and result in considerable morbidity, whereas other manifestations cause no symptoms or minor self-limited illnesses. The nonprogressive forms of histoplasmosis, however, may reduce functional capacity, affecting work capacity and quality of life for several months. Treatment is clearly beneficial and cost-effective for patients with progressive forms of histoplasmosis, such as chronic pulmonary or disseminated infection. It remains unknown whether treatment improves the outcome for patients with the self-limited manifestations, since this patient population has not been studied. Other chronic progressive forms of histoplasmosis are not responsive to pharmacologic treatment. Treatment options Options for therapy for histoplasmosis include ketoconazole, itraconazole, fluconazole, amphotericin B (Fungizone; Bristol-Meyer Squibb, Princeton, NJ), liposomal amphotericin B (AmBisome; Fujisawa, Deerfield, IL), amphotericin B colloidal suspension (ABCD, or Amphotec; Seques, Menlo Park, CA), and amphotericin B lipid complex (ABLC, or Abelcet; Liposome, Princeton, NJ).
339 citations
Cites background from "Progressive disseminated histoplasm..."
...Reddy PA, Gorelick DF, Brasher CA, Larsh H. Progressive disseminated histoplasmosis as seen in adults....
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...Furcolow [6] Amphotericin B 22 68 9 23 Sathapatayavongs [19] Amphotericin B 43 74 7 16 Reddy [17] Amphotericin B 17 76 NR 23 Sarosi [18] Amphotericin B 24 91 20 8 Wheat [16, 20] Amphotericin B 73 88 19 12 Dismukes [11] Itraconazole 10 100 NR NR Wheat [21, 22] Itraconazole 59 85 5 NR Dismukes [12] Ketoconazole 31 56 10 NR Slama [13] Ketoconazole 10 70 40 NR Wheat [16] Ketoconazole 11 9 50 NR Wheat [15] Fluconazole 49 74 31 2 McKinsey [14] Fluconazole 14 86 14 7...
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...In studies that mostly included immunocompetent hosts and specifically excluded those with AIDS, amphotericin B was effective in 68%–92% of patients [6, 17, 18], itraconazole (200–400 mg daily) in 100% (only 10 patients studied) [11], ketoconazole (200–400 mg daily) in 56%–70% [12, 13], and fluconazole (200–400 mg daily) in 86% [14] (table 4)....
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TL;DR: Infection with Histoplasma capsulatum in 58 patients whose immune responses were suppressed (Immunosuppressed patients) was analyzed, and the response to amphotericin B therapy was excellent in those patients in whom the diagnosis was established early and in whom a full course of antifungal therapy could be given.
216 citations
TL;DR: Systemic histoplasmosis should be suspected in patients who have lived in endemic areas with fever, bone marrow suppression, and elevated hepatic enzymes, particularly if they are immunocompromised, and Evaluation including a combination of Histoplasma serologic screening, urine antigen assay, and fungal culture will secure the diagnosis in most cases.
208 citations
01 Jan 1994
TL;DR: This chapter considers the wide range of nonneoplastic and neoplastic lesions that involve the peritoneum, and in some cases the retroperitoneal lymph nodes, of females.
Abstract: This chapter considers the wide range of nonneoplastic and neoplastic lesions that involve the peritoneum, and in some cases the retroperitoneal lymph nodes, of females. The first half of the chapter deals with inflammatory lesions, tumor-like lesions (including mesothelial hyperplasia), mesothelial neoplasms, miscellaneous primary tumors, and metastatic tumors. The second half of the chapter is devoted to a large group of lesions that share a potential origin from the secondary mullerian system, the prototypical example of which is endometriosis.
183 citations
References
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TL;DR: Several of the fungi pathogenic for man appear to have an independent saprophytic existence in the soil or in decaying vegetable matter as discussed by the authors, and human infections can be best explained by inhalation of air-borne spores from the soil.
Abstract: Several of the fungi pathogenic for man appear to have an independent saprophytic existence in the soil or in decaying vegetable matter. Sporotrichum schenckli was isolated from plants in 1908 by Gougerot and deBeurmann (12), and several later investigators have isolated it from soil or plant material (1). The author has isolated it from sphagnum moss (10) and from soil (6). Aspergillus jumigatus and A. niger grow on decaying vegetation at the surface of the soil. Medical-histories of wounds and exposure preceding infection indicate that several of the fungi which cause various types of myeetoma are probably present in soil as saprophytes. The acid-fast actinomycete, Nocardia asteroides, has been isolated from soil (11, 6). Coccidioides immitis is present in soil in the endemic area of coccidioidomycosis (15, 2, 4), and human infections can be best explained by inhalation of air-borne spores from the soil. The ecologic relationship of these pathogenic fungi to the soil is not known, but the existence of naturally acquired coccidioidomycosis in certain species of rodents peculiar to the desert has suggested in the case of Coccidioides that this fungus may be in soil contaminated by infected animal hosts (5). All these mycoses except coccidioidomycosis are widely distributed geographically. Another mycosis which appears to be noncontagious, sporadic, and world-wide in distribution is histoplasmosis. Whether one speaks of proved histoplasmosis which, so far as is definite]y known, is relatively rare and almost always fatal, or of a hypothetic mild form of the disease associated with pulmonary calcifieation, the source of the infectious agent and the mode of human infection have been unknown. Histoplasmosis has been recently shown to occur in wild rats in Virginia (Rattus norvegicus) (8) and in Georgia (R. norvegicus and R. rattus) (9), and in the skunk (Spilogale putorius) (9). A total of 24 rats with histoplasmosis have now been collected in Virginia (6). No association between infected animals and histoplasmosis in man has been found in this area to date, and the relationship of rodent to human infection remains obscure. Indeed, the very limited extent of the lesions and the apparent chronicity of the disease in naturally infected rats in which histopathologic studies were made do not suggest any mode of transfer directly from rats to man (7). The characteristics of histoplasmosis in naturally infected rats seem to be similar to chronic histoplasmosis in experimentally infected guinea pigs which
210 citations
156 citations
TL;DR: An analysis of 123 culturally proved cases of histoplasmosis is presented, finding that this infection characteristically progresses gradually over several years, although remissions and exacerbations may occur.
139 citations
92 citations
TL;DR: Criteria for a diagnosis of primary cutaneous infection with a fungus capable of causing pulmonary mycosis are suggested, with history of traumatic inoculation and subsequent development of a chancriform lesion.
Abstract: THE criteria suggested by several investigators1 , 2 as necessary to establish a diagnosis of primary cutaneous infection with a fungus capable of causing pulmonary mycosis are as follows: history of traumatic inoculation, with subsequent development of a chancriform lesion within three or four weeks at the point of trauma; evidence that the wound was contaminated with the causative fungus; development of lymphangitis and regional lymphadenopathy; no history or clinical or laboratory evidence of previous pulmonary or systemic mycosis; and conversion of the skin test from negative to positive and rising serologic titer (where applicable). This sequence of events, which Wilson3 calls . . .
79 citations