Diagnosis and treatment of pulmonary histoplasmosis
- Carol A Kauffman, MD
Carol A Kauffman, MD
- Section Editor — Fungal Infections
- Professor of Internal Medicine
- University of Michigan Medical School
- Veterans Affairs Ann Arbor Healthcare System
Histoplasmosis is a common endemic mycosis that is usually asymptomatic but occasionally results in severe illness. Histoplasmosis and its causative agent, Histoplasma capsulatum, are found worldwide but particularly in North and Central America. Within the United States, infection is most common in the midwestern states located in the Ohio and Mississippi River valleys. Among the endemic mycoses, it is the most common cause for hospitalization .
The diagnosis and treatment of the various histoplasmosis pulmonary syndromes will be reviewed here. The pathogenesis and clinical features of these syndromes and issues regarding histoplasmosis in HIV-infected patients are discussed separately. (See "Pathogenesis and clinical features of pulmonary histoplasmosis" and "Diagnosis and treatment of histoplasmosis in HIV-infected patients".)
WHEN TO SUSPECT HISTOPLASMOSIS
Pulmonary histoplasmosis should be considered in patients with the following clinical presentations, particularly in the appropriate epidemiologic setting:
●Pneumonia with mediastinal or hilar lymphadenopathy
●Mediastinal or hilar masses
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- WHEN TO SUSPECT HISTOPLASMOSIS
- Histopathology and cytology
- Fungal cultures
- Antigen detection
- - Comparison of serologic methods
- Polymerase chain reaction
- Distinction from sarcoidosis
- SELECTION OF DIAGNOSTIC TESTS FOR DIFFERENT PULMONARY SYNDROMES
- Acute diffuse pulmonary disease
- Acute localized pulmonary disease
- Chronic cavitary pulmonary histoplasmosis
- Mediastinal syndromes, broncholithiasis, and lung nodules
- ANTIFUNGAL THERAPY
- General approach
- Amphotericin B
- THERAPY FOR PULMONARY HISTOPLASMOSIS
- Acute diffuse pulmonary histoplasmosis
- Acute localized pulmonary disease
- Chronic cavitary pulmonary histoplasmosis
- Granulomatous mediastinitis
- Fibrosing mediastinitis
- Pulmonary nodules (histoplasmomas)
- EXTRAPULMONARY MANIFESTATIONS
- Pericarditis or rheumatologic syndromes
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS