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Pathogenesis and clinical features of pulmonary histoplasmosis

Authors
Joseph Wheat, MD
Carol A Kauffman, MD
Section Editor
Kieren A Marr, MD
Deputy Editor
Jennifer Mitty, MD, MPH

INTRODUCTION

Histoplasmosis was first described by a United States Army physician in Panama in 1906 and subsequently has become recognized as a common and usually asymptomatic infection [1,2]. Histoplasmosis is the most prevalent endemic mycosis in the United States [3]. While most infections are asymptomatic or self-limited, some individuals develop acute pulmonary infections or severe and progressive disseminated infection [4].

The pathogenesis and clinical features of the various pulmonary syndromes that may result from Histoplasma capsulatum infection will be reviewed here. The diagnosis and treatment of pulmonary histoplasmosis, as well as the pathogenesis, clinical manifestations, diagnosis, and treatment of disseminated histoplasmosis are discussed separately. (See "Diagnosis and treatment of pulmonary histoplasmosis" and "Pathogenesis and clinical manifestations of disseminated histoplasmosis" and "Diagnosis and treatment of disseminated histoplasmosis in HIV-uninfected patients".)

RESERVOIR

H. capsulatum proliferates best in soil contaminated with bird or bat droppings, which are believed to alter the soil characteristics favoring sporulation of the organism. Sites commonly associated with exposure to H. capsulatum include chicken coops or farm buildings with large accumulations of chicken droppings, abandoned buildings, bird roost sites, caves, and wood lots [5]. Activities that have been associated with exposure include excavation, construction, demolition, remodeling, wood cutting and gathering, exploring caves, and visiting campsites that are visibly contaminated with bat guano [6-12].

Heavy exposure usually occurs with activities disturbing a large accumulation of droppings in an enclosed area, such as a cave or an attic. However, in many cases, patients recall no such exposure.

EPIDEMIOLOGY

Histoplasmosis and its causative agent, H. capsulatum, are found worldwide [4,13,14]. It is estimated that up to 500,000 new infections occur each year in the United States [15]. Among the endemic mycoses, histoplasmosis is the most common cause for hospitalization. H. capsulatum is most prevalent in the midwestern and central states along the Ohio and Mississippi River valleys, but also occurs in microfoci in several states along the East Coast [5]. In addition, H. capsulatum causes disease in Canada, Mexico, Central and South America, as well as in parts of eastern and southern Europe, Africa, eastern Asia, and Australia [16,17].

                

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