Histoplasmosis masquerading as tuberculosis: A report of three cases in immunocompetent children.

The most common cause of granulomatous lymphadenitis in countries like ours is mycobactrium tuberculosis followed by atypical mycobacterial infection, fungal infections, parasitic infection, cat scratch disease, lymphogranuloma venereum (inguinal lymphadenopathy), and leprosy Here, we present three cases of lymphadenopathy due to histoplasmosis in immunocompetent children. Two of them presented with fever, lymphadenopathy, initially diagnosed as granulomatous lymphadenitis consistent with tuberculosis on FNAC and were put on antitubercular drugs. However, their condition gradually became worse. As the patients continued to deteriorate, subsequent lymph node biopsies were done and diagnosed as histoplasmosis. Third case presented with acute loss of vision with hepatosplenomegaly and lymphadenopathy. Initially considered as acute leukemia, but eventually established as histoplasmosis. Histoplasmosis should be considered as one of the possible causes of granulomatous lymphadenitis in children.

Case Report: Histoplasmosis in Himachal Pradesh (India): An Emerging Endemic Focus.

We describe four cases of histoplasmosis indigenous to Himachal Pradesh (India) that will be of considerable public health interest. A 48-year-old human immunodeficiency virus (HIV)-negative man with cervical and mediastinal lymphadenopathy, hepatosplenomegaly, adrenal mass, and bone marrow involvement was treated as disseminated tuberculosis without benefit. Progressive disseminated histoplasmosis was diagnosed from the fungus in smears from adrenal mass. Another 37-year-old HIV-positive man was on treatment of suspected pulmonary tuberculosis. He developed numerous erythema nodosum leprosum-like mucocutanous lesions accompanied by fever, generalized lymphadenopathy, and weight loss. Pulmonary histoplasmosis with cutaneous dissemination was diagnosed when skin lesions showed the fungus in smears, histopathology, and mycologic culture. Both were successfully treated with amphotericin B/itraconazole. Third patient, a 46-year-old HIV-negative man, had oropharyngeal lesions, cervical lymphadenopathy, intermittent fever, hepatosplenomegaly, and deteriorating general health. Progressive disseminated oropharyngeal histoplasmosis was diagnosed from the fungus in smears and mycologic cultures from oropharyngeal lesions and cervical lymph node aspirates. He died despite initiating treatment with oral itraconazole. Another 32-year-old man 3 months after roadside trauma developed a large ulcer with exuberant granulation tissue over left thigh without evidence of immunosuppression/systemic involvement. He was treated successfully with surgical excision of ulcer under amphotericin B/itraconazole coverage as primary cutaneous histoplasmosis confirmed pathologically and mycologically. A clinical suspicion remains paramount for early diagnosis of histoplasmosis particularly in a nonendemic area. Most importantly, with such diverse clinical presentation and therapeutic outcome selection of an appropriate and customized treatment schedule is a discretion the treating clinicians need to make.

African histoplasmosis: the first report of an indigenous case in India.

OBJECTIVES: African histoplasmosis, caused by Histoplasma capsulatum var. duboisii, is an invasive fungal infection endemic in Central and West Africa. Cases seen outside Africa are generally imported. We report a disseminated purely cutaneous form of this infection in an otherwise healthy person from Kerala, in southern India. METHODS: A 59-year-old farmer presented with asymptomatic, generalized, reddish skin lesions of five months in duration. Dermatologic examination revealed multiple erythematous papules and plaques of varying sizes, predominantly over the trunk and upper limbs. The patient was otherwise in good health. Systemic examination including the pulmonary and musculoskeletal systems revealed no abnormalities. RESULTS: Skin biopsy was performed from a lesion on the thigh. Histopathologic examination revealed epithelioid and suppurative granulomas in the upper dermis, with lymphocytes, neutrophils, and plenty of giant cells. Fite-Faraco staining for Mycobacterium leprae was negative. Fungus cultured from the specimen was identified as H. capsulatum var. duboisii, the rarer variant of H. capsulatum. The patient was treated with ketoconazole 200 mg/day for four months and attained complete clearance. No relapse has been detected over two years of follow-up. CONCLUSIONS: To the best of our knowledge, this case represents the first instance of African histoplasmosis to be reported from India. The occurrence of such a rare infection in an immunocompetent individual, who had not travelled elsewhere, raises the possibility of the indigenous existence of H. capsulatum var. duboisii in Kerala. Further studies of the ecology and epidemiology of this rare infection are essential.

[Leprosy-like cutaneous presentation of Histoplasma capsulatum infection in an African HIV+ patient]. / Istoplasmosi a presentazione cutanea simil-lepromatosa in un paziente africano HIV+.

Histoplasma capsulatum is an opportunistic dimorphic fungus responsible for most often self-limiting or flu-like infections but potentially lethal in immunocompromised hosts. Histoplasmosis is rare in Europe. We reported a case of disseminated histoplasmosis in an African HIV patient with a leprosy-like primary cutaneous presentation and involvement of lungs, brain, limphnodes and eye. The therapy with liposomial B amphotericin and itraconazole led to a prompt resolution of the symptoms.

Two unusual cases of histoplasmosis in human immunodeficiency virus-infected individuals.

Histoplasmosis, also called as Darling's disease, is caused by the dimorphic fungus, Histoplasma capsulatum. In India, several cases of histoplasmosis have been reported since 1954, but in only a few cases could the diagnosis be confirmed by fungal culture. Disseminated histoplasmosis in adults is often associated with immunosuppression, as in human immunodeficiency virus (HIV) infection. Oral lesions are seen in 30-50% of the patients. Here, we are reporting two histoplasmosis cases, one with disseminated histoplasmosis with extensive skin and oral lesions in a known HIV-positive patient and the second case presenting with ulcer of the tongue, found to be HIV positive on investigation. It is important to consider histoplasmosis as one of the differential diagnosis of oral lesions in HIV-infected individuals.

Primary mucocutaneous histoplasmosis presents as oral ulcer .

We are reporting a rare case of primary mucocutaneous histoplasmosis. A 47-year-old male with a part-time job of rearing pigeons presented with a non-healing oral ulcer with no associated systemic symptoms. Differential diagnosis of oral ulcerative lichen planus, squamous cell carcinoma and mucocutaneous leishmaniasis was considered. Histopathology showed multiple organisms with a peripheral halo, stained strongly with Gomori methenamine silver stain.

Paracoccidioidomicosis y lepra bordeline lepromatosa / Paracoccidioidomycosis and lepromatous bordeline lepra

Se presenta un caso de un paciente de 63 años de edad, oriundo de Santa Fe, con diagnóstico de Paracoccidioidomicosis (PCM) y Hansen borderline lepromatoso (HBL).Se describen las características clínicas, laboratoriales, histológicas y micológicas, instituyéndose tratamiento específico para cada patología. Se destaca la buena evolución del paciente, y se hace un comentario de la modalidad de presentación y la coexistencia de ambas patologías de manera simultánea. El objeto de esta presentación es mostrar este caso bastante inusual en nuestro medio, teniendo en cuenta que Santa Fe es endémica tanto para Hansen como para Paracoccioidomicosis (AU)

Doenças granulomatosas da laringe / Granulomatous diseases of the larynx

Realizamos uma revisäo sobre as principais doenças granulomatosas que podem acometer a laringe, devido à grande ocorrência dessas afecçöes no Brasil e em outros países de clima tropical e subtropical. Ressaltamos os aspectos histopatológicos para o seu diagnóstico, assim como o seu tratamento.

Reactivity of fungal organisms in tissue sections using anti-mycobacteria antibodies.

Sixty-four cases of deep fungal infections diagnosed using PAS or silver stains and 18 control cases of sarcoidosis, M. tuberculosis and M. leprae infection were stained using commercial polyclonal antibody raised against M. paratuberculosis (MP), M. Duvalii (MD), and Bacillus Calmette-Guerin (BCG). Nine of 13 cases of sporotrichosis stained positively using anti-MP antibody only; 13 of 14 cases of histoplasmosis stained with anti-BCG, anti-MD, and anti-MP; seven cases of cryptococcosis had only focal staining of rare individual organisms within masses of negative organisms; seven of eight cases of coccidioidomycosis stained predominantly with anti-BCG and anti-MP; eight cases of aspergillus had focal (1 to 5% of organisms) staining of hyphae with anti-BCG and anti-MD; and four of 12 cases of Candida infection showed focal nonspecific staining with both antibodies and nonimmune serum. Control cases of sarcoidosis exhibited no staining with any of the three antibodies, whereas cases of mycobacterial infection showed staining of bacilli and intracellular debris with all three antibodies.

Patología regional argentina: enfermedades prevalentes y exóticas conminantes / Argentina regional pathology

Patologías por protozoarios: enfermedad de chagas; paludismo; leishmaniasis. Patologías por helmintos: hidatidosis; uncinariasis. Patologías por bacterias: brucelosis; lepra. Patologías por hongos: paracoccidioidomicosis; histoplasmosis. Patologías por virus: fiebre hemorrágica argentina. Patologías por intoxicaciones: hidroarsenicismo crónico regional endémico. Patologías exóticas conminantes: cólera; dengue; esquistosomiasis

Patología regional argentina: enfermedades prevalentes y exóticas conminantes / Argentina regional pathology

Patologías por protozoarios: enfermedad de chagas; paludismo; leishmaniasis. Patologías por helmintos: hidatidosis; uncinariasis. Patologías por bacterias: brucelosis; lepra. Patologías por hongos: paracoccidioidomicosis; histoplasmosis. Patologías por virus: fiebre hemorrágica argentina. Patologías por intoxicaciones: hidroarsenicismo crónico regional endémico. Patologías exóticas conminantes: cólera; dengue; esquistosomiasis

Manifestações orais das doenças específicas / Oral lesions of granulomatous disease

As lesöes orais säo freqüentes achados das doenças infecciosa tais como a blastomicose sul-americana, a leishmaniose, a tuberculose, a hanseníase, a histoplasmose e a lues. Muitas vezes aparecem como primeiro sintoma, cabendo ao Otorrinolaringologista o seu reconhecimento e diagnóstico precoce