Review of oral histoplasmosis in Malaysians.

We reviewed biopsy records for 37 cases of oral histoplasmosis for patient characteristics, clinical features, and histopathologic findings. These represented cases diagnosed in the Division of Stomatology, Institute for Medical Research, Kuala Lumpur between July 1967 and October 1994. All were male patients who ranged in age from 11 to 79 years (mean age, 56.7 years). There were 40.6% Malays, 37.8% Chinese, 18.9% Indians, and 2.7% other races. Five patients with mouth lesions as the initial presenting lesions were proven to be cases of disseminated histoplasmosis. In the remaining cases apart from the biopsy-proven oral histoplasmosis lesions, the extent of the disease elsewhere was unknown. The majority of these lesions involved the gingiva, tongue, and palate in decreasing order of frequency. The most frequent presenting symptom was oral mucosal ulceration. Squamous cell carcinoma and tuberculosis were the two most common clinical differential diagnoses. Our present findings compare favorably with published reports from other regions.

Oral lesions in Thai heterosexual AIDS patients: a preliminary study.

OBJECTIVE: To study the types of oral lesions in Thai heterosexual AIDS patients. DESIGN: Cross-sectional study and single centre. SETTING: Medical ward of the Prince of Songkla University Hospital, Thailand, from June 1994 to May 1995. SUBJECTS: Heterosexual AIDS patients who had been admitted because of opportunistic infections and/or neoplasms. MAIN OUTCOME MEASURES: Types of oral lesions, opportunistic systemic diseases present and drugs in use, as well as the lymphocyte count, were recorded in each patient. Mycological investigations by the oral rinse technique were also performed. RESULTS: 41 patients were examined (32 male, 9 female; aged 19-53 years, median 29 years). Oral lesions were found in 35 (85%) patients as follows: oral candidiasis (31), hairy leukoplakia (3), aphthous ulcer (3), linear gingival erythema (2), non-Hodgkin's lymphoma (2) and histoplasmosis (2). CANDIDA ALBICANS: was isolated in 31 patients. There was correlation between the clinical signs of oral candidiasis and the colony-forming units of Candida (Mann-Whitney U test; two-tailed P = 0.0007). CONCLUSIONS: Oral candidiasis was the most common lesion. It is of interest that non-Hodgkin's lymphoma was the only neoplasm detected. We conclude that oral lesions among Thai heterosexual AIDS patients may differ from those in other countries.

[A primary investigation on disseminated histoplasmosis in Hubei].

OBJECTIVE: To investigate the epidemiologic features of disseminated histoplasmosis (PDH) in Hubei province. METHODS: Bone marrow smears of 12 patients diagnosed as Kala-azer in Hubei province including 4 patients in Jingsan, 2 patients in Shashi and each 1 in Yichang, Jinmen, Zhongxiang, Luotian, Xianning and Guanghua respectively were re-examed under microscope. Peripheral blood and bone marrow smears of several patients were detected. After inoculated the bone marrow, peripheral blood, liver and spleen tissue of patients in MLI, the single colony was trans-inoculated in BHIB, SDA and CMA and incubated at 25 degrees C and 35 degrees C. Bone marrow, peripheral blood and bacterial fluid of yeast-phase Histoplasma capsulatum (H.cap) were injected into the abdominal cavity of Kunming mice and nude mice. When symptoms and signs developed, the spleen tissue was separated, then observed under microscope and cultured. Mycelium-phase and Yeast-phase H.cap were inoculated in urase and gelatin medium, then incubated at 25 degrees C and 35 degrees C. Histoplasmin was injected subcutaneously into patients, and then followed for 48 - 72 hours. Amphotericin B was selected to treat the PDH patients. RESULTS: Moriform cell cluster and sausage-shaped cell were not observed in mononuclear-macrophages in the bone marrow smears from 12 patients. Leishman-Donovan body was found only in one patient. There wasn't kinetoplast in the cellular plasm of spores in 11 patients and no transeptae was found. The reaction of H.cap to urease was positive and H.cap did not liquefy the gelatin. It appeared to be mycelium-phase at 25 degrees C but no penicillus and catenulate conidia was found. The characteristic denticle macroconidia was observed but produced red coloring matter. It also appeared to be yeast-phase at 35 degrees C. Yeast-phase spores were observed under microscope. No sausage-shaped spore and transeptae were identified. H.cap could be acquired in the spleen tissue in Kunming mice and nude mice. Bacterium forms, characteristics under microscope and biochemical reaction of mycelium-phase and yeast-phase H.cap were different from some other kinds of dimorphic fungi such as Penicillium marneffei and Histoplasm duboisii etc. CONCLUSION: There were scattered epidemics of PDH in Hubei province. The detection rate of PDH was higher in the southeast area then in the northwest area. The golden standards of clinic diagnosis were mycological culture and inoculation to animals. Amphotericin B was necommended as the first choice for treatment.

Oral histoplasmosis associated with HIV infection: a comparative study.

OBJECTIVE: Histoplasmosis is a granulomatous fungal disease caused by Histoplasma capsulatum. The objective of the present paper was to describe the prevalence of oral histoplasmosis (OH) in two services from an endemic area in Argentina between 1991 and 2002 and to compare the clinicopathological profile of OH between HIV-positive and HIV-negative patients. METHODS: About 733 HIV+ (group A) and 14 260 patients (group B) were examined. Clinical diagnosis was confirmed by cytology, biopsy or culture. RESULTS: About 21 (3%) and 10 (0.07%) cases of OH were diagnosed in group A and B respectively. Most patients were male. A total of 90% of patients in group A were <45 years old whereas 70% of group B were more than 45 years old. Palate, gingiva and oropharynx were the most frequent locations. The importance of including histoplasmosis in the differential diagnosis of ulcerated oral lesions in immunocompromised patients was discussed.

Histoplasmosis oral atípica en paciente VIH reactivo: reporte de un caso / Atypical oral histoplasmosis in a HIV-reactive patient: report of a case

La histoplasmosis es una infección granulomatosa causada por un hongo dimórfico, el Histoplasma capsulatum. Clínicamente, existen tres formas: aguda, crónica y diseminada. Nosotros presentamos un caso de un paciente masculino de 19 años, reactivo para el VIH, en el estado C, quien fue derivado al Servicio de Odontología Hospital Juan A. Fernández, Buenos Aires, Argentina, en donde se realizó una evaluación estomatológica. El paciente presentaba erosiones, pápulas y nódulos indoloros de aproximadamente 2,4 mm en la mucosa bucal. Se realizaron tres biopsias correspondientes a cada tipo de lesión presente. Los estudios histológicos revelaron invasión celular por Histoplasma capsulatum. Este caso de reporta como una forma atípica de histoplasmosis en base a lesiones diferentes entre sí, lo cual hizo el diagnóstico difícil. Es común la observación de presentaciones inusuales de lesiones bucales en pacientes VIH positivos.