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Histoplasmosis; chronic pulmonary Causes and Risks:
Histoplasmosis is caused by a fungus in the central and eastern U.S., eastern Canada, Mexico, Central America, South America, Africa, and Southeast Asia. Most cases are mild or without symptoms ( asymptomatic ). Acute histoplasmosis may occur in epidemics. The illness may last for 1 to 6 months but is rarely fatal.
Progressive and chronic disease can also occur. In chronic disease, illness occurs years after exposure to the disease and is usually confined to the lungs. Scar-like (fibrotic) changes occur within the lung tissue.
Risk factors include travel or residence in central or eastern U.S.; environmental or occupational exposure to droppings of chickens, bats, blackbirds; pre-existing COPD ( chronic obstructive pulmonary disease ); and people whose immune systems have been suppressed by disease or medication. The incidence is 5 out of 1,000,000 people.
Prevention:
Avoiding travel to areas where this spore is found would prevent it (but this is not practical). Avoid bird or bat droppings if you are in one of these areas, especially if you are immunosuppressed .
Symptoms:
Signs and Tests:
Tests that may be used in the diagnosis of chronic pulmonary histoplasmosis include:
Treatment:
Antifungal medications are prescribed to control the infection within the lung. Ketoconazole by mouth is usually successful.
Prognosis:
The infection usually responds to antifungal medication, but the fibrotic changes within the lung remain. Death can result from breathing problems ( respiratory insufficiency). In people with AIDS , the disease can be rapidly fatal.
Complications:
Call Your Healthcare Provider:
Call for an appointment with your health care provider if symptoms of chronic pulmonary histoplasmosis develop.
Call your health care provider if symptoms continue despite treatment, or if breathing difficulty or symptoms of disseminated histoplasmosis occur.
This chest X-ray shows the affects of the fungal infection, coccidioidomycosis. In the middle of the left lung (seen on the right side of the picture) there are multiple, thin-walled cavities (seen as light areas) with a diameter of 2 to 4 centimeters. To the side of these light areas are patchy light areas with irregular and poorly defined borders. Diseases that may explain these X-ray findings include lung abscesses, chronic pulmonary coccidioidomycosis, chronic pulmonary tuberculosis, chronic pulmonary histoplasmosis, and others.
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