Histoplasmosis - acute (primary) pulmonary

Acute pulmonary histoplasmosis is a respiratory infection that is caused by inhaling the spores of the fungus Histoplasma capsulatum .

Causes

Histoplasma capsulatum is the name of the fungus that causes histoplasmosis. It is found in the central and eastern United States, eastern Canada, Mexico, Central America, South America, Africa, and Southeast Asia. It is commonly found in the soil in river valleys. It gets into the soil mostly from bird and bat droppings.

You can get sick when you breathe in spores that the fungus produces. Every year, thousands of people with a normal immune system worldwide are infected, but most do not become seriously sick. Most have no symptoms or have only a mild flu-like illness and recover without any treatment.

Acute pulmonary histoplasmosis may happen as an epidemic, with many people in one region becoming sick at the same time. People with weakened immune systems (see Symptoms section below) are more likely to:

Acute

Acute means sudden or severe. Acute symptoms appear, change, or worsen rapidly. It is the opposite of chronic.

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Histoplasmosis

Histoplasmosis is an infection that occurs from breathing in the spores of the fungus Histoplasma capsulatum.

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Weakened immune systems

Immunodeficiency disorders occur when the body's immune response is reduced or absent.

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• Get the disease if exposed to the fungus spores
• Have the disease come back
• Have more symptoms, and more serious symptoms, than others who get the disease

Risk factors include traveling to or living in the central or eastern United States near the Ohio and Mississippi river valleys, and being exposed to the droppings of birds and bats. This threat is greatest after an old building is torn down and the spores get into the air, or when exploring caves.

Symptoms

Most people with acute pulmonary histoplasmosis have no symptoms or only mild symptoms. The most common symptoms are:

• Chest pain
• Chills
• Cough
• Fever
• Joint pain and stiffness
• Muscle aches and stiffness
• Rash (usually small sores on the lower legs)
• Shortness of breath

Acute pulmonary histoplasmosis can be a serious illness in the very young, older people, and people with a weakened immune system, including those who:

• Have HIV/AIDS
• Have had bone marrow or solid organ transplants
• Take medicines that suppress their immune system

Symptoms in these people may include:

• Inflammation around the heart (called pericarditis )

  Pericarditis

  Pericarditis is a condition in which the sac-like covering around the heart (pericardium) becomes inflamed.

  

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• Serious lung infections
• Severe joint pain

Exams and Tests

To diagnose histoplasmosis, you must have the fungus or signs of the fungus in your body. Or your immune system must show that it is reacting to the fungus.

Tests include:

• Antibody tests for histoplasmosis
• Biopsy of infection site
• Bronchoscopy (usually only done if symptoms are severe or you have an abnormal immune system)

  Bronchoscopy

  Bronchoscopy is a test to view the airways and diagnose lung disease. It may also be used during the treatment of some lung conditions.

  

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• Complete blood count (CBC) with differential

  Complete blood count

  A complete blood count (CBC) test measures the following:The number of red blood cells (RBC count)The number of white blood cells (WBC count)The tota...

  

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• Chest CT scan

  Chest CT scan

  A chest CT (computed tomography) scan is an imaging method that uses x-rays to create cross-sectional pictures of the chest and upper abdomen....

  

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• Chest x-ray (might show a lung infection or pneumonia)

  Chest x-ray

  A chest x-ray is an x-ray of the chest, lungs, heart, large arteries, ribs, and diaphragm.

  

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• Sputum culture (this test often does not show the fungus, even if you are infected)

  Sputum culture

  Routine sputum culture is a laboratory test that looks for germs that cause infection. Sputum is the material that comes up from air passages when y...

  

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• Urine test for Histoplasma capsulatum antigen

Treatment

Most cases of histoplasmosis clear up without specific treatment. People are advised to rest and take medicine to control fever.

Your health care provider may prescribe medicine if you are sick for more than 4 weeks, have a weakened immune system, or are having breathing problems.

Outlook (Prognosis)

When histoplasmosis infection is severe or gets worse, the illness may last up to 6 months. Even then, it is rarely fatal.

Possible Complications

Acute pulmonary histoplasmosis can get worse over time, or can become long-term (chronic) pulmonary histoplasmosis (which doesn't go away).

Histoplasmosis can spread to other organs through the bloodstream (dissemination). This is often seen in infants, young children, and people with a suppressed immune system.

When to Contact a Medical Professional

Call your provider if:

• You have symptoms of histoplasmosis, especially if you have a weakened immune system or have recently been exposed to bird or bat droppings
• You are being treated for histoplasmosis and develop new symptoms

Prevention

Avoid contact with bird or bat droppings if you are in an area where the spore is common, especially if you have a weakened immune system.