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Histoplasmosis

Histoplasmosis , also known as Darling's disease , is a disease caused by the fungus Histoplasma capsulatum . This microscopic fungus, which is found throughout the world in river valleys and soil where bird or bat droppings accumulate, is released into the air when soil is disturbed by plowing fields, sweeping chicken coops, or digging holes. Droppings from chickens, pigeons, starlings, blackbirds, and bats support its growth. Birds are not infected with it because of their high body temperatures, but they do carry it on their feathers But for some people - primarily infants and those with compromised immune systems - histoplasmosis can be much more serious. When these conidia are inhaled, they are small enough that they enter the lungs and start an infection. Many of these infections are easily overlooked because they either produce mild symptoms or none at all. In fact, if you had histoplasmosis symptoms, you might dismiss them as those from a cold or flu, since the body's immune system normally overcomes the infection in a few days without treatment. But these therapies often involve extensive hospital stays and can cause serious side effects, so people with compromised immune systems should do everything possible to avoid histoplasmosis infection

Histoplasma capsulatum is a dimorphic fungus that remains in a mycelial form at ambient temperatures and grows as yeast at body temperature in mammals. Occasionally, other organs are affected-this form of the disease is called disseminated histoplasmosis, and it can be fatal if untreated. H. capsulatum is found throughout the world and is endemic in certain areas of the United States , particularly in states bordering the Ohio River valley and the lower Mississippi River. Bats can be infected because they have a lower body temperature than birds and can excrete the organism in their droppings. Most people with histoplasmosis never develop signs and symptoms and aren't aware they have the disease. The conidia of Histoplasma capsulatum are only two millionths of a meter (microns, µm) in diameter. Effective treatments are available for even the most severe forms of histoplasmosis.However, histoplasmosis, even mild cases, can later cause a serious eye disease called ocular histoplasmosis syndrome (OHS), a leading cause of vision loss in Americans ages 20 to 40.

Causes of Histoplasmosis

The common Causes of Histoplasmosis :

• Individuals who are immunocompetent and exposed to a low inoculum of histoplasmosis are usually asymptomatic.
• Reactivation, reinfection, or complications of infection usually occur in individuals who are immunocompromised or immunosuppressed.
• Most patients with symptomatic histoplasmosis will have a flu-like syndrome and pulmonary (lung) complaints related to underlying pneumonia or other lung involvement.
• Histoplasmosis is caused by infection with a fungus.
• This condition is called "chronic" pulmonary histoplasmosis. 
• Humans become infected by exposure to bird and bat droppings.
• Inhalation of a large inoculum can cause diffuse pulmonary symptoms that may have a protracted course.
• The symptoms and chest x-ray findings of chronic pulmonary histoplasmosis are similar to tuberculosis.

Symptoms of Histoplasmosis

Some common Symptoms of Histoplasmosis :

• cough
• Unintentional weight loss
• fever
• Cough that brings up mucus or pus
• Skin involvement (erythema nodosum)
• Weakness
• Headache
• Achy muscles
• Malaise (a feeling of discomfort or uneasiness)
• Hemoptysis (spitting out blood)
• Chest pain
• Shortness of breath

Treatment of Histoplasmosis

• The mainstay of therapy for histoplasmosis is antifungal therapy.
• Monitor mild symptoms (without treatment).
• In disseminated disease particularly meningitis therapy with intravenous amphotericin is used followed by long-term suppression with an oral agent
• Persistent cavitations despite multiple courses of medical treatment warrant surgical consideration.
• Antifungal medications are prescribed to control the infection within the lung.
• In non-AIDS patients with milder disease, ketoconazole, itraconazole, voriconazole, or fluconazole used for at least 12 months may be effective.
• Treat extensive maculopathy in presumed ocular histoplasmosis with steroids.
• Surgical resection of pulmonary cavitary lesions is required when repeated relapses or progressive disease occurs despite repeated intensive medical therapy.

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