HISTOPLASMOSIS

Question 1

caused by

Answer 1

airborne spores

may be asymptomatic or limited lung dx

Question 2

primary pulmo histo

Answer 2

Benign self limited form of acute pneumonitis char by fever malaise night sweat chest pain cough hilar adenopathy.

+ skin test to histoplasmin

10% of acyte symptomatic infectuon dev arthiritis and erythema nodosum.

Question 3

Progressive disseminated histoplasmosis

Answer 3

20% no RF

most common mucocutaneous lesions- Granulomas of oronasopharynx.

begin as indurated plaques. leauons ulcerate and become deep seated painful and secondarily affected.

most common manif in children- purpura wc usually appeare a few days before death.

in HIV pop, dyspnea; plt count <100,000 and lactate dehydrogenase more than 2 fold the upper limit of normal are poor prognostic factors. independently assoc w death during 1st 30 days of antifungal treatment.

Question 4

primary cutaneous histoplasmosis lesion

Answer 4

Chancre type lesion with regional adenopathy.

Question 5

african histoplasmosis

Answer 5

causes by histoplasma capsulatum va duboisii.

skin lesions are much more common and inc superficial cutaneous granulomas. subcu granuloma, osteomyelitic w secondary involvement of skin (cold abscesses). papular nodular circunate eczematoud psoriasiform lesions may be seenZ granulomas are dome shaped nodules, painless but slighlty pruritic.

Question 6

etio

Answer 6

h capsulatum. organism found in bat and bird feces.

in tissue there are 2-3 um bodies within the cytoplasm of large macrophages or cytoplasm of keratinocytes.

in dissemjnated dx: BM is freq involved.

PCR- Rapid culture confirmation

Question 7

epid

Answer 7

North america.
Central US.

transmission: Soil by inhalation of the spores.

Question 8

best dx test -

Answer 8

ELISA

Question 9

compelement fixation test

Answer 9

positive at a titer on 1:32 or greater indicates active or recent infection.

culture remains gold st.

Question 10

tx of choice. in mild mod severe

Answer 10

mild to mod progressive disseminated dx- itraconazole 200mg 3x a day for 3 days f by 200 mg once or 2x a day for 12 months.

Amphotericin B - Tx of choice in severely ill pxs and immunocompormised.
suppressive dose of itraconazole 200mg/day ff the IV amphotericin and may be needed as lifelong tx.