HISTOPLASMOSIS
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HISTOPLASMOSIS
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HISTOPLASMOSISDarlings diseaseCausative fungus:Histoplasma capsulatum
Disease of reticuloendothelial system
Intracellular parasiteDimorphic fungusWorld wide in distribution but is most common in America
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PATHOGENESIS
Source of infection :soil enriched with excreta of birds or bats
Route of infection :inhalation of spores
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CLINICAL FEATURES90-95% are asymptomatic
Acute pulmonary histoplasmosis :
flu like symptoms malaise fever chills profuse sweating sore throat
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Continued…….. chest pain cough dyspnoea Chronic progressive pulmonary histoplasmosis:
acute stage progresses leading to
haemoptysis Apical and subapical cavities
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Disseminated histoplasmosis: develops in minority of infected
individuals
Involvement of RES leads to
lymphadenopathy hepatosplenomegaly fever and anaemia
Cutaneous and mucocutaneous: granulomatous ulcerative lesions
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LAB DIAGNOSISSPECIMENS sputum bone marrow aspirate peripheral blood scrapings from ulcers biopsies of lymph nodes
and other organs
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DIRECT EXAMINATION
Smears of sputum or pus are stained with giemsa or wright stain
On microscopic examination H.capsulatum appears as
small,oval yeast cell (2-4micron)
Packed within the cytoplasm of macrophages or monocytes
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CULTURE
SDA or brain heart infusion (BHI)agar with cycloheximide and chloramphenicol are inoculated
At 37c yeast phase is formed
At 25c appears as white cottony
mycelial growth containing large(8-20microns)thick walled ,spherical spores with tubercles or finger like projections
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SEROLOGICAL TESTS
latex agglutination precipitation complement fixation They become positive 2 weeks after infection
Increase in titre of antibody indicates a progressive disease
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HISTOPLASMIN SKIN TEST
Delayed hypersensitivity testSimilar to tuberculin test but antigen used is histoplasmin
Positive reaction indicates past or present infection,but does not differentiate active and passive infections
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AFRICAN HISTOPLASMOSISCausative fungus:Histoplasma duboisiiMainly confined with in the continent
of AfricaPrimarily involves skin and
subcutaneous tissuesIt is morphologically identical to
H.capsulatum in its mycelial phase but differs in yeast phase
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BLASTOMYCOSISCausative fungus:Blastomyces
dermatitidisDimorphic fungusCharacterised by suppurative and
granulomatous lesions particularly in lungs
Also effects skin,bone and genitourinary tract
North american blastomycosis
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PATHOGENESIS
Route:inhalationSource :soil containing spores
CLINICAL FEATURES:
PULMONARY BLASTOMYCOSIS:
Primary infection of lung may resemble TB or
histoplasmosis
May be asymptomatic or may leads to focal
consolidations,miliary lesions,abscess
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CUTANEOUS BLASTOMYCOSIS
Primary lesion is papule secondary nodules ulcerative lesions
DISSEMINATED
Mainly seen in immunocompromised individuals including AIDS
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LAB DIAGNOSIS
• Specimens sputum pus scrapings from skin lesions
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DIRECT MICROSCOPY
10%KOH mount thick walled yeast cells with a single broad based bud
• H&E stain and PAS stains also show yeast cells in section
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CULTURESDA or blood agarAt 25 c mycelial phase occurs slowly on
incubation. filamentous with septate hyphae
and many round or oval conidia• At 37 c yeast phase is seen-cells with
thick,double contoured walls
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Cultures should be incubated for atleast six weeks before discarding them as negative.
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TREATMENTNot recommended in asymptomatic
casesAMPHOTERICIN BKETOCONAZOLEITRACONAZOLE