Histoplasmosis

Last reviewed: 17 Apr 2022
Last updated: 24 Mar 2022

Summary

Definition

History and exam

Key diagnostic factors

  • exposure to fungal spores
  • risk factors that impair host defenses
  • fever
  • headache
  • dyspnea
  • dry or nonproductive cough
  • pleuritic chest pain
  • anorexia
  • productive cough
More key diagnostic factors

Other diagnostic factors

  • abdominal pain
  • fatigue
  • malaise
  • arthralgias
  • weight loss
  • hepatosplenomegaly
  • scattered crackles on chest auscultation
  • bronchial breathing on chest auscultation
  • distant breath sounds on chest auscultation
  • hemoptysis
  • meningitis-like symptoms
  • skin lesions
  • gastrointestinal symptoms
  • sepsis-like syndrome
Other diagnostic factors

Risk factors

  • exposure to fungus
  • emphysema
  • HIV infection
  • treatment with tumor necrosis factor (TNF)-alpha antagonists
  • treatment with corticosteroids
  • treatment with immunosuppressants
  • neutropenia
  • stem cell and solid organ transplant
  • graft-versus-host disease
More risk factors

Diagnostic investigations

1st investigations to order

  • chest x-ray
  • culture of pulmonary secretions
  • antigen testing
  • immunodiffusion precipitin test
  • complement fixation assay
  • serology (enzyme immunoassay)
  • CT scan of chest
  • CBC
  • LFTs
More 1st investigations to order

Investigations to consider

  • tissue biopsy
More investigations to consider

Treatment algorithm

ACUTE

latent asymptomatic disease (nonpregnant)

acute pulmonary disease: <4 weeks (nonpregnant)

acute pulmonary disease: >4 weeks (nonpregnant)

chronic pulmonary disease (nonpregnant)

disseminated disease (nonpregnant)

mediastinal granuloma (nonpregnant)

mediastinal fibrosis (nonpregnant)

broncholithiasis (nonpregnant)

pericarditis (nonpregnant)

rheumatologic syndrome (nonpregnant)

meningoencephalitis (nonpregnant)

pregnant

Contributors

Authors

Zainab A. Malik, MD, MS, FAAP

Consultant

Pediatrics and Pediatric Infectious Diseases

Mediclinic City Hospital

Dubai

United Arab Emirates

Disclosures

ZAM has received speakers' honoraria from Merck-MSD.

David L. Goldman, MD

Associate Professor

Pediatric Infectious Diseases

The Children's Hospital at Montefiore

New York

NY

Disclosures

DLG declares that he has no competing interests.

Peer reviewers

Paul Roberts, MD

Assistant Professor

Family Medicine

Mayo Clinic

Jacksonville

FL

Disclosures

PR declares that he has no competing interests.

Janak Koirala, MD

Associate Professor of Medicine

Division of Infectious Diseases

Department of Internal Medicine

Southern Illinois University School of Medicine

Springfield

IL

Disclosures

JK declares that he has no competing interests.

  • Histoplasmosis images
  • Differentials

    • Community-acquired pneumonia
    • Pneumocystis jirovecii pneumonia (PCP)
    • Pulmonary tuberculosis
    More Differentials
  • Guidelines

    • Guidelines for the prevention and treatment of opportunistic infections in adults and adolescents with HIV
    • Global guideline for the diagnosis and management of the endemic mycoses
    More Guidelines
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