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Histoplasmosis

Last reviewed: 15 Apr 2025
Last updated: 19 Feb 2025

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
Full details

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
Full details

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
Full details

Diagnostic tests

1st tests to order

  • chest x-ray
  • culture
  • antigen testing
  • serology (immunodiffusion precipitin test)
  • serology (complement fixation assay)
  • serology (enzyme immunoassay)
  • CT scan of chest
  • CBC
  • LFTs
Full details

Tests to consider

  • tissue biopsy
Full details

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

Kassem Hammoud, MD

Associate Professor

Division of Infectious Diseases

University of Kansas Health System

Kansas City

MI

Disclosures

KH declares that he has no competing interests.

Adriana M. Rauseo, MD

Assistant Professor of Medicine

Division of Infectious Diseases

Department of Internal Medicine

Washington University in St Louis

St Louis

MI

Disclosures

AMR declares that she has no competing interests.

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.

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Key articles

Wheat LJ, Freifeld AG, Kleiman MB, et al. Clinical practice guidelines for the management of patients with histoplasmosis: 2007 update by the Infectious Diseases Society of America. Clin Infect Dis. 2007 Oct 1;45(7):807-25.Full text  Abstract

Thompson GR 3rd, Le T, Chindamporn A, et al. Global guideline for the diagnosis and management of the endemic mycoses: an initiative of the European Confederation of Medical Mycology in cooperation with the International Society for Human and Animal Mycology. Lancet Infect Dis. 2021 Dec;21(12):e364-74. Abstract

National Institutes of Health, Centers for Disease Control and Prevention, HIV Medicine Association, and the Infectious Diseases Society of America. Guidelines for the prevention and treatment of opportunistic infections in adults and adolescents with HIV: histoplasmosis. Sep 2019 [internet publication].Full text

Hage CA, Carmona EM, Epelbaum O, et al. Microbiological laboratory testing in the diagnosis of fungal infections in pulmonary and critical care practice. An official American Thoracic Society clinical practice guideline. Am J Respir Crit Care Med. 2019 Sep 1;200(5):535-50.Full text  Abstract

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
  • Histoplasmosis images
  • Differentials

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

    • Clinical testing guidance for coccidioidomycosis, histoplasmosis, and blastomycosis in patients with community-acquired pneumonia
    • Global guideline for the diagnosis and management of the endemic mycoses
    More Guidelines
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