Summary
Definition
History and exam
Key diagnostic factors
- presença de fatores de risco
- febre
- cefaleia
- dispneia
- tosse seca ou não produtiva
- dor torácica pleurítica
- anorexia
- tosse produtiva
Other diagnostic factors
- dor abdominal
- fadiga
- mal-estar
- artralgias
- perda de peso
- hepatoesplenomegalia
- estertores dispersos à ausculta torácica
- sopro tubário à ausculta torácica
- murmúrio vesicular diminuído à ausculta torácica
- hemoptise
- sintomas tipo meningite
- lesões cutâneas
- sintomas gastrointestinais
- síndrome tipo sepse
Risk factors
- exposição ao fungo
- enfisema
- Infecção pelo vírus da imunodeficiência humana (HIV)
- tratamento com antagonistas do fator de necrose tumoral (TNF)-alfa
- tratamento com corticosteroides
- tratamento com imunossupressores
- neutropenia
- transplante de células-tronco e de órgão sólido
- doença do enxerto contra o hospedeiro
Diagnostic investigations
1st investigations to order
- radiografia torácica
- cultura
- teste de antígeno
- sorologia (teste de precipitina [imunodifusão])
- sorologia (ensaio de fixação de complemento)
- sorologia (imunoensaio enzimático)
- TC do tórax
- Hemograma completo
- TFHs
Investigations to consider
- biópsia tecidual
Treatment algorithm
doença assintomática latente (não gestantes)
doença pulmonar aguda: <4 semanas (não gestantes)
doença pulmonar aguda: >4 semanas (não gestantes)
doença pulmonar crônica (não gestantes)
doença disseminada (não gestantes)
granuloma mediastinal (não gestantes)
fibrose mediastinal (não gestantes)
broncolitíase (não gestantes)
pericardite (não gestantes)
síndrome reumatológica (não gestantes)
meningoencefalite (não gestantes)
gestante
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
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.
Differentials
- Pneumonia adquirida na comunidade
- Pneumonia por Pneumocystis jirovecii (PCP)
- Tuberculose pulmonar
More DifferentialsGuidelines
- 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
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