What causes histoplasmosis pneumonia in immunocompromised patients?

Answer

For the immunocompetent host, histoplasmosis is frequently asymptomatic or self-limited. In the setting of HIV/AIDS, this infection is much more common and frequently progresses to disseminated disease.

This infection is endemic to certain areas of the United States, particularly in states bordering the Ohio River valley and the lower Mississippi River.

Spores of the mold phase are inhaled and cause a localized or patchy bronchopneumonia. CD4 lymphocytes normally activate macrophages to control the infection.^[27]

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Media Gallery

Chest radiograph demonstrating diffuse bilateral infiltrates in a patient with Pneumocystis carinii pneumonia.
High-resolution computed tomography scan obtained through the upper lobes in the prone position in a patient with a history of Pneumocystis carinii pneumonia. This image shows parenchymal and subpleural cysts and patchy fibrosis that resulted from the Pneumocystis carinii infection.
Chest radiograph in a patient with HIV infection, bilateral perihilar infiltrates, and Pneumocystis carinii pericarditis.
Chest radiograph in a patient with HIV infection and focal infiltrates due to tuberculosis.
Chest radiograph of HIV-infected patient with PJP shows diffuse patchy infiltrates with predominantly perihilar and interstitial prominence, as well as a few pneumatocoeles up to 1cm in size. Courtesy of Radiopaedia (https://radiopaedia.org/), case of Dr Andrew Dixon, rID 9613.
Chest CT of HIV-infected patient with PJP shows early findings of diffuse ground glass opacities, and chronic findings of linear opacities and thickening of interlobular septa. Courtesy of Radiopaedia (https://radiopaedia.org/), case of Dr Yune Kwong, rID 26697.
CT of AML patient with a fungal pneumonia in the right upper lobe characterized by a cavitary lesion without air fluid levels. Courtesy of Radiopaedia (https://radiopaedia.org/), case of Dr Roberto Schubert, rID 17628.

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Author

Julie B Zhao, MD Physician, Department of Emergency Medicine, NewYork-Presbyterian-Weill Cornell Medical Center

Disclosure: Nothing to disclose.

Coauthor(s)

Richard D Shin, MD Director of Simulation, Department of Emergency Medicine, New York-Presbyterian Queens; Clinical Assistant Professor of Emergency Medicine in Medicine, Weill Cornell Medical College; Emergency Physician, Envision Physician Services

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Paul Blackburn, DO, FACOEP, FACEP Attending Physician, Department of Emergency Medicine, Maricopa Medical Center

Paul Blackburn, DO, FACOEP, FACEP is a member of the following medical societies: American College of Emergency Physicians, Arizona Medical Association, American College of Osteopathic Emergency Physicians, American Medical Association

Disclosure: Nothing to disclose.

Chief Editor

Barry E Brenner, MD, PhD, FACEP Professor of Emergency Medicine, Professor of Internal Medicine, Program Director for Emergency Medicine, Sanz Laniado Medical Center, Netanya, Israel

Barry E Brenner, MD, PhD, FACEP is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Chest Physicians, American College of Emergency Physicians, American College of Physicians, American Heart Association, American Thoracic Society, New York Academy of Medicine, New York Academy of Sciences, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Additional Contributors

Christopher I Doty, MD, FAAEM, FACEP Professor of Emergency Medicine, Vice Chair, Department of Emergency Medicine, University of Kentucky-Chandler Medical Center

Christopher I Doty, MD, FAAEM, FACEP is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, Council of Emergency Medicine Residency Directors

Disclosure: Nothing to disclose.

Dana A Stearns, MD Assistant Director of Undergraduate Education, Department of Emergency Medicine, Massachusetts General Hospital; Associate Director, Undergraduate Clerkship in Surgery, Massachusetts General Hospital/Harvard Medical School; Assistant Professor of Surgery, Harvard Medical School

Dana A Stearns, MD is a member of the following medical societies: American College of Emergency Physicians

Disclosure: Nothing to disclose.

Michael H Augenbraun, MD, FACP Professor of Medicine and Preventive Medicine and Community Health, Director of 3rd Year Medical Clerkship, State University of New York Downstate College of Medicine; Hospital Epidemiologist and Director, Department of Epidemiology, University Hospital of Brooklyn; Medical Director of Sexually Transmitted Diseases Clinic, Director of Lumbar Puncture Clinic, Kings County Hospital Center

Michael H Augenbraun, MD, FACP is a member of the following medical societies: American College of Physicians, Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Marie Abdallah, MD Primary Care and Infectious Diseases Physician, Kings County Hospital

Marie Abdallah, MD is a member of the following medical societies: American College of Physicians

Disclosure: Nothing to disclose.

Acknowledgements

David J Wallace, MD, MPH Critical Care Medicine Fellow, University of Pittsburgh Medical Center

David J Wallace, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, American College of Emergency Physicians, and Society of Critical Care Medicine

Disclosure: Nothing to disclose.

What causes histoplasmosis pneumonia in immunocompromised patients?

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