Histoplasmosis (patient information)

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Overview
Chronic pulmonary histoplasmosis is a long-term respiratory infection caused by breathing the spores of the fungus, Histoplasma capsulatum.

What are the symptoms of Histoplasmosis?

 * Chills
 * Cough that brings up blood, mucus, or pus
 * Fever
 * Shortness of breath
 * Unintentional weight loss

What causes Histoplasmosis?
Histoplasma capsulatum is a fungus found in the soil of the central and eastern United States (especially Mississippi and Ohio river valleys), eastern Canada, Mexico, Central America, and South America. The infection occurs when a person breathes in the reproducing parts of the fungus, called spores. Those who have a healthy immune system usually do not have symptoms, or only mild ones.

Who is at highest risk?
This "acute" infection does not last, but can leave a person with small scars (granulomas). These scars can be difficult to distinguish from tumors in the lung. However, the infection can cause severe illness right away, or redevelop years after the first exposure, if a person's immune system is weakened by: Cancer Chemotherapy Immune-suppressing drugs HIV infection Risk factors for chronic pulmonary histoplasmosis include: Living in or traveling to central or eastern United States Exposure to soil or particles contaminated with droppings of chickens, bats, or blackbirds Pre-existing COPD Weakened immune system, such as in people who have AIDS

When to seek urgent medical care?
Call for an appointment with your health care provider if you develop symptoms of chronic pulmonary histoplasmosis. Call your health care provider if your symptoms continue despite treatment, or if you have breathing difficulty or symptoms of disseminated histoplasmosis.

Diagnosis
Tests that may be used to diagnose chronic pulmonary histoplasmosis include:
 * Biopsy of infected tissue, such as open lung biopsy
 * Bronchoscopy with transbronchial biopsy or bronchoalveolar lavage
 * CBC
 * Chest CT scan
 * Chest x-ray
 * Histoplasma complement fixation titer
 * Histoplasma urinary antigen test (positive only if the person also has disseminated histoplasmosis)
 * Immunodiffusion test
 * Sputum culture and stain

Treatment options
The doctor will prescribe antifungal medications to control the infection within the lung. These medications must be taken for 1 to 2 years.

Where to find medical care for Histoplasmosis?
Directions to Hospitals Treating Histoplasmosis

What to expect (Outlook/Prognosis)?
The infection usually goes away with antifungal medication, but scarring inside the lung often remains. Histoplasmosis is unusual enough that if you develop it, your health care provider should check to find out whether another disease is weakening your immune system. Often, those who have had chronic pulmonary histoplasmosis must follow up with their doctor, who will check for signs of relapse. In rare cases, a pulmonary histoplasmosis infection can spread through the blood to other organs. This is called disseminated histoplasmosis. People who have a suppressed immune system and very young children are more likely to develop this condition. If this occurs, the prognosis is less favorable.

Possible complications
Patients who breathe in a large amount of fungus can develop a severe and potentially deadly and sudden type of lung infection.
 * Arthritis
 * Disseminated histoplasmosis
 * Lung scarring (fibrosis)
 * Pericarditis
 * Respiratory insufficiency

Prevention
Be aware of your surroundings, especially if you are in a weakened state from another medical condition, or from immune-suppressing medications.