Histoplasma Capsulatum: fungal pneumonia

Epidemiology
-clearning and burning wood from a field that served as a bird roost, was laden with bird feces

Pathogenicity
-asymptomatic infections occur but calcified tubercle like lesions can be observed on X-rays primarily in visceral organs
~liver
~spleen
~adrenals
~lungs

Agent is:
facultative intracellular found in macrophages

*systemic disease is characterized by massive parasitism of macrophages*

Progressive disseminated disease in adult
-Darling’s Disease
symptoms similar to miliary tuberculosis and lesions in:
~liver, spleen, adrenals

-destruction of adrenal can result in *Addison’s Disease*: if untreated death occurs in 10 months

Progressive systemic disease in infant
-unrelenting fever and hepatosplenomegaly
-if untreated: death in 6 weeks

Diagnosis
-microscopic exam of appropriately stained tissue samples reveals:
~rounded to oval yeast forms in macrophages from pulmonary or extra-pulmonary tissue (bone marrow)

-Serology:
1) Complement fixation: test with histoplasmin (mycelial antigen) and whole yeast cell antigens (histolyn)

2) Immunodiffusion test: Precipitin bands form to H and M antigens:
~H antigen positive: occurs in active histoplasmosis, indicates primary disease
~M antigen positive: occurs in acute or chronic disease

3) RIA test for H. capsulatum polysaccharide antigen in serum or urine

4) ELISA assay using man to H. capsulatum 69–> 70 kDa antigen present in serum

Treatment
-Amphotericin B lipid formulations followed by oral itraconazole

Prevention
none

Yeasts Unicellular; have buds called *blastoconidia*; divide by budding; colonize plates like bacteria Molds Multicellular; have filaments called *hyphae* to replicate/spread; “hairy” growth on plates -Part of mycelium involved in gaining nutrients=vegetative mycelium -Part of mycelium involved in growth and …

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