Histoplasmosis/Ohio valley disease is associated with exposure to soil contaminated with bird or bat droppings. It presents as acute/chronic pulmonary and disseminated forms. It has a very high mortality among immunocompromised patients. Possible complications include ARDS, meningitis, pericarditis, and adrenal insufficiency. Diagnosis is by direct tissue staining, serology, cultures and detection of antigen. We studied 18 cases of culture positive Histoplasmosis at SLUH (St Louis University Hospital ), a 356 bed teaching hospital from 2000-2013.
Methods: Using EMR, we retrospectively studied patients >18 yrs with culture positive Histoplasma. We collected data regarding demographics, underlying immunodeficiency states, clinical features, lab findings, treatment and outcomes.
The average age at diagnosis was 49.1 yrs . 15/18 (83.3%) were males. 11/18 (61.1%) were caucasian . 11/18 ( 61.1% ) were from Missouri state. 8/18 (44.4 %) had AIDS and 8/18 (44.4%) were immunocompromised with transplant and cancer. 16/18 (88.8%) had disseminated histoplasmosis. Common presenting symptoms included, fever 13/18 (72.2%), GI symptoms 12/18 (66.6%), and fatigue 10/18(55.5%). Positive blood cultures were found in 15/18 (82.2%). Of the 18, 15 (82.2%) were tested for urine histoplasma antigen of which 9 (60 %) were positive. The most common radiological findings were nodules in 11/18 (61.1%) and lymphadenopathy 9 (50 %) . Of the 15/18 patients who were treated, 13 (86.6%) were adherent to IDSA guidelines with Amphotericin B and itraconazole. In hospital mortality was 16.6%. 80%of the patients followed up in ID clinic were treated successfully at one year.
The study suggested that histoplasmosis is more common amongst Caucasian middle aged men from Missouri and Illinois area. The study also suggested that patients with Histoplasmosis should be worked up to exclude a immunocompromised state. Common symptoms are fever, GI symptoms, and fatigue. Blood culture was the best test for the diagnosis of histoplasmosis. Common radiological findings in this study were pulmonary nodules and lymphadenopathy. The majority of the treated patients were adherent to the IDSA guidelines of treatment. In hospital mortality was found to be 16.6%.
M. Alhassen, None
G. Gajanan, None
C. Bohra, None
J. Greene, None