Pulmonary Histoplasmosis

Angela María Tobón; Beatriz L Gómez

doi:10.1007/s11046-021-00588-4

Pulmonary Histoplasmosis

Título traducido de la contribución: Histoplasmosis pulmonar

Angela María Tobón
, Beatriz L Gómez

Producción científica: Contribución a revista › Artículo de revisión › revisión exhaustiva

37 Citas (Scopus)

Resumen

La histoplasmosis es una de las causas más frecuentes de infección respiratoria fúngica en regiones endémicas, tiene un amplio espectro de manifestaciones clínicas y puede presentarse de varias formas. La extensión de la enfermedad viene determinada por el número de conidios inhalados, la respuesta inmunitaria del huésped y la integridad de las vías respiratorias. De una forma inicial y más benigna, la histoplasmosis pulmonar aguda (una enfermedad similar a la gripe que suele ser asintomática o leve en personas sin compromiso inmunitario previo), la histoplasmosis puede convertirse en una infección diseminada progresiva (IDP) potencialmente mortal que afecta principalmente a pacientes inmunodeprimidos, con una elevada morbilidad y mortalidad. La histoplasmosis pulmonar crónica es una manifestación infrecuente de la infección por Histoplasma, con características similares a la tuberculosis pulmonar, y si permanece sin diagnosticar o tratar también puede causar una morbilidad significativa. También pueden producirse algunas complicaciones raras pero graves producidas por una respuesta inmunitaria excesiva, como fibrosis mediastínica, histoplasmoma y broncolitiasis. La histoplasmosis es muy endémica en regiones de Norteamérica, Centroamérica y Sudamérica, y también se ha descrito en partes de Asia y África. El riesgo de histoplasmosis es mayor en pacientes con infección por VIH, especialmente en aquellos con recuentos de CD4+ <200 células/μL. Se revisan las manifestaciones clínicas, los hallazgos radiológicos y las opciones de tratamiento según la forma clínica (terapia de inducción y terapia de mantenimiento), así como las diferentes herramientas de diagnóstico y las nuevas pruebas de laboratorio que se han desarrollado y validado recientemente y que están empezando a estar ampliamente disponibles. Estos deberían tener un impacto en la reducción del tiempo para el diagnóstico y el inicio de la terapia y en la reducción de la morbilidad y la mortalidad, especialmente en pacientes con infección por VIH, donde actualmente se estima que la histoplasmosis es responsable del 5-15% de las muertes relacionadas con el SIDA.

Título traducido de la contribución	Histoplasmosis pulmonar
Idioma original	Inglés estadounidense
Páginas (desde-hasta)	697–705
Número de páginas	9
Publicación	Mycopathologia
Volumen	186
N.º	October 2021
DOI	https://doi.org/10.1007/s11046-021-00588-4
Estado	Publicada - sep. 8 2021

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title = "Pulmonary Histoplasmosis",

abstract = "Histoplasmosis is one of the most frequent causes of fungal respiratory infection in endemic regions, has a broad spectrum of clinical manifestations and can present in several forms. The extent of disease is determined by the number of conidia inhaled, the immune response of the host and the integrity of the respiratory tract. From an initial and most benign form, acute pulmonary histoplasmosis (an influenza-like illness that is typically asymptomatic or mild in persons without prior immune compromise), histoplasmosis can become a lifethreatening progressive disseminated infection (PDH) that affects mainly immunocompromised patients, with high morbidity and mortality. Chronic pulmonary histoplasmosis is an uncommon manifestation of Histoplasma infection, with features similar to pulmonary tuberculosis, and if it remains undiagnosed or untreated it also can cause significant morbidity. Some rare but serious complications may also occur that are produced by an excessive immune response, such as mediastinal fibrosis, histoplasmoma and broncholithiasis. Histoplasmosis is highly endemic in regions of North, Central and South America as well as being reported in parts of Asia and Africa. The risk of histoplasmosis is greatest in patients with HIV infection, especially those with CD4+ counts of <200 cells/μL. We review clinical manifestations, radiological findings and treatment options according to the clinical form (induction therapy and maintenance therapy), as well as different diagnosis tools and new laboratory tests that have been recently developed and validated and are becoming widely available. These should have an impact in reducing time for diagnosis and starting therapy and in reducing morbidity and mortality, especially in patients with HIV infection, where histoplasmosis is currently estimated to be responsible for 5-15\% of AIDS-related deaths.",

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doi = "10.1007/s11046-021-00588-4",

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TY - JOUR

T1 - Pulmonary Histoplasmosis

AU - Tobón, Angela María

AU - Gómez, Beatriz L

PY - 2021/9/8

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N2 - Histoplasmosis is one of the most frequent causes of fungal respiratory infection in endemic regions, has a broad spectrum of clinical manifestations and can present in several forms. The extent of disease is determined by the number of conidia inhaled, the immune response of the host and the integrity of the respiratory tract. From an initial and most benign form, acute pulmonary histoplasmosis (an influenza-like illness that is typically asymptomatic or mild in persons without prior immune compromise), histoplasmosis can become a lifethreatening progressive disseminated infection (PDH) that affects mainly immunocompromised patients, with high morbidity and mortality. Chronic pulmonary histoplasmosis is an uncommon manifestation of Histoplasma infection, with features similar to pulmonary tuberculosis, and if it remains undiagnosed or untreated it also can cause significant morbidity. Some rare but serious complications may also occur that are produced by an excessive immune response, such as mediastinal fibrosis, histoplasmoma and broncholithiasis. Histoplasmosis is highly endemic in regions of North, Central and South America as well as being reported in parts of Asia and Africa. The risk of histoplasmosis is greatest in patients with HIV infection, especially those with CD4+ counts of <200 cells/μL. We review clinical manifestations, radiological findings and treatment options according to the clinical form (induction therapy and maintenance therapy), as well as different diagnosis tools and new laboratory tests that have been recently developed and validated and are becoming widely available. These should have an impact in reducing time for diagnosis and starting therapy and in reducing morbidity and mortality, especially in patients with HIV infection, where histoplasmosis is currently estimated to be responsible for 5-15% of AIDS-related deaths.

AB - Histoplasmosis is one of the most frequent causes of fungal respiratory infection in endemic regions, has a broad spectrum of clinical manifestations and can present in several forms. The extent of disease is determined by the number of conidia inhaled, the immune response of the host and the integrity of the respiratory tract. From an initial and most benign form, acute pulmonary histoplasmosis (an influenza-like illness that is typically asymptomatic or mild in persons without prior immune compromise), histoplasmosis can become a lifethreatening progressive disseminated infection (PDH) that affects mainly immunocompromised patients, with high morbidity and mortality. Chronic pulmonary histoplasmosis is an uncommon manifestation of Histoplasma infection, with features similar to pulmonary tuberculosis, and if it remains undiagnosed or untreated it also can cause significant morbidity. Some rare but serious complications may also occur that are produced by an excessive immune response, such as mediastinal fibrosis, histoplasmoma and broncholithiasis. Histoplasmosis is highly endemic in regions of North, Central and South America as well as being reported in parts of Asia and Africa. The risk of histoplasmosis is greatest in patients with HIV infection, especially those with CD4+ counts of <200 cells/μL. We review clinical manifestations, radiological findings and treatment options according to the clinical form (induction therapy and maintenance therapy), as well as different diagnosis tools and new laboratory tests that have been recently developed and validated and are becoming widely available. These should have an impact in reducing time for diagnosis and starting therapy and in reducing morbidity and mortality, especially in patients with HIV infection, where histoplasmosis is currently estimated to be responsible for 5-15% of AIDS-related deaths.

U2 - 10.1007/s11046-021-00588-4

DO - 10.1007/s11046-021-00588-4

M3 - Review article

C2 - 34498137

SN - 0301-486X

VL - 186

SP - 697

EP - 705

JO - Mycopathologia

JF - Mycopathologia

IS - October 2021

ER -

Pulmonary Histoplasmosis

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