Histoplasmosis in patients at risk for the acquired immunodeficiency syndrome in a nonendemic setting.
We reviewed 18 cases of histoplasmosis in patients at risk for the acquired immunodeficiency syndrome seen at two New York City hospitals in the past 3 1/2 years. Seventeen patients were Hispanic, including 13 born in Puerto Rico and three in South America. Clinical presentation was subacute, with high fever, weight loss, and mild respiratory symptoms with well-maintained gas exchange. Five patients had normal chest roentgenograms. The most common chest roentgenographic abnormality was diffuse small nodules. A rapid diagnosis was established histologically in 72 percent of patients, most commonly by transbronchial lung biopsy; cultures were positive in 94 percent of patients while serology was positive in five of six patients. Mycobacterium tuberculosis was a concurrent, often unrecognized, pathogen in six cases. Most patients responded to amphotericin therapy. Histoplasmosis may represent an early sign of altered host immunity in the acquired immunodeficiency syndrome.
Salzman
S H
SH
Bellevue Chest Service, New York Veterans Administration Medical Center, New York.
Smith
R L
RL
Aranda
C P
CP
D000163:Acquired Immunodeficiency Syndrome / Q000150:complications*; D000328:Adult; D006679:HIV Seropositivity; D006630:Hispanic or Latino; D006660:Histoplasmosis / Q000453:epidemiology / Q000209:etiology*; D006716:Homosexuality; D006801:Humans; D008172:Lung Diseases, Fungal / Q000453:epidemiology / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D009519:New York City; D011647:Puerto Rico / Q000208:ethnology; D012307:Risk Factors; D013020:South America / Q000208:ethnology; D019966:Substance-Related Disorders; D014397:Tuberculosis, Pulmonary / Q000453:epidemiology