title: Disseminated histoplasmosis.
abstract: OBJECTIVE
  To study the clinical features and natural history of disseminated histoplasmosis(DH) in India.
  
  
  METHODS
  We retrospectively analyzed the data obtained from the in-patient medical records of adults (age > 13 years) diagnosed to have DH during the period from January 1989 to December 1999. DH was diagnosed when histologically compatible intracellular organisms were present or Histoplasma capsulatum was obtained in culture from the extrapulmonary sites.
  
  
  RESULTS
  Nineteen patients (18 male and 1 female) were diagnosed to have DH. Diabetes mellitus and HIV infection were the most common co-morbid conditions. Weight loss, fever and oropharyngeal ulcers were the commonest symptoms. Physical signs included hepatosplenomegaly, oropharyngeal ulcers and lymphadenopathy. The diagnosis was confirmed by histopathology and/or culture from the following sites: bone marrow, adrenal gland, lymph node, oropharyngeal ulcers, rectal mucosa and skin. Two patients were treated with Amphotericin B, 6 with various azoles and 3 had Amphotericin B followed by various azoles. Among the eleven treated, 7 were cured, 2 improved, 1 had a relapse and 1 patient died.
  
  
  CONCLUSIONS
  DH is not uncommon in India and should be considered in the diagnosis of patients with prolonged fever, weight loss, oropharyngeal ulcers, hepatosplenomegaly, lymphadenopathy and adrenal enlargement. Correct diagnosis and treatment leads to a favourable outcome.
authors.affiliation: Department of General Medicine, Unit 1 Christian Medical College, Ida Scudder Road, PB No. 3, Vellore, Tamil Nadu, India.
authors.forename: S
authors.initials: S
authors.lastname: Subramanian
authors.forename: O C
authors.initials: OC
authors.lastname: Abraham
authors.forename: Priscilla
authors.initials: P
authors.lastname: Rupali
authors.forename: A
authors.initials: A
authors.lastname: Zachariah
authors.forename: Mary S
authors.initials: MS
authors.lastname: Mathews
authors.forename: D
authors.initials: D
authors.lastname: Mathai
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000935:Antifungal Agents / Q000627:therapeutic use; D005260:Female; D006658:Histoplasma / Q000302:isolation & purification; D006660:Histoplasmosis / Q000175:diagnosis / Q000188:drug therapy / Q000503:physiopathology*; D006801:Humans; D007194:India; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies
chemical_list: D000935:Antifungal Agents