Disseminated histoplasmosis.
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.
Subramanian
S
S
Department of General Medicine, Unit 1 Christian Medical College, Ida Scudder Road, PB No. 3, Vellore, Tamil Nadu, India.
Abraham
O C
OC
Rupali
Priscilla
P
Zachariah
A
A
Mathews
Mary S
MS
Mathai
D
D
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
D000935:Antifungal Agents