title: Histoplasmosis in Australia: report of 16 cases and literature review.
abstract: We describe 16 previously unreported patients with histoplasmosis from Queensland and northern New South Wales, Australia, and review all previous Australian reports, providing 63 cases in total to study (17 cases of acute pulmonary histoplasmosis, 2 cases of chronic pulmonary disease, and 44 cases of systemic disease, including 17 cases of single-organ infection and 27 instances of disseminated disease). All acute pulmonary disease was acquired in Australia, with 52% of systemic disease definitely autochthonous. Most cases of single-organ disease occurred in immunocompetent patients (76%), and were oropharyngeal (53%) in location. Forty-one percent of disseminated disease occurred in patients with human immunodeficiency virus (HIV). Patients with HIV had high rates of systemic symptoms, pancytopenia, fungemia, and hepatosplenomegaly. Oropharyngeal and adrenal involvement as well as systemic symptoms were prominent in immunocompetent patients with disseminated disease, with 6 of 7 cases of adrenal involvement leading to Addison disease. Most systemic disease was diagnosed by culture of Histoplasma capsulatum. Where serology was assessed in cases other than acute pulmonary disease, it was positive in only 32%.Prognosis for patients with single-organ disease was excellent. Disseminated disease was associated with recurrence in 30% and death in 37%. The results of this study confirm several previously known patterns of disease but also provide new insights into this rare but endemic condition in Australia.
authors.affiliation: From Department of Endocrinology (DSAM), Mater Adult Hospital, South Brisbane; Department of Endocrinology (RHM, DAPK), Department of Infectious Diseases (AA, MLW), Royal Brisbane & Women's Hospital, Herston; Pathology Queensland (JPK), Herston; School of Medicine and Dentistry (WJHM), Cairns Base Hospital Campus, James Cook University,Cairns; The Prince Charles Hospital (CC), Queensland; and Sullivan Nicolaides Pathology (JMBR), Queensland; Australia.
authors.forename: Donald S A
authors.initials: DSA
authors.lastname: McLeod
authors.forename: Robin H
authors.initials: RH
authors.lastname: Mortimer
authors.forename: Donald A
authors.initials: DA
authors.lastname: Perry-Keene
authors.forename: Anthony
authors.initials: A
authors.lastname: Allworth
authors.forename: Marion L
authors.initials: ML
authors.lastname: Woods
authors.forename: Joanna
authors.initials: J
authors.lastname: Perry-Keene
authors.forename: William J H
authors.initials: WJH
authors.lastname: McBride
authors.forename: Christopher
authors.initials: C
authors.lastname: Coulter
authors.forename: Jennifer M B
authors.initials: JMB
authors.lastname: Robson
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000453:epidemiology; D005260:Female; D006660:Histoplasmosis / Q000453:epidemiology* / Q000276:immunology; D006801:Humans; D016867:Immunocompromised Host; D008297:Male; D009517:New South Wales / Q000453:epidemiology; D011379:Prognosis; D011793:Queensland / Q000453:epidemiology; D012008:Recurrence; D012307:Risk Factors