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Histoplasmosis (Darling's disease) is a mycosis caused by the yeast fungus Histoplasma capsulatum. It occurs all over the world, although it is rarely recognized in Poland. And that's good, because untreated generalized histoplasmosis is usually a fatal disease. What are the symptoms of histoplasmosis? How is Darling's disease treated?

Histoplasmosis( Darling's disease ) is the most commonly diagnosed endemic mycosis in North America. It is caused by fungiHistoplasma capsulatumbelonging to yeasts - they come in two varieties, which differ in the size of cells and the thickness of cell membranes.

In Poland, histoplasmosis is rarely diagnosed, and its cases are much more common, especially in the regions of Africa, Australia and Asia.

Histoplasmosis (Darling's disease): route of infection

The reservoir of the fungus is moist soil rich in organic debris, especially contaminated with bird or bat droppings, which can also spread the disease by droplets. Contaminated soil containing fungal spores has been a source of contamination for many years. Infection occurs after inhalation of spores, which are quickly recognized and absorbed by pulmonary macrophages.

Histoplasmosis (Darling's disease): course

Histoplasmosis is an often fatal disease. Untreated generalized histoplasmosis is characterized by a mortality of approximately 80%.

The disease usually affects people with reduced immunity (AIDS, taking immunosuppressive drugs, e.g. after organ transplantation) and smokers, and people at increased risk of fungal invasion (a large amount of fungus).

Depending on the course, we distinguish:

  • acute form of histoplasmosisin which the course is electrifying and quickly leads to death. In this form, usually the mucous membranes of the oral cavity or even the entire length of the gastrointestinal tract are affected, as well as the liver, pancreas, spleen, kidneys and adrenal glands.
  • chronic histoplasmosis- fungi can develop in the host's body for months or years

Histoplasmosis occurs in various clinical forms, such as:

  • pulmonary histoplasmosis

May be acute, givingsymptoms such as fever, chills, headache, muscle aches, cough, chest pain (incubation period is 1-3 weeks).

When reinfected, these symptoms appear very quickly, within a few days. If the fungus enters the chest lymph nodes, their enlargement may lead to obstruction of the trachea, bronchi, and even blood vessel thrombosis.

Chronic lung histoplasmosis is more common in men. Here, apart from the above symptoms, we can also mention weight loss and hemoptysis, which requires differentiation from tuberculosis. In the case of bacterial superinfection of the cavities in the lungs, lung abscesses form, which may rupture and generalize the disease.

In the pulmonary form, chest X-rays describe small nodular infiltrates (often with calcifications and fibrosis) and enlarged lymph nodes of the pulmonary cavities. These changes must be differentiated from neoplastic changes.

  • extrapulmonary histoplasmosis

Usually affects the eyes or the mediastinum. Ocular histoplasmosis can cause blindness. Mediastinal histoplasmosis can compress the airways or large vessels.

  • generalized histoplasmosis

This character manifests itself in malaise, significant increasing weakness, lack of appetite, weight loss, fever with chills. Physical examination describes features of respiratory tract involvement, liver enlargement and spleen enlargement, and oral mucosa involvement.

Anemia is noticeable in additional tests - bone marrow involvement with pancytopenia is common.

There are also skin changes - erythema and ulcerations.

In some cases, the central nervous system may be affected, which causes headaches, impaired consciousness.

In most cases, the lesions cover the gastrointestinal mucosa along its entire length. Kidney involvement may occur.

The chest X-ray usually describes segmental interstitial infiltrates, which then form cavities.

Histoplasmosis (Darling's disease): diagnosis

In order to diagnose histoplasmosis, it is necessary to collect a sputum culture or mucosal ulceration or to perform a histopathological examination of the specimen taken from the affected organ.

In the generalized form, it is sometimes possible to diagnose histoplasmosis in peripheral blood or cerebrospinal fluid preparations. Small oval buds, present in macrophages, are described then.

Histoplasmosis (Darling's disease): treatment

Usually treated conservatively. In light casesmonitoring is enough.

Others use Amphotericin B for 2-4 weeks or 3-4 months, depending on the drug form, or itraconazole / fluconazole (least effective in treating histoplasmosis).

The therapy may last up to 1 year in very severe cases.

Surgery may be necessary in situations where there is fibrosis in the mediastinum.

A cured person must be under constant medical observation, because, especially people treated with immunosuppressants, have a tendency to relapse.

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Category:

Infectious diseases