An Unusual Presentation of Disseminated Histoplasmosis: Case Report and Review of Pediatric Immunocompetent Patients from India
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Histoplasmosis is a progressive disease caused by dimorphic intracellular fungi and can prove fatal. Usually, it is present in immunocompromised individuals and immunocompetent individuals in the endemic zones. We report an unusual presentation of progressive disseminated histoplasmosis. The patient in the present case report was immunocompetent child and had fever, bone pains, gradual weight loss, lymphadenopathy and hepatosplenomegaly. Disseminated histoplasmosis (DH) was diagnosed on microscopic examination and fungal culture of bone marrow, blood, skin biopsy and lymph node aspirate. The patient died on seventh day of amphotericin B. In the absence of predisposing factors and classical clinical presentation of febrile neutropenia, lung, adrenal and oropharyngeal lesions, the disease posed a diagnostic challenge. Progressive disseminated histoplasmosis in children can be fatal despite timely diagnosis and therapy. In India, disseminated histoplasmosis is seen in immunocompetent hosts. All the pediatrics immunocompetent cases from India are also reviewed.
KeywordsDisseminated histoplasmosis (DH) Immunocompetent hosts Children Complications
The authors acknowledge the help of Dr (Prof.) Arunaloke Chakrabarti and Dr M. R. Shivaprakash, National Culture Collection of Pathogenic Fungi, PGIMER, Chandigarh, India, for reconfirming the isolate by DNA sequencing. The authors also acknowledge the help of Late Mrs. Kamlawati, Senior Technician, Department of Microbiology, V.M.M.C and Safdarjung Hospital, Delhi, India, for her technical expertise in the case.
- 1.Reiss E, Shadomy HJ, Lyon GM III. Histoplasmosis. In: Reiss E, Shadomy HJ, Lyon III GM, editors. Fundamental medical mycology. New Jersey: Wiley-Blackwell Publication; 2012. p. 165–86.Google Scholar
- 4.Kleinman MB. Histoplasma capsulatum (histoplasmosis). In: Long SS, Pickering LK, Prober CG, editors. Principle and practice of infectious diseases. Philadelphia: Churchill Livingstone (Elsevier); 2003.Google Scholar
- 5.Histoplasmosis KR. The Madras. Clin J. 1966;3:81.Google Scholar
- 6.Chakravorty SC, Damodaran VN, Abraham S. Histoplasmosis in childhood in India (a case report with family study). Indian J Chest Dis. 1968;10:204.Google Scholar
- 17.Kurowski R, OstapchuK. Overview of histoplasmosis. Am Fam Phys. 2002;66(12):2247–52.Google Scholar
- 18.Tan JS, File TM Jr, Salata RA, Tan MJ, editors. Expert guide to infectious diseases. Philadelphia: ACP Press; 2008.Google Scholar