, Volume 180, Issue 5–6, pp 359–364 | Cite as

An Unusual Presentation of Disseminated Histoplasmosis: Case Report and Review of Pediatric Immunocompetent Patients from India

  • Poojan Agarwal
  • Malini R. Capoor
  • Mukul Singh
  • Arpita Gupta
  • Arini Chhakchhuak
  • Pradeep Debatta


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.


Disseminated 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. 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
  2. 2.
    Adderson EE. Histoplasmosis in a pediatric oncology center. J Pediatr. 2004;144(1):100–6.CrossRefPubMedGoogle Scholar
  3. 3.
    Brodsky AL, Gregg MB, Lowenstein MW, Kaufman L, Mallison GF. Outbreak of histoplasmosis associated with the 1970 Earth Day activities. Am J Med. 1970;54:333–42.CrossRefGoogle Scholar
  4. 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. 5.
    Histoplasmosis KR. The Madras. Clin J. 1966;3:81.Google Scholar
  6. 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
  7. 7.
    Mukherjee AM, Khan KP, Sanyal M, Basu N. Histoplasmosis in India with report of two cases. J Indian Med Assoc. 1971;56:121–5.PubMedGoogle Scholar
  8. 8.
    Mukherjee AK, Mukherjee D, Mukhopadhyay M. Histoplasmosis in India: a clinicopathological review with report of a case in a child. Indian J Pathol Microbiol. 1986;29:263–70.PubMedGoogle Scholar
  9. 9.
    Dhawan J, Verma P, Sharma A, et al. Disseminated cutaneous histoplasmosis in an immunocompetent child, relapsed with itraconazole, successfully treated with voriconazole. Pediatr Dermatol. 2010;27:549–51.CrossRefPubMedGoogle Scholar
  10. 10.
    Kathuria S, Capoor MR, Yadav S, Singh A, Ramesh V. Disseminated histoplasmosis in an apparently immunocompetent individual from north India: a case report and review. Med Mycol. 2013;51:774–8.CrossRefPubMedGoogle Scholar
  11. 11.
    Kathuria S, Singh Pradeep K, Meis JF, Chowdhary A. In vitro antifungal susceptibility profile and correlation of mycelia and yeast forms of molecularly characterized Histoplasma capsulatum strains from India. Antimicrobial Agents Chemother. 2014;58:5613–6.CrossRefGoogle Scholar
  12. 12.
    Vishwanathan R, Chakravarty SC, Randhawa HS, deMonte AJH. Pilot histoplasmosis survey in Delhi area. Br Med J. 1960;1:399–400.CrossRefGoogle Scholar
  13. 13.
    Subramanian S, Abraham OC, Rupali P, Zachariah A, Mathews MS, Mathai D. Disseminated histoplasmosis. JAPI. 2005;53:185–9.PubMedGoogle Scholar
  14. 14.
    Anstead GM, Patterson TF. Endemic mycoses. In: Aaisse EJ, McGinnis MR, Pfaller MA, editors. Clinical mycology. Philadelphia: Churchill Livingstone, Elsevier; 2009. p. 355–73.CrossRefGoogle Scholar
  15. 15.
    Gurney JW, Conces DJ. Pulmonary histoplasmosis. Radiology. 1996;199:297–306.CrossRefPubMedGoogle Scholar
  16. 16.
    Bradsher RW. Histoplasmosis and blastomycosis. Clin Infect Dis. 1996;22(suppl 2):S102–11.CrossRefPubMedGoogle Scholar
  17. 17.
    Kurowski R, OstapchuK. Overview of histoplasmosis. Am Fam Phys. 2002;66(12):2247–52.Google Scholar
  18. 18.
    Tan JS, File TM Jr, Salata RA, Tan MJ, editors. Expert guide to infectious diseases. Philadelphia: ACP Press; 2008.Google Scholar
  19. 19.
    Elin RJ, Whitis J, Snyder J. Infectious disease diagnosis from a peripheral blood smear. Lab Med. 2000;31:324–8.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media Dordrecht 2015

Authors and Affiliations

  • Poojan Agarwal
    • 1
  • Malini R. Capoor
    • 2
  • Mukul Singh
    • 1
  • Arpita Gupta
    • 3
  • Arini Chhakchhuak
    • 3
  • Pradeep Debatta
    • 3
  1. 1.Department of Pathology, Safadarjung HospitalVardhmaan Mahavir Medical CollegeDelhiIndia
  2. 2.Department of Microbiology, Safadarjung HospitalVardhmaan Mahavir Medical CollegeDelhiIndia
  3. 3.Department of Pediatrics, Safadarjung HospitalVardhmaan Mahavir Medical CollegeDelhiIndia

Personalised recommendations