![]() Pulmonary histoplasmosis may progress to a systemic infection. Within a few days, histoplasmosis can reach a fatality rate of 100% if not treated aggressively and appropriately. However, the infection in immunocompromised hosts disseminated histoplasmosis progresses very aggressively. Non-immunocompromised patients present with a self-limited respiratory infection. In our case, the patient did travel outside of Nebraska within the last year and owned two birds these are her primary increased risk factors. Likewise, ownership of pet birds increases the rate of inoculation. have grown particularly well in organic matter enriched with bird or bat excrement, leading to the association that spelunking in bat-feces-rich caves increases the risk of infection. Infection ranges from an asymptomatic illness to a life-threatening disease, depending on the host’s immunological status, fungal inoculum size, and other factors. However, the precise mechanism of reactivation in chronic carriers remains unknown. The finding that individuals who have moved or traveled from endemic to non-endemic areas may exhibit a reactivated infection after many months to years supports this long-term viability. Infected individuals may harbor many yeast-forming colonies chronically, which remain viable for years after initial inoculation. Human-to-human transmission has not been reported. Inhalation from soil is a major route of transmission leading to infection. This transition is an important determinant in the establishment of infection. The mycelial phase is present at ambient temperature in the environment, and upon exposure to 37 C, such as in a host’s lungs, it changes into budding yeast cells. ![]() Histoplasmosis is caused by inhaling the microconidia of Histoplasma spp. Histoplasmosis, also known as Darling disease, Ohio valley disease, reticuloendotheliosis, caver's disease, and spelunker's lung, is a disease caused by the dimorphic fungi Histoplasma capsulatum native to the Ohio, Missouri, and Mississippi River valleys of the United States. The two phases of Histoplasma are the mycelial phase and the yeast phase. ![]() Respiratory: She has diffuse rales and mild wheezing tachypneic.Ĭardiovascular: She has a regular rate and rhythm with no murmurs, rubs, or gallops. She is conversing freely, with respiratory distress causing her to stop mid-sentence. General: She is well appearing but anxious, a pleasant female lying on a hospital stretcher. Vitals: Temperature, 97.8 F heart rate 88 respiratory rate, 22 blood pressure 130/86 body mass index, 28 Medications: Lisinopril 10 mg by mouth every day She traveled to Mexico for a one-week vacation one year ago.Īllergies: No known medicine, food, or environmental allergies. She denies alcohol and illicit drug use. She is in a married, monogamous relationship and has three children aged 15 months to 5 years. Social History: Her tobacco use is 33 pack-years however, she quit smoking shortly prior to the onset of symptoms, six months ago. She admits a cough, shortness of breath, and shortness of breath on exertion. A brief review of systems is negative for fever, night sweats, palpitations, chest pain, nausea, vomiting, diarrhea, constipation, abdominal pain, neural sensation changes, muscular changes, and increased bruising or bleeding. She denies camping, spelunking, or hunting activities. She reports a 20-pound (9 kg) intentional weight loss over the past year. This management did not improve her symptoms, and she has gradually worsened over six months. ![]() She reports that she was seen for similar symptoms previously at her primary care physician’s office six months ago. At that time, she was diagnosed with acute bronchitis and treated with bronchodilators, empiric antibiotics, and a short course oral steroid taper. History of Present Illness: A 33-year-old white female presents after admission to the general medical/surgical hospital ward with a chief complaint of shortness of breath on exertion.
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