obsolete Histoplasma duboisii pericarditis

Obsolescence of Histoplasma duboisii Pericarditis

Histoplasma duboisii pericarditis, a rare and usually self-limited condition, has been largely considered an outdated concept in modern medicine. The distinction between Histoplasma capsulatum var. duboisii (Hcd) and Histoplasma capsulatum var. capsulatum (Hcc) has become increasingly complex, leading to a reevaluation of the epidemiology and therapeutic management of histoplasmosis.

Historical Context

Histoplasma pericarditis was first described in 1955 by Billings and Couch in a patient with pericardial calcification and positive histoplasmin skin test [11]. Three cases were reported, highlighting the rarity of this condition. However, subsequent studies have shown that histoplasmosis is more common than previously thought, and its manifestations are often diverse.

Current Understanding

The pathogenesis of Histoplasma pericarditis is believed to involve hypersensitivity to antigens from the yeast within mediastinal lymph nodes [1][2]. Pericardial involvement represents an inflammatory response rather than infection, which explains why organisms are not recovered from pericardial fluid and cannot be isolated or cultured from biopsy specimens.

Implications

The obsolescence of Histoplasma duboisii pericarditis as a distinct entity has significant implications for the diagnosis and management of histoplasmosis. Clinicians should consider alternative diagnoses, such as reactive pericarditis or rheumatologic syndromes, when evaluating patients with symptoms suggestive of histoplasmosis.

References

[1] Billings and Couch (1955) - First description of Histoplasma pericarditis [2] Hsu et al. (2024) - Pathogenesis of Histoplasma pericarditis [11-13] Various studies on histoplasmosis and its manifestations

Note: The citations refer to the corresponding search results in the provided context.

Pericarditis in Obsolete Histoplasma duboisii Infections

Pericarditis, an inflammation of the sac surrounding the heart (pericardium), is a known complication of histoplasmosis. Specifically, in cases caused by Histoplasma duboisii, also known as African histoplasmosis, pericarditis can be a significant sign and symptom.

Symptoms of Pericarditis in Histoplasma duboisii

The symptoms of pericarditis in Histoplasma duboisii infections may include:

• Chest pain or discomfort that worsens with deep breathing or coughing
• Shortness of breath (dyspnea)
• Fatigue
• Fever
• Cough

These symptoms can be accompanied by physical examination findings such as:

• A friction rub, a grating sound heard when listening to the heart with a stethoscope
• Muffled heart sounds
• Enlargement of the heart (cardiomegaly)

Radiological Findings

Imaging studies may show:

• Pericardial effusion, an accumulation of fluid in the pericardial sac
• Cardiac tamponade, a life-threatening condition where fluid accumulates in the pericardial sac and compresses the heart

Complications

Pericarditis can lead to complications such as cardiac arrest or death if left untreated.

References:

• [12] Symptoms of disseminated disease include fever, malaise, anorexia, and weight loss. Physical examination will often show hepatosplenomegaly, lymphadenopathy, pallor and petechiae if pancytopenia is present, and, in some patients, mucous membrane ulcerations as well.
• [13] The mildest forms of histoplasmosis cause no signs or symptoms. But severe infections can be life-threatening. When signs and symptoms occur, they usually appear 3 to 17 days after exposure and can include: ... Inflammation of the sac that surrounds your heart (pericardium) is called pericarditis.
• [14] Histoplasma capsulatum var. capsulatum (Hcc) and Histoplasma capsulatum var. duboisii (Hcd), 2 variants of this fungus can infect humans and cause, classical or American histoplasmosis and African ...

Treatment Options for Obsolete Histoplasma duboisii Pericarditis

According to the available information, the standard treatment for H. duboisii infections is amphotericin B (1 mg/kg per day) with a minimum cumulative dose of 2 g [7]. However, it's essential to note that this information might be outdated.

For severe histoplasmosis, amphotericin B was recommended as initial therapy, followed by itraconazole as consolidation therapy [9]. Long-term treatment for at least 12 months with itraconazole is also suggested for patients with severe disease [9].

It's worth mentioning that the likely cause of pericarditis in H. duboisii infections is the granulomatous inflammatory response mounted in mediastinal lymph nodes adjacent to the pericardium [6]. However, this information does not provide specific treatment options.

Current Treatment Guidelines

Unfortunately, there is limited information available on current treatment guidelines for obsolete Histoplasma duboisii pericarditis. The recommended treatments mentioned above might be outdated or no longer applicable.

If you're looking for the most up-to-date information on treating H. duboisii infections, it's essential to consult a healthcare professional or a medical resource that provides current guidelines and recommendations.

References

[7] O Lortholary · 1999 · Cited by 178 — Histoplasma duboisii infections. [6] The likely cause of the pericarditis is the granulomatous inflammatory response that is mounted in mediastinal lymph nodes adjacent to the pericardium. However, ... [9] by MA Man · 2023 · Cited by 1 — For severe histoplasmosis, amphotericin B is recommended as initial therapy, followed by itraconazole as consolidation therapy. Long-term treatment for at least ...

The differential diagnosis of histoplasmosis, specifically for Histoplasma duboisii pericarditis, involves considering other conditions that may present with similar symptoms. According to the search results, the following conditions should be considered in the differential diagnosis:

• Leishmania species: These parasites are similar in size to H. duboisii and have one kinetoplast, which can make them difficult to distinguish from each other [14].
• Other causes of mediastinal granuloma, such as:
  • Lymphomas
  • Sarcoidosis
  • Mycobacterial infections [6]
• Pericarditis caused by rheumatological conditions or other pericardial diseases [14]

It's worth noting that the diagnosis of histoplasmosis is typically made through a combination of clinical, radiographic, and laboratory evidence, including biopsy, smears, and cultures taken from skin or bone lesions [4]. However, in cases where H. duboisii pericarditis is suspected, it's essential to consider these alternative conditions as part of the differential diagnosis.

References:

[4] The diagnosis is made by biopsy, smears, and cultures taken from skin or bone lesions. H. duboisii are larger than H. capsulatum, measure 8 to 15 µm in diameter ... [6] Nov 27, 2010 — Lymphomas, sarcoidosis, and mycobacterial infections must be differentiated from disseminated histoplasmosis. [14] For Histoplasma capsulatum var. duboisii, many features remain undiscovered as ... The differential diagnosis includes Leishmania species, which is similar in size but has one kinetoplast [3, 6, ... (pericarditis, rheumatological), Culture Pulmonary tissue or secretions (LBA, sputum) x x x x