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Histoplasmosis, disseminated in HIV patient
Histoplasmosis, disseminated in HIV patient


Definition:

Skin lesions of histoplasmosis are a symptom of widespread infection with the fungus Histoplasma capsulatum.



Causes, incidence, and risk factors:

Histoplasmosis is a fungal infection. It occurs all over the world.

Histoplasma fungus grows in soil. When particles become airborne they can be breathed into the lungs, causing infection. Soil contaminated with bird or bat droppings may have a higher concentration of the fungus.

After infecting the lungs, the fungus travels (disseminates) to distant organs throughout the body, including the skin, the bone marrow, and the brain. This is most common in immunosuppressed people, such as those with AIDS or cancer, or who've had a transplant.

Skin lesions can be caused by an immune response to the infection (usually a rash called erythema nodosum or erythema multiforme ), or by the fungus itself when it spreads to the skin.



Symptoms:

The symptoms may include:

  • Mouth ulcer, usually painless
  • Pustules or nodules all over the body
  • Symptoms related to the erythema nodosum and erythema multiforme rashes


Signs and tests:

In some cases, a biopsy of the skin lesion can identify the fungus. On the other hand, erythema nodosum and erythema multiforme are inflammatory reactions and usually do not have fungus in them. A urine test may help detect the fungus in some cases.



Treatment:

Anti-fungal drugs, such as amphotericin B, itraconazole, and ketoconazole, are the usual treatments. Anti-fungals may be given intravenously depending on the form or stage of disease. In some cases, long-term treatment with anti-fungal drugs may be needed.



Support Groups:



Expectations (prognosis):

The outlook depends on the form of histoplasmosis and the condition of the individual's immune system. Death can occur in some cases.



Complications:
  • Bacterial skin infection
  • Complications of medications (for example, amphotericin B can have severely unpleasant side effects)


Calling your health care provider:

The skin lesions may be similar to skin problems from other infections or illnesses. Notify your health care provider if you develop any suspicious lesions on your skin, so that you may be tested correctly.



Prevention:

Histoplasmosis may be prevented by reducing exposure to dust in chicken coops, bat caves, and other high-risk locations. Wear masks and other protective equipment if you work in these environments.



References:

Kauffman CA. Histoplasmosis. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007: chap 353.




Review Date: 9/28/2008
Reviewed By: David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine; Jatin M. Vyas, MD, PhD, Instructor in Medicine, Harvard Medical School, Assistant in Medicine, Division of Infectious Disease, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
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