HISTOPLASMOSIS

General Information

DEFINITION--A fungus infection confined mostly to people who live in eastern and midwestern parts of the U.S. Most cases are minor and go undiagnosed.

BODY PARTS INVOLVED--Lungs; central nervous system; gastrointestinal system.

SEX OR AGE MOST AFFECTED--Both sexes; all ages.

SIGNS & SYMPTOMS

• Persistent cough and other symptoms similar to a cold.
• Loss of appetite, diarrhea and weight loss.
• Fever; headache.
• Irritability.
• Paleness.
• Abdominal swelling.
• Breathing difficulty (rare).

CAUSES--Infection by the fungus, Histoplasma capsulatum. People become infected by breathing dust that contains fungus spores. The fungus is found in soil contaminated by feces of birds and bats that carry the fungus. Contaminated soil is most often in pigeon lofts, barns, chicken houses, damp areas under bridges, along streams and in caves.

RISK INCREASES WITH

• Recent severe illness, especially uremia, diabetes mellitus, chronic lung disease, cancer or severe burns.
• Geographic location. The disease occurs most often in the western Appalachian slopes and the Mississippi, Missouri and Ohio River valleys. Millions of people living in these areas have been infected, but never experience symptoms or they are so mild, they go unrecognized.
• Use of immunosuppressive, anticancer or cortisone drugs.

HOW TO PREVENT--Avoid areas where the soil is likely to be infected with histoplasma spores.

What To Expect

DIAGNOSTIC MEASURES--

• Your own observation of symptoms.
• Medical history and physical exam by a doctor.
• Laboratory studies, such as a sputum culture, blood studies, skin tests and chest x-ray.

APPROPRIATE HEALTH CARE

• Self-care after diagnosis.
• Doctor's treatment.
• Hospitalization for complications.

POSSIBLE COMPLICATIONS

• Spread of infection to the heart, spleen, adrenal glands and meninges (membranes that cover the brain). This is rare, but it can be fatal.
• Histoplasmosis often recurs in AIDS patients.

PROBABLE OUTCOME--

• Mild cases usually resolve spontaneously. Most people only feel tired or "bad" for several weeks.
• Severe cases are treatable with antifungal drugs.

How To Treat

GENERAL MEASURES--

• Isolation is not necessary. The disease is not transmitted from person to person.
• Use a cool-mist or ultrasonic humidifier with distilled water and no medicine in it to increase air moisture. This helps thin lung secretions so they can be coughed up more easily. Clean humidifier daily.
• Don't smoke.
• Use warm compresses or a heating pad on the chest to relieve pain.
• Weigh daily and keep a record.

MEDICATION--

• For mild cases, no medicine is usually necessary.
• For severe cases, your doctor may prescribe antifungal drugs (some must be given intravenously in a hospital).
• For AIDS patients with histoplasmosis, chronic therapy with antifungal medication will be necessary.
• You may use non-prescription drugs, such as acetaminophen or aspirin, to relieve pain.

ACTIVITY--Stay in bed until fever, pain and shortness of breath disappear for at least 48 hours. Then resume your normal activities gradually. Many people are fatigued and weak after recovery. Don't expect too much too soon.

DIET--No special diet.

Call Your Doctor If

• You have symptoms of histoplasmosis.
• The following occurs during treatment: Weight loss continues. Fever rises to 101F (38.3C) orally. Diarrhea is uncontrollable. Severe headache and stiff neck begin.