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ISSN: 2165-7920

Journal of Clinical Case Reports
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3rd Euro-Global Experts Meeting on Medical Case Reports
June 30-July 02, 2016 Valencia, Spain

Sowmya Nanjappa
University of South Florida, USA
Posters & Accepted Abstracts: J Clin Case Rep
DOI: 10.4172/2165-7920.C1.009
Introduction: Histoplasmosis/Ohio valley disease is associated with exposure to soil contaminated with bird or bat droppings. It presents as acute/chronic pulmonary and disseminated forms. It is associated with very high mortality among immunocompromised patients. Possible complications include ARDS, Meningitis, pericarditis and adrenal insufficiency. Diagnosis is by direct tissue staining, serology, cultures and detection of antigen. We studied 18 cases of culture positive histoplasmosis at SLUH (St Louis University Hospital), a 356 bed teaching hospital from 2009-2013. Methods: Using EMR, we retrospectively studied patients >18 years with culture positive Histoplasma. We collected data regarding demographics, underlying immunodeficiency states, clinical features, lab findings, treatment and outcomes. Results: The average age at diagnosis was 49.1 years. 15/18 (83.3%) were males. 8/18 (44.4%) had AIDS and 8/18 (44.4%) were immunocompromised with transplant and cancer. 16/18 (88.8%) had disseminated histoplasmosis. Common presenting symptoms included, fever 13/18 (72.2%), GI symptoms 12/18 (66.6%), fatigue 10/18 (55.5%). Positive blood cultures were found in 15/18 (82.2%). Of the 18, we tested 15 (82.2%) for urine histoplasma antigen of which 9 (60%) tested positive. The most common radiological findings were nodules 11/18 (61.1%) and lymphadenopathy 9 (50 %). Of 18 patients, 15 were treated and amongst them 13 (86.6%) were adherent to IDSA guidelines. In hospital mortality was 16.6%. 80% patients followed up in ID clinic were treated successfully at one year. Conclusion: The study suggested that histoplasmosis is more common amongst middle aged men. Importantly, patients with histoplasmosis should be a screened for Immunocompromised states like HIV or immunosuppressive drugs. Common symptoms are fever, GI symptoms and fatigue. Blood culture was the best test for the diagnosis of histoplasmosis. Main radiological findings were pulmonary nodules and lymphadenopathy. Majority of the treated patients were adherent to the IDSA guidelines of treatment. In hospital mortality was found to be 16.6%. Most (80%) of the patients followed up in ID clinic were treated successfully at one year.


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