Histoplasmosis history and symptoms

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Aravind Kuchkuntla, M.B.B.S[2]


Majority of the patients are asymptomatic and few develop acute pulmonary histoplasmosis presenting with fever, cough and dyspnea. Few patients develop rheumatological symptoms such as erythema nodosum and symmetrical joint pain. Severe form of disseminated histoplasmosis presents with features of sepsis, acute respiratory distress syndrome and disseminated intravascular coagulation.

History and Symptoms

Acute Pulmonary Histoplasmosis

It is an acute self-limiting illness in patients exposed to the organism for the first time or the patient is exposed to a large amount of inoculum or is exposed to virulent strains of histoplasma. The symptoms of an acute infection include the following:[1][2][3]

Chronic Cavitatory Pulmonary Histoplasmosis

It is usually seen in elderly patients with emphysema and presents with the following symptoms:

Granulomatous Mediastinitis

Majority of patients with mediastinal lymph node involvement are asymptomatic but few patients present with symptoms resulting from compression on the esophagus, superior vena cava and bronchus, which include:

Mediastinal Fibrosis

It is a complication of histoplasma infection of the mediastinal structures resulting in fibrosis and causing compression of the surrounding structures in the mediastinum. The symptoms of fibrosis include the following:


In patients with calcified nodules bursting into the bronchus present with features of bronchial obstruction and inflammation. The features include the following:

  • Lithoptysis:
    • Spitting of tiny pieces of gravel like particles.
  • Dyspnea
  • Hemoptysis
  • Cough
  • Occasional wheezing can be present with significant airway obstruction.

Chronic Progressive Disseminated Histoplasmosis

Disseminated Histoplasmosis

It is seen in patients with risk factors resulting in a weakened immune system. Clinical features of disseminated histoplasmosis include the following: [4]


  1. Goodwin RA, Owens FT, Snell JD, Hubbard WW, Buchanan RD, Terry RT; et al. (1976). "Chronic pulmonary histoplasmosis". Medicine (Baltimore). 55 (6): 413–52. PMID 792626.
  2. Chiller, TM. Chapter 3 Infectious Diseases Related to Travel. Histoplasmosis. Available at: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseases-related-to-travel/histoplasmosis. Accessed February 2, 2016.
  3. Kumari M, Udayakumar M, Kaushal M, Madaan GB (2017). "Unusual presentation of disseminated histoplasmosis in an immunocompetent patient". Diagn Cytopathol. doi:10.1002/dc.23742. PMID 28474430.
  4. Zhang Y, Su X, Li Y, He R, Hu C, Pan P (2016). "[Clinical comparative analysis for pulmonary histoplasmosis and progressive disseminated histoplasmosis]". Zhong Nan Da Xue Xue Bao Yi Xue Ban. 41 (12): 1345–1351. doi:10.11817/j.issn.1672-7347.2016.12.016. PMID 28070050.
  5. Nasa M, Patel N, Lipi L, Sud R (2017). "Gastrointestinal Histoplasmosis and CMV Co-Infection in an Immunocompetent Host". J Assoc Physicians India. 65 (2): 94–95. PMID 28457046.
  6. Rog CJ, Rosen DG, Gannon FH (2016). "Bilateral adrenal histoplasmosis in an immunocompetent man from Texas". Med Mycol Case Rep. 14: 4–7. doi:10.1016/j.mmcr.2016.11.006. PMC 5154969. PMID 27995051.
  7. Sachdev R, Goel RK, Malviya S, Goel S, Gajendra S (2017). "Scrotal Histoplasmosis Masquerading as Fournier's Gangrene". Int J Surg Pathol: 1066896916687078. doi:10.1177/1066896916687078. PMID 28112039.
  8. Hariri OR, Minasian T, Quadri SA, Dyurgerova A, Farr S, Miulli DE; et al. (2015). "Histoplasmosis with Deep CNS Involvement: Case Presentation with Discussion and Literature Review". J Neurol Surg Rep. 76 (1): e167–72. doi:10.1055/s-0035-1554932. PMC 4520962. PMID 26251798.