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Dibyendu De
Uttam Kumar Nath


fungal infection, hemophagocytosis syndrome, adrenal failure, cytopenia, bone marrow



Histoplasmosis is a rare fungal disease caused by dimorphic fungi Histoplasma capsulatum. The causative fungus is present in soil, infects through inhalation and manifests in three main types-acute primary, chronic cavitary and progressive disseminated Histoplasmosis. Disseminated Histoplasmosis (DH) is defined as a clinical condition where fungus is present in more than one location. Among the forms of histoplasmosis, DH is the rarest and generally found in immune-compromised individual.

Here we are presenting our experiences of the series of cases of Disseminated Histoplasmosis in immune-competent individuals who have been diagnosed in our institute in last 5 years.

Materials and methods:

This is a single centre retrospective observational study, from May 2009 to April 2014. Only cases with Disseminated Histoplasmosis in otherwise healthy immune-competent individuals were included in the study. The Histoplasmosis is confirmed by either presence of Histoplasma in biopsy specimen from extra-pulmonary organ or by positive growth in fungal culture


Total seven patients met the inclusion criteria. Five out of 7 patients were male. The mean age was 35 years. Five of the 7 patients presented with fever for long duration. Six patients complained of significant weight loss before diagnosis. On examination, one patient had skin nodules, five patients had hepato-splenomegaly, and two patients had lymphadenopathy.

The laboratory investigation revealed anaemia in six out of 7 patients, and pancytopenia in 3 patients. Two patients had features of hemophagocytic syndrome in the bone marrow.

All of the patient had undergone treatment with conventional amphotericine B  deoxy-cholate and azole antifungal. One patient with adrenal involvement died in hospital. The patient with skin nodule had recurrent relapses. The other patients had resolution of symptoms and clinically cured.


Disseminated Histoplasmosis is not an uncommon etiology of fever of prolonged duration even in immuno-competent individual, and should be kept as a differential diagnosis. Targeted investigation with early bone marrow biopsy and fungal culture may help in diagnosis of DH. Imaging study to exclude adrenal involvement prevents case fatality in DH. Cytopenia may be due to secondary hemophagocytic syndrome, which improves with anti-fungal therapy. Treatment with either amphotericine B or itraconazole gives excellent outcome, though therapy may have to given for prolonged period in case of relapses.



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1. Dodd K, Tompkins EH. A case of histoplasmosis of Darling in a infant. Am J Trop Med 1934; 14:127-137

2. Chang RC, Susanto I. Histoplasmosis. e-medicine J. available from http://www.emedicine.com/med/topic1021. 2007. Accessed 26 Jan 2012.

3. Harrison’s Principle of Internal Medicine

4. Sane SY, Patel MG, Patel BM, Kokal KK (1983) Disseminated histoplasmosis (a case report). J Postgrad Med 29:270–273

5. Sanyal M, Thammayya A. Histoplasma capsulatum in the soil of Gangetic Plain in India. Indian J Med Res 1975;63:1020- 8.

6. Panja G, Sen S . A unique case of histoplasmosis. J Ind Med Assoc 1954;23:257.

7. R andhawa HS, Khan ZU. Histoplasmosis in India: Current Status Indian J Chest Dis Allied Sci 1994;36:193-213.

8. S Subramanian, OC Abraham, Priscilla Rupali, A Zachariah, Mary S Mathews, D Mathai. Disseminated Histoplasmosis J Assoc Physicians India 2005;53:185-9

9. Gopalakrishnan R, Senthur Nambi P, Ramasubramanian V, Abdul Ghafur K, Parameswaran A. Histoplasmosis in India: truly uncommon or uncommonly recognized? J Assoc Physicians India. 2012;60:25–28

10. Symmers WS. Histoplasmosis in southern and south-eastern Asia. A syndrome associated with a peculiar tissue form of Histoplasma : A study of 48 cases. Ann Soc Belg Med Trop 1972;52:435-52.

11. Goodwin Jr RA, Shapiro JL, Thurman GH, et al: Disseminated histoplasmosis: Clinical and pathologic correlations. Medicine (Baltimore) 1980;59:1-31.

12. Kurtin PJ, McKinsey D S, Gupta M R, Driks M. Histoplasmosis in patients with Acquired Immunodeficiency Syndrome- Hematologic and Bone marrow manifestations. Am J Clin Pathol 1990;367-372.

13. Prasad Rao Koduri, et al Reactive Hemophagocytic Syndrome: A New Presentation of Disseminated Histoplasmosis in Patients with AIDS Clin Infect Dis. (1995) 21 (6): 1463-1465

14. Johnson P, Wheat L J, Cloud G, Thomas C, Dismukes W, Goldman M, et al. A Multicenter randomized trial comparing Amphotericin B(AmB) and liposomal Amphotericin B (AmBisome, LamB) as induction therapy of disseminated histoplasmosis in AIDS patients [abstract 232].Presented at the 7th Conference on retroviruses and Opportunistic Infections. San Francisco CA, January 31,2000