Infectious, in particular, fungal diseases are by no means a rarity in the modern world. People face similar problems regardless of age, gender and other factors. And quite dangerous is a disease called histoplasmosis.
What it is? What are the symptoms associated with? What complications can lead to? What treatment methods does modern medicine offer? The answers to these questions will be of interest to many readers. After all, it is no secret to anyone that almost any disease is much easier to treat in the early stages.
Histoplasmosis: what is it?
In many countries, patients are faced with a similar diagnosis. So what is histoplasmosis? Immediately it is worth saying that this is a fungal disease in which the pathogen infects mononuclear phagocytes, affecting the functioning of the immune system. This ailment in medicine is also known under the terms "reticuloendothelial cytoplasmosis" and "Darling's disease."
It is worth noting that this disease has a very clear geographical distribution. In Central and South America, as well as in the southwestern regions of the United States, infection is recorded quite often. The disease also occurs in Southeast Asia and Africa. But in Canada, Russia and European countries, this disease is considered quite rare - such cases are recorded most often among tourists who spent a long time in countries at risk. Despite such an insignificant spread of the disease in Russia, it will be useful for each reader to find out what exactly is histoplasmosis. Symptoms, transmission routes, forms and characteristics of the course of the disease are important points that will help to suspect something was wrong and consult a doctor in time.
According to statistics, among men, such a disease occurs twice as often. In addition, children and people with a weakened immune system are more prone to it (in pediatrics there are twice as many cases of this ailment).
Pathogen Description and Transmission Mechanism
In order to understand what histoplasmosis is, you first need to learn more about its causative agent. It is a dimorphic fungus Histoplasma capsulatum. Its tissue form is a small, unicellular organism of a pear-shaped or rounded shape. Dimensions do not exceed 2-4 microns. A characteristic feature of this form is its intracellular location - as a rule, fungi penetrate into macrophages, spleen cells, liver, lymph nodes, etc. Histoplasmosis is a disease that primarily affects the structures of the immune system.
It is worth noting that these microorganisms are not very resistant to the effects of the external environment, however, in the presence of humidity and an appropriate temperature, they can retain the ability to live. Warming up to 55-60 degrees for 45 minutes leads to the death of cell cultures. But the fungi are more resistant to the effects of chloramine, phenol, formalin - their death begins after 15-30 minutes from the beginning of the exposure.
The natural reservoir of these fungi is soil that is contaminated with feces and droppings of infected animals (it can be pigeons, dogs, cats, chickens). For example, abandoned buildings, caves, wells and even air conditioners create excellent conditions for the life of these microorganisms. As a rule, infection occurs by air, when a person inhales dust with fungi. Risk groups include builders, miners, farmers, tourists, geologists, cavers, etc. Direct transmission by contact with an infected person or animal is not observed.
Once in the human respiratory tract, fungal microorganisms acquire a tissue form, as a result of which there is a lesion of the lungs, as well as regional lymph nodes. Further spread of pathogenic agents along with blood flow leads to sensitization of the body, the production of specific antigens, and then to damage to other organs (not observed in all patients).
The main forms of the disease
Immediately it is worth saying that there are several forms in which histoplasmosis can occur. What is it and what are the features and differences of these varieties of the disease?
For example, depending on the course, an acute and chronic form of the disease is distinguished. In acute histoplasmosis, the symptoms appear sharply, the disease develops rapidly. Chronic disease, on the contrary, is sluggish, but often leads to irreversible changes in the tissues.
Most often, the infection affects the respiratory system, resulting in lung histoplasmosis. However, extrapulmonary forms are also possible. In particular, desminuted histoplasmosis is quite dangerous - this is a form of ailment that affects mucous tissues, skin, internal organs and leads to various complications, including arthritis, encephalitis, disorders of the cardiovascular system, etc.
Acute histoplasmosis of the lungs: symptoms
As mentioned earlier, fungal pathogens penetrate the human body along with inhaled dust. That is why the most common is pulmonary histoplasmosis. Symptoms of it largely depend on the state of the patient’s immune system.
The incubation period ranges from 4 to 30 days, although most often the infection is activated 7-14 days after inhalation of pathogenic fungi. In most people, the disease is mild, without causing any serious disturbances. Quite often, patients do not even know about their illness. Histoplasmosis may be accompanied by a slight cough, runny nose, and a short-term fever. Symptoms disappear after a few days, so they are often confused with the common cold.
However, some patients are diagnosed with severe histoplasmosis. What it is? A similar form of the disease is accompanied by more pronounced disorders. First, a fever appears (often the body temperature rises to 41 degrees), as well as some other symptoms of intoxication, including nausea, vomiting, diarrhea. The patient complains of severe sweating, which alternates with severe chills. Weakness, severe headaches, cough with sputum production, which attacks are often accompanied by chest pain. Symptoms of the disease include arthralgia.
After a few days (sometimes even weeks), the fever disappears, but the subfertile body temperature persists. Patients during this period complain of severe weakness and fatigue, loss of appetite, a sharp decrease in body weight.
Chronic form of the disease
In the absence of treatment or improperly conducted therapy, patients sometimes develop chronic histoplasmosis. Symptoms of this disease are most often lubricated. From time to time, patients experience a slight fever, which, however, quickly passes by itself. In addition, the symptoms of the disease include a persistent cough, which is often accompanied by sputum production, and also causes breathing problems.
There are some very serious complications that chronic histoplasmosis can lead to. The X-ray photo above shows that lung tissue changes over time. First, infiltrates are formed in the foci of inflammation, which can disappear or pass into fibrosis. Also, this form of the disease is fraught with the formation of calcifications in the lung tissue. It is worth noting that chronic histoplasmosis is often combined with other equally dangerous diseases, including tuberculosis, leukemia, sarcoidosis, and reticulosis.
Unfortunately, this form of the disease is difficult to treat. As a rule, patients require repeated courses of therapy that help to avoid changes in lung tissue and other complications.
Disseminated Histoplasmosis
This form of the disease is accompanied by a secondary lesion of various organ systems. What does disseminated histoplasmosis look like? Symptoms in the early stages resemble a common cold. First, body temperature rises. Then, patients exhibit standard manifestations of intoxication. Patients complain of body aches and weakness, severe headaches, nausea, vomiting, diarrhea, fatigue, chills. There is also increased sweating.
Common is histoplasmosis of the skin. With a similar condition, skin tissue is affected, which is accompanied by certain symptoms. What exactly does a similar histoplasmosis look like? The photo shows that patients have rashes of different intensities. This can be erythema, hemorrhagic or maculopapular rash, and sometimes furunculosis.
There are other options for the course of the disease. Often, the vital activity of pathogenic microorganisms leads to the development of subcutaneous tissue abscesses, ulcerative stomatitis, pharyngitis, and the appearance of ulcerations on the external genitalia. Histoplasmosis of the eyes is accompanied by a lesion of the conjunctiva and often leads to dangerous complications, up to and including loss of vision.
There are many other complications associated with this form of the disease. Their list includes peritonitis, choroiditis, pericarditis, lymphadenopathy, infectious endocarditis, ulcerative colitis, meningitis, encephalitis, etc.
Chronic, diminished histoplasmosis proceeds more sluggishly - intoxication symptoms are practically absent and patients go to the doctor even if there are lesions of one or another organ system. Nevertheless, in almost every case, such an ailment leads to the development of serious complications.
Features of the course of the disease in children and people with weakened immunity
Even the smallest patients are not immune to a disease called histoplasmosis. Symptoms in children are quite characteristic. At first there is a fever - the body temperature rises to about 38-39 degrees. In addition, you can notice pallor, sometimes even yellowness of the skin, which is associated with some violations in the liver. Some parents also report diarrhea in their child with a rather unpleasant odor. During the examination, an increase in the size of the spleen and liver can be noted.
In most cases, in babies the disease proceeds according to a desinated type. The same applies to patients with a weakened immune system: they have an ailment in very severe forms, so drug therapy is urgently needed.
Separately, it is worth mentioning people with HIV infection, because the immune system in such patients is very weak. In the absence of therapy, everything ends in death in almost 80% of cases. But with well-conducted treatment, this figure decreases to 15%. Unfortunately, patients diagnosed with AIDS cannot be saved - mortality among this group of patients is 100%, since even large doses of the medicine cannot protect against subsequent relapse. That is why patients with the fungal infection we are considering are also recommended to be tested for HIV.
Modern diagnostic methods
Immediately it should be said that only a doctor after a thorough examination can determine the patient's histoplasmosis. Diagnosis of this disease is a long process. Studies here are aimed not only at identifying the causative agent, but also at assessing the damage caused to the body by infection.
The diagnosis is confirmed after isolation of Histoplasma capsulatum strain from samples. For analysis, sputum from the respiratory tract, as well as rinsing water from the bronchi, are suitable. With the disseminated form of the disease, the pathogen can be found in the blood, feces, urine, cerebrospinal fluid, the content of abscesses. The laboratory conducts bacteriological culture on a nutrient medium.
In some cases, a biopsy of the lymph nodes or bronchi is required, as well as tissue sampling from the edges of the skin ulcers - the collected samples are then amenable to histological examination.
These are far from all the methods by which histoplasmosis can be detected. Diagnosis often involves conducting serotological reactions, as well as an intradermal test with histoplasmin.
In addition, other studies are being conducted to help determine the condition of the body. For example, radiography of the lungs makes it possible to see large- and medium-focal infiltrates, which are characteristic of the acute stage of the disease.
Disease treatment
What to do if you have histoplasmosis? Treatment in this case is selected individually. Important! In no case should you neglect the advice of a doctor or refuse therapy, as this can lead to very dangerous consequences.
The choice of therapy depends on many factors. It is necessary to take into account the severity of the disease, its form, the degree of damage to various organs, the age of the patient, the state of his immune system, etc.
Mild to moderate histoplasmosis does not require the use of antifungal agents, which in themselves are quite toxic. As a rule, in such cases, patients are recommended bed rest, proper nutrition, and plenty of drinking. Symptomatic therapy can also be carried out , which may include the use of antipyretic drugs, vitamin complexes, antihistamines.
In more severe cases, antifungal therapy is necessary. For this purpose, various drugs are used. The most effective drugs are Ketoconazole, Itraconazole, Amfoglucamin, Amphotericin B. Symptomatic treatment is also necessary. If there are skin or eye lesions, anti-inflammatory drugs are used, often corticosteroids. Since the lungs are the first to suffer from infection, patients are prescribed special medicinal inhalations that help prevent tissue changes and ease the patient’s breathing.
In severe complications, surgical interventions are sometimes required, in particular, removal of the lymphatic corners with a strong abscess, pericardial puncture, prosthetic heart valves (if the infection affects the heart tissue), lung resection for severe complications, etc.
It is worth saying that severe complications with timely and correctly started treatment are observed very rarely and most often among patients with a strongly weakened immune system. For most people, the prognosis is quite favorable - histoplasmosis is easily amenable to medical treatment, and its symptoms decay quite quickly.
Are there effective preventative measures?
Today, many are interested in questions about what constitutes histoplasmosis. Symptoms and treatment, possible complications - this is extremely important information. On the other hand, patients often ask questions about whether it is possible to somehow prevent the onset of the disease.
Unfortunately, there is no specific prophylaxis for this disease - there are currently no vaccines or other medications. Histoplasmosis of the lungs, as well as any other form of the disease, is very dangerous. Therefore, it is imperative to observe safety precautions and personal hygiene.
For example, during construction and earthworks, you need to think about protecting the respiratory tract with masks, respirators, etc. The same applies to workers in poultry farms and other agricultural institutions. We must not forget to wash the fruit, especially when it comes to products brought from countries where this infection is common.
The same rules apply to tourists. In the presence of certain impairments, you should consult a doctor as soon as possible, since the sooner treatment is started, the lower the likelihood of developing unpleasant complications.
Histoplasmosis in animals and its features
Not only a person is susceptible to this infection. Animals often suffer from such a disease, and this is found both in the wild and among pets. It is immediately worth saying that the transmission of the pathogen in direct contact with the animal is impossible, since fungi are excreted into the external environment along with feces. Nevertheless, during the treatment of a pet, one must carefully observe the rules of personal hygiene (especially for children).
To consider the clinical picture, we can consider the course of the disease in felines. So what does histoplasmosis look like in cats? Symptoms of it are not always possible to recognize from the first day.
As a rule, a fever first appears. The pet becomes weak, often sleeps, does not move much. As the disease develops, one can observe a deterioration in appetite, vomiting, and fairly rapid weight loss. Often, animals develop anorexia, which further requires additional therapy.
There are some other symptoms. In particular, an increase in lymph nodes, pallor of mucous membranes, difficulty in breathing, and the appearance of abnormal sounds from the lungs can be noted. Sometimes sick animals also suffer from dehydration. On examination, the veterinarian may notice an enlarged liver. Nevertheless, the final diagnosis can be made only after analysis, when this fungus is found in cultures when laboratory inoculation is performed.
Animals can also develop a disseminated form, which, as a rule, is manifested by lesions of the skin, eyes, ulcerations of the mucous membranes, and a malfunction of internal organs.
Histoplasmosis in cats is treated with antifungal drugs. In particular, Ketoconazole and Intraconazole are considered quite effective. In some cases, additional rehabilitation therapy will be required, especially if serious nutritional problems have occurred amid the infection. The prognosis for most pets is favorable, especially if help was provided to the animal on time. But, unfortunately, at later stages, histoplasmosis is difficult to treat - relapses and complications in the form of pathologies of the digestive system, heart, and brain are possible.