Acute pulmonary histoplasmosis is a respiratory infection caused by inhaling the spores of the fungus Histoplasma capsulatum.
Histoplasma capsulatum, the fungus that causes histoplasmosis, is found in the Central and Eastern United States, Eastern Canada, Mexico, Central America, South America, Africa, and Southeast Asia. It is commonly found in the soil along river valleys. It gets into the soil mostly from bird and bat droppings.
You can get sick when you breathe in spores produced by the fungus. Every year, thousands of people worldwide are infected, but do not become seriously sick. Most people have no symptoms or have only a mild flu-like illness and recover without any treatment.
Acute pulmonary histoplasmosis may happen as an epidemic, with many people in one geographical area becoming sick at the same time. In people with impaired immune systems, such as those with HIV, the disease can continue to get worse.
Risk factors include traveling to or living in the Central or Eastern United States near the Ohio and Mississippi River Valleys, and being exposed to the droppings of birds and bats. This threat is greatest after an old building is torn down, or when exploring caves. Having a weakened immune system increases your risk for getting or reactivating the disease, and for having more and worse symptoms.
Most people with acute pulmonary histoplasmosis have no or mild symptoms. The most common symptoms are:
In the very young, elderly, or people with a compromised immune system, symptoms may be more severe, including:
To diagnose histoplasmosis, the doctor needs to find the fungus or fungal products in the body, or evidence that your immune system is reacting to the fungus.
Most cases of histoplasmosis clear up without specific treatment. Patients are advised to rest and take medication to control fever.
If you are sick for more than 4 weeks, immunocompromised, or are having breathing problems, your doctor may prescribe medication. Drugs used to treat this condition include itraconazole and amphotericin B.
When histoplasmosis infection is severe or gets worse, the illness may last for 1 to 6 months. Even then, it is rarely fatal.
It can be a serious illness in people with weak immune systems, such as those who:
Acute pulmonary histoplasmosis can get worse over time, or can become chronic pulmonary histoplasmosis (which doesn't go away).
Histoplasmosis can spread to other organs through the bloodstream (dissemination). This is usually seen in infants, young children, and patients with a suppressed immune system.
Call your health care provider if:
Avoid contact with bird or bat droppings if you are in an area where the spore is common, especially if you have a weakened immune system.
Deepe GS Jr. Hisoplasma capsulatum. In Mandell GL, Bennett JE, Dolin R, eds. Principles and Practice of Infectious Diseases. Philadelphia, Pa: Elsevier Churchill Livingstone; 2009:chap 264.
Kauffman CA. Histoplasmosis. In: Goldman L, Ausiello D, eds. Cecil Medicine. 24th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 340.
Waht LJ, Freifeld AG, Kleiman MB, et al. Clinical practice guidelines for the management of patients with histoplasmosis: 2007 update by the Infectious Diseases Society of America. Clin Infect Dis. 2007; 45(7):807-825.
Updated by: Jatin M. Vyas, MD, PhD, Assistant Professor in Medicine, Harvard Medical School; Assistant in Medicine, Division of Infectious Disease, Department of Medicine, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M. Health Solutions, Ebix, Inc.
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