Aug 2026· Journal of the Pediatric Infectious Diseases Society· 0 citations
TL;DR
The importance of recognizing histoplasmosis in high-risk populations and the need for integrated care approaches is emphasized and increased awareness, early clinical suspicion, and access to appropriate diagnostics are essential to improve outcomes.
Abstract
Histoplasmosis is a fungal infection caused by Histoplasma capsulatum, highly endemic in Central and South America, the United States, and Africa. The fungus exists as a mold in the environment and as yeast in human tissue, proliferating in soils contaminated by bird and bat excrement in environments like caves, abandoned buildings, and construction sites. In immunocompetent hosts, histoplasmosis is often asymptomatic, but in immunocompromised individuals, including pediatric patients, it can lead to disseminated disease with severe outcomes. Misdiagnosis as tuberculosis is common, and incidence rates are underreported. Nonspecific symptoms such as fever, fatigue, hepatosplenomegaly, and hematologic abnormalities complicate diagnosis, and the disease disproportionately affects children under 2 years old or those with compromised cellular immunity.
This study reports four pediatric cases of disseminated histoplasmosis from Hospital Escuela in Honduras. Case 1: A 3-year-old male with interleukin-12 receptor deficiency and a history of Mycobacterium bovis infection developed severe disseminated histoplasmosis and succumbed to multiorgan failure. Case 2: A 3-year-old female from a rural area presented with neuroinfection and hydrocephalus; post-mortem analysis confirmed Histoplasma capsulatum. Case 3: A 14-year-old male with previous histoplasmosis presented with reactivation and responded favorably to itraconazole. Case 4: A 6-year-old male with disseminated tuberculosis and histoplasmosis faced disease related complications resulting in death.
Disseminated histoplasmosis in pediatric patients presents unique challenges, particularly in resource-limited settings, where diagnostic tools such as antigen detection, cultures, and molecular techniques may be unavailable. Increased awareness, early clinical suspicion, and access to appropriate diagnostics are essential to improve outcomes. This study emphasizes the importance of recognizing histoplasmosis in high-risk populations and the need for integrated care approaches.
Histoplasmosis is a fungal infection caused by Histoplasma capsulatum, highly endemic in Central and South America, the United States, and Africa. The fungus exists as a mold in the environment and as yeast in human tissue, proliferating in soils contaminated by bird and bat excrement in environments like caves, abandoned buildings, and construction sites. In immunocompetent hosts, histoplasmosis is often asymptomatic, but in immunocompromised individuals, including pediatric patients, it can lead to disseminated disease with severe outcomes. Misdiagnosis as tuberculosis is common, and incidence rates are underreported. Nonspecific symptoms such as fever, fatigue, hepatosplenomegaly, and hematologic abnormalities complicate diagnosis, and the disease disproportionately affects children under 2 years old or those with compromised cellular immunity.
This study reports four pediatric cases of disseminated histoplasmosis from Hospital Escuela in Honduras. Case 1: A 3-year-old male with interleukin-12 receptor deficiency and a history of Mycobacterium bovis infection developed severe disseminated histoplasmosis and succumbed to multiorgan failure. Case 2: A 3-year-old female from a rural area presented with neuroinfection and hydrocephalus; post-mortem analysis confirmed Histoplasma capsulatum. Case 3: A 14-year-old male with previous histoplasmosis presented with reactivation and responded favorably to itraconazole. Case 4: A 6-year-old male with disseminated tuberculosis and histoplasmosis faced disease related complications resulting in death.
Disseminated histoplasmosis in pediatric patients presents unique challenges, particularly in resource-limited settings, where diagnostic tools such as antigen detection, cultures, and molecular techniques may be unavailable. Increased awareness, early clinical suspicion, and access to appropriate diagnostics are essential to improve outcomes. This study emphasizes the importance of recognizing histoplasmosis in high-risk populations and the need for integrated care approaches.
Cinthya Karina Mejía-Escobar, José Roberto Andino, Sandra Montoya et al.· Journal of the Pediatric Inf...· 0 citations
Disseminated histoplasmosis should be considered in patients with prolonged unexplained fever, even in the absence of apparent immunodeficiency, and in selected cases, may help avoid invasive procedures such as bone marrow examination.
Nikunj Mehta, Amar Chapla, Dhaval Nathwani et al.· Journal of Hematology and Al...· 0 citations
Histoplasmosis is a fungal infection caused by Histoplasma capsulatum, which is endemic in several countries, including Brazil. Disseminated histoplasmosis is a severe manifestation caused by the systemic spread of the infection. It usually occurs in immunocompromised patients, particularly in individuals with HIV infection and transplant recipients, but few reports have described cases in immunocompetent individuals. This report describes a case of disseminated histoplasmosis with oral and intestinal manifestations in a non-HIV patient with a history of alcohol abuse, hepatitis B, lymph node, and pulmonary tuberculosis, but no known risk factor for disseminated histoplasmosis. At physical examination, the patient presented with bilateral submandibular lymphadenopathy. A chest radiograph revealed a diffuse micronodular infiltrate with bilateral hilar and right paratracheal lymph node enlargement. Histopathological analysis of oral lesion confirmed the diagnosis of chronic and active ulcerated mucositis associated with a fungal infection suggestive of histoplasmosis. Due to a previous history of intestinal histoplasmosis with incomplete treatment, colonoscopy and intestinal biopsy were performed and confirmed gastrointestinal involvement by disseminated histoplasmosis. Treatment with intravenous amphotericin B followed by itraconazole maintenance therapy resulted in complete regression of the oral lesion and clinical improvement of the gastrointestinal manifestations. This case report contributes to the clinical data on histoplasmosis in non-HIV patients and helps clarify its diagnosis in immunocompetent individuals or those with unclear immunosuppression status.
Débora de Souza Ferreira Sávio, Maria Júlia Pagliarone, J. Faria et al.· SN Comprehensive Clinical Me...· 0 citations
Histoplasma capsulatum is a dimorphic fungus endemic to the Ohio and Mississippi River valleys that typically causes self-limited pulmonary disease in immunocompetent individuals. Immunocompromised patients, particularly those receiving TNF-α inhibitors, face substantially elevated risk for severe and disseminated infection. Empyema due to histoplasmosis is exceedingly rare, with fewer than five cases documented in the published literature.
We report a 51-year-old woman with rheumatoid arthritis on adalimumab, methotrexate, and hydroxychloroquine who presented with progressive dyspnoea, fever, and hypoxia after multiple prior healthcare encounters. Imaging demonstrated diffuse bilateral micronodules, lingular consolidation, and a worsening left pleural effusion requiring chest tube drainage. Initial urine Blastomyces antigen testing returned positive due to cross-reactivity, but pleural fluid culture and PCR ultimately confirmed Histoplasma capsulatum thus establishing the diagnosis of Histoplasma empyema. Treatment with liposomal amphotericin B followed by itraconazole, combined with pleural drainage, resulted in clinical and radiographic resolution.
This case highlights the diagnostic challenges of Histoplasma empyema, including nonspecific presentation, low pleural fluid culture sensitivity, and antigen cross-reactivity with Blastomyces. A multimodal diagnostic approach and early combined antifungal and drainage-based management are essential for favourable outcomes in immunocompromised patients with atypical or refractory pleural disease.
Vikram Oke, Aditi Iyer, J. Do et al.· Research Connections· 0 citations
Disseminated histoplasmosis (DH) is a common opportunistic mycosis in endemic regions, yet it remains underreported in pediatric patients with primary immunodeficiency or acquired immunosuppression. We present the clinical progression and fatal outcome of DH in a 12-year-old female from southeastern Honduras with an established diagnosis of Ataxia-Telangiectasia (AT) and Autoimmune hepatitis (AIH) managed with daily prednisone (1 mg/kg/day) and azathioprine (2 mg/kg/day), presented with fever, non-productive cough and progressive hypoxemic respiratory failure. Despite broad-spectrum antimicrobials, she rapidly developed severe acute respiratory distress syndrome (ARDS) and multi-organ dysfunction syndrome (MODS), culminating in irreversible cardiorespiratory arrest 24 h after ICU admission. Diagnosis of DH was confirmed via enzyme immunoassay (EIA) demonstrating high levels of antigenuria (15 ng/mL; threshold for high-level >5 ng/mL). This case highlights a critical therapeutic paradox where standard management for an autoimmune complication fully unmasked a lethal fungal infection in a vulnerable host. DH remains a notorious diagnostic mimicker in resource-limited settings where atypical presentation and delayed culture processing restrict timely polyene antifungal intervention. In endemic territories, proactive baseline screening for endemic mycoses and strict primary surveillance are mandatory before executing or maintaining intensive immunosuppression in pediatric patients with congenital immune dysregulation.
Lía Esthefany Loredo Paz, Andrea Michelle Pineda Velasquez, María Regina Rodríguez Rosales et al.· IDCases· 0 citations
Histoplasma capsulatum var. capsulatum is a thermally dimorphic fungus endemic in regions like the Midwestern USA, Africa, and Central/South America. It grows as a mold in the environment and as yeast in human tissues. The disease's severity and presentation depend mostly on the host's immunity. In immunocompromised individuals, it often causes progressive disseminated histoplasmosis (PDH), a severe systemic condition. PDH symptoms include pneumonia, enlarged spleen and liver, enteritis, pancytopenia, lymphadenopathy, skin and mucosal lesions, and joint pain, making the diagnosis a challenge. Though more described in Acquired Immunodeficiency Syndrome (AIDS) patients, PDH can also occur in kidney transplant (KT) recipients, although it is rare even in endemic areas. It can also complicate with acute kidney injury (AKI), graft loss, disease recurrence, hemophagocytic lymphohistiocytosis, and treatment toxicity. This review summarizes key aspects of PDH, including its epidemiology, pathophysiology, clinical and laboratorial features, diagnostic approaches, acute kidney injury, treatment options and prophylaxis among KT recipients with histoplasmosis.
Osvaldo Mariano Viana Neto, Matheus Alves de Lima Mota, Pedro Yago Lima de Mesquita et al.· BMC Nephrology· 0 citations