A middle-aged woman was admitted to the Teaching Hospital of the Universidade de São Paulo, Brazil with pneumonia symptoms. She had fever, cough and weakness associated with epigastric pain. An abdominal computed tomography scan showed extensive adenopathy with an enlarged spleen. Serology for HIV was positive and yeast forms were observed in the peripheral blood smear (Figures 1 and 2).
Diagnosis of histoplasmosis is made by the detection of Histoplasma capsulatum in sputum, blood or liquor but it is common to observe negative results due to technical constraints wherein a reduced number of fungal forms are found in samples.11 de Oliveira RB, Atobe JH, de Souza SA, Castro Lima Santos DW. Epidemiology of invasive fungal infections in patients with acquired immunodeficiency syndrome at a reference hospital for infectious diseases in Brazil. Mycopathologia. 2014;178(1–2):71–8. Imaging, diagnostic scanning tests and biopsy of target organs are important to differentiate from tuberculosis, sarcoidosis or metastatic carcinoma and lymphoma and usually the culture of biological samples and serological assays are performed to confirm the diagnosis.11 de Oliveira RB, Atobe JH, de Souza SA, Castro Lima Santos DW. Epidemiology of invasive fungal infections in patients with acquired immunodeficiency syndrome at a reference hospital for infectious diseases in Brazil. Mycopathologia. 2014;178(1–2):71–8.,22 Carreto-Binaghi LE, Damasceno LS, Pitangui Nde S, Fusco-Almeida AM, Mendes-Giannini MJ, Zancopé-Oliveira RM, et al. Could Histoplasma capsulatum be related to healthcare-associated infections? Biomed Res Int. 2015:982429. However, a blood smear is important to establish the diagnosis of disseminated histoplasmosis and, after in vitro contamination is excluded, the presence of both free and intracellular H. capsulatum should be reported.
Arrows show phagocytes containing one or more intracellular Histoplasma capsulatum (magnification: 1000×; May-Grünwald stain).
REFERENCES
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1de Oliveira RB, Atobe JH, de Souza SA, Castro Lima Santos DW. Epidemiology of invasive fungal infections in patients with acquired immunodeficiency syndrome at a reference hospital for infectious diseases in Brazil. Mycopathologia. 2014;178(1–2):71–8.
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2Carreto-Binaghi LE, Damasceno LS, Pitangui Nde S, Fusco-Almeida AM, Mendes-Giannini MJ, Zancopé-Oliveira RM, et al. Could Histoplasma capsulatum be related to healthcare-associated infections? Biomed Res Int. 2015:982429.
Publication Dates
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Publication in this collection
Jan-Feb 2016
History
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Received
18 Sept 2015 -
Accepted
15 Dec 2015
