YOU ARE NOW CONNECTED TO THE TOXLINE (1981 FORWARD, NON-ROYALTY) FILE. ==HISTOPLASMOSIS== 29 AUTHOR Band JD TITLE Histoplasmosis SOURCE Occupational Respiratory Diseases. J. A. Merchant, Editor; Division of Respiratory Disease Studies, Appalachian Laboratory for Occupational Safety and Health, NIOSH, U. S. Department of Health and Human Services,, 1986 SOURCE DHHS (NIOSH) Publication No. 86-102, pages 699-702, 22 references ABSTRACT Histoplasmosis is reviewed with regard to etiology, epidemiology, pathology, diagnostic criteria, methods of prevention, and research needs. Histoplasmosis is defined as a systemic fungal infection caused by the soil fungus Histoplasma-capsulatum. The organism is most heavily concentrated in the central United States, and more than 90 percent of the residents of the Ohio, Mississippi, and Missouri river valleys were shown to have evidence of being infected. Persons having close contact with the soil, particularly soil enriched with avian and bat feces, have been identified as being at high risk. Occupations at risk include farmers, bird handlers, construction workers, landscapers, earth movers, and workers involved in the cleaning or dismantling of contaminated buildings. The clinical manifestation of the primary acute disease is minimal in 95 percent of persons infected. Progressive disseminated histoplasmosis ia rare except in individuals at the extremes of age or immunologically compromised persons. Chronic progressive pulmonary histoplasmosis ia uncommon unless significant cavitation is evident. The chronic cavitary disease, left untreated, results in progressive pulmonary disability and death in 50 percent of affected persons within 5 years. Progressive pulmonary histoplasmosis occasionally results from excessive fibrosis of the lungs and lymph nodes. 3 AUTHOR Saag MS AUTHOR Dismukes WE TITLE Treatment of histoplasmosis and blastomycosis. SOURCE Chest; VOL 93, ISS 4, 1988, P848-51 (REF: 11) ABSTRACT Prior to the development of ketoconazole, the treatment of systemic histoplasmosis and blastomycosis was limited to AMB. The convenience of oral dosing, combined with avoidance of the significant toxicities associated with AMB, make ketoconazole an attractive alternative for the treatment of selected forms of histoplasmosis and blastomycosis. Although high-dose (800 mg/day) ketoconazole is generally more effective than low-dose (400 mg/day), therapy should be initiated at the lower dose due to significantly more adverse effects at higher doses; the daily dose should be increased in patients with progressive disease. Caution should be exercised when ketoconazole is used to treat patients with GU tract disease and in patients with naturally occurring or pharmacologically induced achlorhydria. Thus, AMB remains the drug of choice for difficult to treat cases of histoplasmosis and blastomycosis; however, recent studies have established ketoconazole as the drug of choice in immunocompetent patients with non-life-threatening, non-meningeal H capsulatum and B dermatitidis disease. 5 AUTHOR TAYLOR ML AUTHOR TORIELLO C AUTHOR PEREZ MEJIA A AUTHOR DE LOS ANGELES MARTINEZ M AUTHOR DEL ROCIO REYES-MONTES M AUTHOR ESPINOSA-AVILA L AUTHOR CHAVEZ-TAPIA C TITLE Histoplasmosis in the state of Guerrero, Mexico: A biological approach. SOURCE REVISTA MEXICANA DE MICOLOGIA; 10 (0). 1994. 49-62. ABSTRACT BIOSIS COPYRIGHT: BIOL ABS. A pilot project has been developed in the state of Guerrero, Mexico, to establish a model of epidemiological, immunological, and biological research for histoplasmosis in susceptible populations, and to characterize the causative agent, Histoplasma capsulatum, in nature. The Mexican state selected for this work shows records with a great prevalence for this mycosis, and two areas, Juxtlahuaca and Olinala, were chosen. High levels of positive histoplasmin-skin test (87% in Juxtlahuaca and 80% in Olinala) were found in both areas. Individuals studied referred occupational activities related with bats and birds excreta. Three H. capsulatum isolates were obtained from excreta-contaminated soil, and three isolates from insectivorous bats identified as Myotis californicus, Mormoops megalophyla and Pteronotus parnelli. The fungal infection of the first two bat species is considered as the first record in the world, whereas P. parnelli infection is a new record for Mexico. The fungus was identified by its macro and microscopic characteristics, as well as by its exoantigens. Mice inoculated with different soil samples revealed high anti- H. capsulatum antibody titers in sera, determined by ELISA in 26 out of 80 soil samples with bat guano, as well as in 3 out of 13 bird droppings samples. The high incidence of positive histoplasmin-skin test in the studied population, the isolation of the fungus from bird droppings and infected bats, and the high specific antibody titers from mice sera inoculated with soil samples, demonstrate the great prevalence of histoplasmosis in the studied areas of Guerrero state. 28 AUTHOR George RB AUTHOR Penn RL TITLE Histoplasmosis SOURCE Fungal Diseases of the Lung, G. A. Sarosi and S. F. Davies, Editors; Grune and Stratton, Inc., Orlando, Florida, pages 69-85, 43 references, 19861986 ABSTRACT Histoplasmosis was reviewed, including epidemiology, pathogenesis, clinical pattern, diagnosis, and treatment. Studies have indicated that histoplasmosis is caused by Histoplasma-capsulatum, a dimorphic fungus existing in mycellial form in soil and in yeast form at body temperature. Histoplasmosis is endemic to the great river valleys of the eastern and central United States. Epidemiological studies have shown that in the isolated foci form the organism can be found in large quantities in soil contaminated with fowl or bat excreta. Spores may become airborne, infecting persons who may inhale them. Laboratory workers have been infected by exposure to cultures of the mycelial form. Special precautions may be necessary during construction or clearing of bird and bat roosting sites to prevent intense exposure. Once inhaled, spores take on the yeast form and growth occurs in parenchyma of the lung. The organism results in pneumonitis which gives rise to a cellular immunity by the body followed by an inflammatory reaction and infection of the lung, lymph nodes, liver, spleen and distal foci. Immunity for individuals exposed to large quantities of spores over a lengthy period is common. Forms of the disease range from acute to chronic to inactive or healed forms. Symptoms range from those reflective of viral respiratory infections to the rare pericarditis, esophageal obstruction and mediastinal abscesses. The majority of acute infections are benign, not requiring treatment. The chronic pulmonary form has been treated with amphotericin-B.