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Histoplasma capsulatum Histoplasmosis; Ajecllomyces capsulatus
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Taxonomy of Histoplasma capsulatum: Superkingdom: Eukaryota Kingdom: Fungi Phylum: Ascomycota / Subphylum: Pezizomycotina Class: Eurotiomycetes Order: Onygenales Family: Onygenaceae Genus: Ajellomyces
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Histoplasma capsulatum:
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The Endemic Mycoses (Pathogenic classification) Characterized by: *Caused by dimorphic fungi which exist as filamentous organisms in nature and as yeast cells in infected tissue. *All are endemic to certain geographical areas where they can usually be found in the soil.
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Similar Pathogens Blastomyces dermatitidis The causative agent of Blastomycosis Found in the southeastern and middle western areas of the U.S.
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Coccidioides immitis Cause of coccidioidmyco-sis Found in the southwestern areas of the U.S.
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Diseases and targeted tissues: Targets primarily the lungs and the respiratory system BUT The disease can progress to systemic forms affecting all of the major organs. Causes primary lesions in the lungs the most common cause of fungal respiratory infections in the world. poses a particular threat to the elderly and to immunocompromised patients such as those infected with HIV, or to organ transplant recipients undergoing immunosuppressant drug therapy. May contribute to development of secondary disease, such as pneumonia.
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Life Cycle of Histoplasma capsulatum
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HIV patients are more suceptible to symptomatic infection. Why? Yeast grows more rapidly within macrophages from HIV-infected individuals or within macrophages infected in vitro with a macrophage-tropic strain of HIV. Among T-cell populations, CD4 cells are vitally important
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Ecology/Infection Process: After conidia have been inhaled and settle into the alveoli, they bind to the CD2/CD18 family of integral protiens and are engulfed by both neutrophils and macrophages but not killed. In the macrophages, conidia transform into yeast within the pulmonary parenchyma; It then migrates to local draining lymph nodes and, subsequently, to distant organs rich in mononuclear phagocytes, such as the liver and spleen
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Ecology of Histoplasma capsulatum Histoplasma capsulatum is a dimorphic fungus. The mold or mycelial form exists as a mold in the soil where it absorbs nutrients from dead organic matter and produces infectious spores. Exists as a yeast in tissues. When these spores are inhaled, they encounter the warm moist environment of the lungs. In the lung, the spores are ingested by macrophages and become yeasts. The disease may be asymptomatic or, in some cases, resemble tuberculosis. they undergo a transformation to the yeast or parasitic form.
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Ecology of Histoplasma capsulatum cont. HOSTS : Humans, dogs, cats, cattle, horses, rats, skunks, opossums, foxes and other animals INFECTIOUS DOSE: inoculation of 10 spores is lethal in mice VECTORS: None SURVIVAL OUTSIDE HOST: Spores are resistant to drying and may remain viable for long periods of time INFECTIVE STAGE: (conidia) present in sporulating mold from cultures and in soil from endemic areas; yeast form in tissues or fluids from infected animals or humans
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Symptoms in the Host may include the following: flu-like symptoms headache cough lymphadenopathy caseating necrosis fever muscle pain chest pain Hepatomegaly (coughing up blood) erythema nodosum malaise anorexia dyspnea splenomegaly coin lesion
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General Stats: Begins as lower respiratory infections as a result of inhalation of the conidia. X-ray findings are similar to tuberculosis or cancer and infections Misdiagnosed especially in non- endemic areas. Most infections may be asymptomatic in immunocompetent patients.
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Diagnostic Testing: 4 Preferred Methods: Histoplasmin skin test Detection of antigens or antibody to the agent in the blood (serology) Complement fixation (preferred) Identification of cells in the microscope Differential Diagnosis Goal: Other disease or conditions that need to be eliminated Other infectious diseases Other fungal infections Other infections of the respiratory tract Miliary tuberculosis Other problems Bronchitis Emphysema Inhalation poisoning
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Serologic tests A high serum concentration of antibodies develops within 8 weeks of exposure in most patients and then declines to low or undetectable levels over a 2- to 5-year period.
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Diagnostic Factors that May be Tested: Growth rate as measured in , Sabouraud's agar medium resistance to 10% KOH yeast in lung microscopic examination septate, branching hyphae yeast in macrophages hyphae
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Histoplasma capsulatum Culture Identification Test Most Common form of testing Rapid DNA probe Test Uses Nucleic Acid Hybridization for identification when isolated from a culture
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Treatment/ Prevention FIRST AID/TREATMENT: Amphotericin B for disseminated or chronic pulmonary cases; conazole drugs may be added or used in rotation for therapy in immunocompromised patients because relapse is common IMMUNIZATION: None PHYSICAL INACTIVATION: Inactivated by moist heat (121° C for at least 15 min) Supportive care : Oxygen for respiratory care; Glucorticoids to support adrenal function; Antipyretics and antiemetics to support treatment with antifungals; Surgery may be needed to treat fibrosis
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Epidemiology TRANSMISSION: Inhalation of airborne conidia; small size of infective conidia (< 5 µm) INCUBATION PERIOD: Symptoms appear within 3-18 days after exposure, commonly 10 days COMMUNICABILITY: Not transmitted from person-to-person Focal infections are common worldwide; clinical disease and severe progressive disease less frequent; 80% of population show hypersensitivity to H. capsulatum in eastern and central North America; outbreaks in families or groups exposed to bird or bat droppings or recently disturbed contaminated soil; prevalence increases from childhood to 15 years of age
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Cites of Infection and Sources
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Geographical Distribution In the US: Most common in the southeastern, mid-Atlantic, and central states and in the Ohio and Mississippi River valleys. Internationally: Endemic in areas of North and Latin America but can be found throughout the world. Favorable Growth Conditions: In soil: typically are found in the temperate zone between latitudes 45° north and 30° south. Factors accounting for its geographic distribution include humid environmental conditions and acidic permeable soil. The organism commonly is found in bird and bat droppings, most often where guano is decaying and mixed with soil.
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History and Background First was described in 1905 by Samuel Darling, a US Army pathologist stationed in Panama. Darling examined visceral tissues and bone marrow from a young man from Martinique whose death originally was attributed to miliary tuberculosis. The organism initially was described as protozoal. Because it lacked a kinetoplast, Darling assumed that it was a different species of Leishmania. He termed it H capsulatum. In 1912, after reviewing tissue specimens, da Rocha-Lima suggested that the organism resembled a yeast rather than a protozoan
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Morbidity and Mortality Rates: Only 5% of infected individuals develop symptomatic disease after a low-level exposure to Histoplasma. The estimated incidence is 1 per 2000 persons
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References: Weinberg M, Weeks J, Lance-Parker S, Traeger M, Wiersma S, Phan Q, et al. Severe Histoplasmosis in Travelers to Nicaragua. Emerg Infect Dis. Vol. 9, No 10. 2003 Oct.{accessed 12/02/03}. Available from: http://www.cdc.gov/ncidod/EID/vol9no10/03-0049.htm Fahad M Alhameed, MD, FRCPC, Consultant Critical Care and Pulmonary Medicine, Department of Internal Medicine, Sections of Pulmonary and Critical Care, et al. Histoplasmosis, Thoracic.. © Copyright 2003, eMedicine.com, Inc. January 15, 2003 {accessed 12/04/03}. Available from:http://www.emedicine.com/radio/topic344.htm Mycology Fungi. Histoplasma capsulatum. Author not listed. Available through Rutgars Pharmacy. {Accessed 12/06/03} . Available from: http://pharmacy.rutgers.edu/lcr/pdfs/miller2.pdf Office of Laboratory Security, PPHB. Histoplasmosis, essential data. Copyright, Health Canada, 2001. 2001 March. Accessed 12/03/03. Available from: http://www.cbwinfo.com/Biological/Pathogens/HC.html. Histoplasma capsulatum Sequencing at the GSC in collaboration with the University of California at San Francisco and the Department of Molecular Microbiology here at Washington University. Last modified: November 19 2003 15:21:18.{accessed 11/29/03}. Available from:http://www.genome.wustl.edu/projects/hcapsulatum/