Clinical Manifestations of Histoplasmosis

Acute Pulmonary Histoplasmosis

The most common symptoms of histoplasmosis include fever, chills, headache, myalgia, anorexia, cough, and chest pain, which are seen in 85-100% of cases 1, 2
Chills, headache, myalgia, and anorexia are frequently reported in patients with acute pulmonary histoplasmosis 1, 4
Cough and chest pain occur in most cases, with possible pleuritic pain, according to the Clinical Infectious Diseases guidelines 1, 2
Physical examination may reveal rales or pleural friction rubs, though findings are often unremarkable except for fever, as noted in the Clinical Infectious Diseases journal 1
Symptoms typically abate within a few weeks in immunocompetent patients with low-level exposure, with a strength of evidence based on clinical observations 1, 2

Diffuse radiographic involvement following intense exposure can cause more severe disease, characterized by hypoxemia and potential requirement for ventilatory support 1
Without treatment, recovery is usually slow and can potentially be fatal, emphasizing the need for prompt medical attention 1
Prolonged symptoms (>1 month) may indicate progression to more severe disease, with a moderate strength of evidence based on clinical studies 1, 4

Disseminated histoplasmosis is common in immunocompromised patients, particularly those with CD4+ counts <150 cells/μL, according to the MMWR Recommendations and Reports guidelines 5
Characterized by fever, fatigue, weight loss, hepatosplenomegaly, and lymphadenopathy, with a high strength of evidence based on clinical trials 5
Respiratory symptoms (cough, chest pain, dyspnea) occur in approximately 50% of patients, with a moderate strength of evidence based on clinical observations 5
CNS, gastrointestinal, and cutaneous manifestations occur in a smaller percentage of cases, with a low strength of evidence based on limited clinical data 5

Patients with CNS histoplasmosis typically experience fever and headache, with a high strength of evidence based on clinical studies 5
If brain involvement is present, seizures, focal neurological deficits, and mental status changes may occur, with a moderate strength of evidence based on clinical observations 5
Meningitis presents with lymphocytic pleocytosis, elevated protein, and low glucose in CSF, according to the MMWR Recommendations and Reports guidelines 5

Diarrhea, fever, abdominal pain, and weight loss are common presentations, with a moderate strength of evidence based on clinical observations 5
Hepatosplenomegaly may be present on physical examination, with a high strength of evidence based on clinical trials 5, 3

Rheumatologic syndromes and pericarditis can occur within the first year after exposure, with a moderate strength of evidence based on clinical studies 1, 4
Chronic mediastinal inflammation or fibrosis may develop, with a low strength of evidence based on limited clinical data 1
Broncholithiasis and enlarging parenchymal granulomas (histoplasmomas) are potential complications, with a moderate strength of evidence based on clinical observations 1, 1

Severity of illness varies based on exposure intensity and host immunity, with a high strength of evidence based on clinical trials 2, 4
Asymptomatic infection or mild disease follows low-intensity exposures in healthy individuals, with a moderate strength of evidence based on clinical observations 2
In immunocompetent patients, most infections are self-limited and resolve without therapy, with a high strength of evidence based on clinical studies 1, 4
Patients with CD4+ counts >300 cells/μL often have symptoms limited to the respiratory tract, according to the MMWR Recommendations and Reports guidelines 5