Presentation and Treatment for Intestinal Histoplasmosis

Authors' Affiliations

Annemarie Phemister, Graduate Student-Doctoral, Medical Student, Lincoln Memorial University- Debusk College of Osteopathic Medicine, Knoxville, TN Abbey Hinton, Graduate Student-Doctoral, Medical Student, Lincoln Memorial University- Debusk College of Osteopathic Medicine, Knoxville, TN James Carter IV, Graduate Student-Doctoral, Medical Student, Lincoln Memorial University- Debusk College of Osteopathic Medicine, Knoxville, TN

Location

D.P. Culp Center Ballroom

Start Date

4-5-2024 9:00 AM

End Date

4-5-2024 11:30 AM

Poster Number

93

Name of Project's Faculty Sponsor

Erin Hood

Faculty Sponsor's Department

Internal Medicine

Classification of First Author

Clinical Doctoral Student

Competition Type

Competitive

Type

Poster Presentation

Presentation Category

Health

Abstract or Artist's Statement

Intestinal histoplasmosis is a rare condition caused by Histoplasma Caspulatum typically associated with disseminated disease in immunosuppressed patients. Histoplasmosa Caspulatum is a thermally dimorphic microconidia spore that is endemic to the Ohio and Mississippi River Valleys. It is classically transmitted through bat and bird feces. The spores in the feces are inhaled and travel to alveoli where they are phagocytosed by alveolar macrophages. The macrophages then divide against T cell mediated immunity and invade surrounding regional hilar lymph nodes. This can lead to systemic infection which is seen in 3-12% of cases and has been found to develop up to 20 years after initial diagnostic workup. The disseminated infection can spread to any organ system, but has a high probability of gastrointestinal invasion. This case involved a 19-year-old female who lived on a farm that presented with dyspnea and recurrent diarrhea. She was also immunocompromised due to relapsing polychondritis. Her initial chest X-ray showed bilateral interstitial and airspace infiltrates most pronounced in the base of the lungs, and peripheral smear confirmed histoplasmosis. After a colonoscopy was performed, a biopsy was taken and was also positive for histoplasmosis. The patient was initially started on Amphotericin B and switched to Itraconazole. Three months following therapy, the patient appeared to be responding well to treatment with symptomatic improvement. This case illustrates how disseminated histoplasmosis can lead to gastrointestinal invasion, how it can present, and how treatment can be effective.

This document is currently not available here.

Share

COinS
 
Apr 5th, 9:00 AM Apr 5th, 11:30 AM

Presentation and Treatment for Intestinal Histoplasmosis

D.P. Culp Center Ballroom

Intestinal histoplasmosis is a rare condition caused by Histoplasma Caspulatum typically associated with disseminated disease in immunosuppressed patients. Histoplasmosa Caspulatum is a thermally dimorphic microconidia spore that is endemic to the Ohio and Mississippi River Valleys. It is classically transmitted through bat and bird feces. The spores in the feces are inhaled and travel to alveoli where they are phagocytosed by alveolar macrophages. The macrophages then divide against T cell mediated immunity and invade surrounding regional hilar lymph nodes. This can lead to systemic infection which is seen in 3-12% of cases and has been found to develop up to 20 years after initial diagnostic workup. The disseminated infection can spread to any organ system, but has a high probability of gastrointestinal invasion. This case involved a 19-year-old female who lived on a farm that presented with dyspnea and recurrent diarrhea. She was also immunocompromised due to relapsing polychondritis. Her initial chest X-ray showed bilateral interstitial and airspace infiltrates most pronounced in the base of the lungs, and peripheral smear confirmed histoplasmosis. After a colonoscopy was performed, a biopsy was taken and was also positive for histoplasmosis. The patient was initially started on Amphotericin B and switched to Itraconazole. Three months following therapy, the patient appeared to be responding well to treatment with symptomatic improvement. This case illustrates how disseminated histoplasmosis can lead to gastrointestinal invasion, how it can present, and how treatment can be effective.