Histoplasmosis, african B39.5

Author: Prof. Dr. med. Peter Altmeyer

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Last updated on: 29.10.2020

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Definition
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Rare form of histoplasmosis in Africa.

Pathogen
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Histoplasma capsulatum var. duboisii

Occurrence/Epidemiology
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Very rare and only sporadically in Europe. Prevalent in Madagascar and West and Central Africa.

Etiopathogenesis
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Entry portal not yet secured (percutaneous, inhalation).

Clinical features
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Superficial subcutaneous granulomas with abscesses. Infection of the lymph nodes with fistulization is the rule.

Histology
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Large, yeast-like fungal cells in tissue, giant tissue reaction, multinucleated giant cells, contain up to 30 fungal cells.

Internal therapy
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Amphotericin B once/day 0.3-0.8 mg/kg bw i.v. for 6 weeks, creeping in at 0.25 mg/kg bw/day i.v.; if well tolerated, increase to the above dose as a continuous infusion over 4-6 hours. Side effects such as paresis, arachnoiditis or radiculitis can be alleviated by pre-injection of glucocorticoids. In mild forms of the disease, cotrimoxazole (e.g. Eusaprim forte) can also be given as a long-term therapy over 1 year. Ketoconazole (e.g. Nizoral) also seems to be effective.

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Last updated on: 29.10.2020