A Review of Literature on Unusual Clinical Presentations and Potential Challenges in Diagnosis of Histoplasmosis

Abstract

Histoplasmosis is not a rare disease though its clinical diagnosis sometimes may prove a daunting task among clinicians. This study was therefore set up to review the various clinical presentations of the disease. The study was based on literature review on clinical features of histoplasmosis from original research articles, review articles, short communications, letters to editor and case reports on the disease for the past 10 years (April 2000 to April 2010). The results were analysed using simple descriptive methods and Epi Info 6 version. From 881 literature views on 7,791 patients with histoplasmosis, 75.0% (5,843) presented with pulmonary features while 25.0% (1,948) presented as disseminated histoplasmosis (DH). Some of the rare and unusual presentations of DH encountered were: mimicking of teratomas, urinary bladder ulcerations, prostatic abscess,, Addison’s disease, macular degeneration and choroidal neovascularization, mimicking celiac and Crohn’s diseases, gall bladder tumours, psoas abscess, carpal tunnel syndrome and advanced breast cancer as well as Hodgkin’s and Non-Hodgkin’s lymphomas (0.1 - 2.2%). Pyrexia of unknown origin (PUO) was significantly common among DH patients with HIV AIDS (P = 0.05). More possibilities should be accommodated and facilities deployed as much as possible while investigating patients with these features and many more by clinicians so as to skip probable diagnostic and therapeutic dilemmas occasioned by histoplasmosis. Also, HIV AIDS patients presenting with persistent fever or PUO unresponsive to available medications could be given a therapeutic trial for disseminated histoplasmosis with amphotericin B.