By Martha A. Simpson, D.O., M.B.A.
Associate Professor of Family Medicine
Ohio University College of Osteopathic Medicine

HISTOPLASMOSIS OFTEN MILD, READER’S WIFE PROBABLY HAD RARE FORM

Question: My wife died from a disease called histoplasmosis.  The doctor who X-rayed her lungs said they were in bad shape.  I have never heard of anything like this before.  Can you explain to me what this disease is, and what causes it?

Answer: I’m sorry to hear of your wife’s death. I’ll give you a general overview of Histoplasmosis as you request. This disease is caused by a fungus called Histoplasma capsulatum. The spores of this fungus live in the soil and come from bat or bird droppings. They become airborne when the soil is stirred up and can then be inhaled into the lungs and cause infection.

Histoplasma capsulatum grows naturally in soil in parts of the United States -- particularly the Midwest, the Southeast, and along the Ohio and Mississippi River valleys. In these areas, over 80 percent of the people can have positive skin tests for histoplasmosis. In most people, histoplasmosis does not cause any illness, but for others, it can be quite severe -- even life threatening. This is especially true in young children and people with compromised immune systems.

The most common type of histoplasmosis is called asymptomatic primary histoplasmosis. This occurs when a person is exposed to the spores and become infected without any symptoms. This diagnosis is usually made after scars are seen on a routine chest X-ray.

Acute symptomatic pulmonary histoplasmosis, as the name implies, produces intense symptoms that seem to come on suddenly. The most prominent symptoms are usually fever, chills, headache, dry cough, weight loss and sweats. When the person has an underlying disease, the Histoplasma capsulatum spores can cause moderate to severe lung damage and lead to disability.

Histoplasmosis can be difficult to diagnose since the symptoms -- which usually begin within three to 17 days of inhaling the spores -- resemble many other acute lung problems like pneumonia. To establish the diagnosis, the doctor may first ask for a chest X-ray. If results are suspicious, a blood test may be recommended to look for the presence of antibodies to the histoplasmosis spores. Also, the doctor may ask for a bronchoscopy -- a procedure that allows him or her look at the patient’s airways through a thin viewing instrument. During this procedure, a sample of lung tissue can be obtained. Analysis of the tissue in the lab can confirm the diagnosis.

Most people don’t require any treatment for histoplasmosis. But, in severe cases an antifungal medication may be needed. These are usually given intravenously and require some hospitalization. Oxygen and steroids can be used to help with breathing in some cases. The prognosis is usually excellent.

The most severe form of this disease -- and also the rarest -- is called disseminated histoplasmosis. It involves the spreading of the fungus to other organs outside the lungs. Unfortunately, disseminated histoplasmosis can cause death, sometimes even when proper treatment is instituted.

I need to end with a word about the best treatment -- prevention. Wearing a face mask when working in contaminated soil or in caves where bats dwell can prevent spore inhalation. Keeping the soil watered down can prevent the spores from becoming airborne.

Family Medicine® is a weekly column. To submit questions, write to Martha A. Simpson, D.O., M.B.A., Ohio University College of Osteopathic Medicine, P.O. Box 110, Athens, Ohio 45701, or via e-mail to readerquestions@familymedicinenews.org. Medical information in this column is provided as an educational service only. It does not replace the judgment of your personal physician, who should be relied on to diagnose and recommend treatment for any medical conditions. Past columns are available online at www.familymedicinenews.org.