Dr. Charles "Pat" Davis, MD, PhD, is a board certified Emergency Medicine doctor who currently practices as a consultant and staff member for hospitals. He has a PhD in Microbiology (UT at Austin), and the MD (Univ. Texas Medical Branch, Galveston). He is a Clinical Professor (retired) in the Division of Emergency Medicine, UT Health Science Center at San Antonio, and has been the Chief of Emergency Medicine at UT Medical Branch and at UTHSCSA with over 250 publications.
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
For asymptomatic people or people with acute localized infection who are
otherwise healthy, antifungal treatment is usually not recommended as these
people have or will resolve the infection in about three weeks. If symptoms
persist a month or more, itraconazole (Sporanox), ketoconazole (Nizoral) or
amphotericin B (Fungizone, Amphocin) may be effective. If CNS involvement occurs, or if the person is
compromised by other diseases or is immunocompromised and has severe
histoplasmosis (progressive disseminated histoplasmosis), either itraconazole or
amphotericin B is recommended. The lengths of time, dosing amounts, and dosing
routes are usually individualized for the patient; consultations with both
infectious disease and pulmonary specialists are recommended. Other new azole
compound drugs may be effective in some difficult or unresponsive cases; the
consultants could help select the appropriate new drug treatment.
Surgery has been used to treat some complications seen in some cases of
histoplasmosis. Examples of surgical procedures include pericardiocentesis or a
pericardial window procedure (both designed to remove fluid that compresses the
heart) in the few patients that develop pericarditis; resection of cavitary lung
lesions; excision of lymph nodes that compress pulmonary, vascular, or other
structures; and replacement of damaged heart valves or other structures.
What are the complications seen with histoplasmosis?
The majority (about 90%) of people that are infected with H. capsulatum recover
completely with no complications. A few cases may show small areas of lung
scarring on chest X-rays. With progressive severity of the disease (chronic to
disseminated), the complications become more numerous and disabling. Pleural
effusions and pericarditis can develop in about 5% of acute symptomatic
patients. Another 5% may develop rheumatologic problems like arthritis, erythema
nodosum, or erythema multiforme. About 90% of patients with chronic pulmonary
histoplasmosis develop cavitary lung lesions, and some may develop pulmonary
fibrosis and dyspnea (shortness of breath), and some may get adrenal gland
infections which may be rarely associated with Cushing's syndrome (elevated
cortisol levels, causing upper body obesity and a rounded face). Others may
develop ocular histoplasmosis syndrome in which H. capsulatum spreads from the
lungs to the retinal blood vessels (choroid) which become inflamed (uveitis) and
then develop fragile abnormal blood vessels. This area can form scar tissue and
thus replace the retina's macular tissue, which results in partial blindness.
Patients with acute progressive disseminated histoplasmosis may develop CNS
problems that result in encephalopathy or seizures; adrenal insufficiency; or
cardiac problems like valve failure, angina, and poor cardiac output. Acute
progressive disseminated histoplasmosis, if not treated quickly and
appropriately, can lead to death in a few weeks. Even with lifelong antifungal
treatment, about 10%-20% of cases will relapse.
Abdominal pain is pain in the belly and can be acute or chronic. Causes include inflammation, distention of an organ, and loss of the blood supply to an organ. Abdominal pain can reflect a major problem with one of the organs in the abdomen such as the appendix, gallbladder, large and small intestine, pancreas, liver, colon, duodenum, and spleen.
Pneumonia is inflammation of one or both lungs with consolidation. Pneumonia is frequently but not always due to infection. The infection may be bacterial, viral, fungal or parasitic. Symptoms may include fever, chills, cough with sputum production, chest pain, and shortness of breath.
Headaches can be divided into two categories: primary headaches and secondary headaches. Migraine headaches, tension headaches, and cluster headaches are considered primary headaches. Secondary headaches are caused by disease. Headache symptoms vary with the headache type. Over-the-counter pain relievers provide short-term relief for most headaches.
Lymph nodes help the body's immune system fight infections. Causes of swollen lymph nodes (glands) may include infection (viral, bacterial, fungal, parasites). Symptoms of swollen lymph nodes vary greatly. They can sometimes be tender, painful or disfiguring. The treatment of swollen lymph nodes depends upon the cause.
Chronic cough is a cough that does not go away and is generally a symptom of another disorder such as asthma, allergic rhinitis, sinus infection, cigarette smoking, GERD, postnasal drip, bronchitis, pneumonia, medications, and less frequently tumors or other lung disease. Treatment of chronic cough is dependant upon the cause.
Although a fever technically is any body temperature above the normal of 98.6 degrees F. (37 degrees C.), in practice a person is usually not considered to have a significant fever until the temperature is above 100.4 degrees F (38 degrees C.). Fever is part of the body's own disease-fighting arsenal: rising body temperatures apparently are capable of killing off many disease- producing organisms.
Chest pain is a common complaint by a patient in the ER. Causes of chest pain include broken or bruised ribs, pleurisy, pneumothorax, shingles, pneumonia, pulmonary embolism, angina, heart attack, costochondritis, pericarditis, aorta or aortic dissection, and reflux esophagitis. Diagnosis and treatment of chest pain depends upon the cause and clinical presentation of the patient's chest pain.
Epilepsy is a brain disorder in which the person has seizures. There are two kinds of seizures, focal and generalized. There are many causes of epilepsy. Treatment of epilepsy (seizures) depends upon the cause and type of seizures experienced.
Obesity is the state of being well above one's normal weight. A person has traditionally been
considered to be obese if they are more than 20 percent over their ideal weight.
That ideal weight must take into account the person's height, age, sex, and
build.
AIDS is the advanced stage of HIV infection. Symptoms and signs of AIDS include pneumonia due to Pneumocystis jiroveci, tuberculosis, toxoplasmosis, seizures, weakness, meningitis, yeast infection of the esophagus, and Kaposi's sarcoma. Anti-retroviral therapy (HAART) is used in the treatment of AIDS.
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