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Genome-Wide Association Study of 58 Individuals with Fibrosing Mediastinitis Reveals Possible Underlying Genetic Susceptibility.
Richmond BW, Guo Y, Yu C, Kendall PL, Mason WR, Cogan JD, Loyd JE
(2018) Am J Respir Crit Care Med 197: 1219-1220
MeSH Terms: Adult, Aged, Female, Genetic Predisposition to Disease, Genome-Wide Association Study, Histoplasmosis, Humans, Male, Mediastinitis, Middle Aged, Reproducibility of Results, Sclerosis, United States, Young Adult
Added March 30, 2020
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Risk Factors for Targeted Fungal and Mycobacterial Infections in Patients Taking Tumor Necrosis Factor Inhibitors.
Salt E, Wiggins AT, Rayens MK, Huaman MA, Mannino D, Schwieterman P, Merkley SA, Jones AR, Crofford LJ
(2016) Arthritis Rheumatol 68: 597-603
MeSH Terms: Blastomycosis, Case-Control Studies, Coccidioidomycosis, Cryptococcosis, Female, Histoplasmosis, Humans, Male, Middle Aged, Mycobacterium Infections, Mycoses, Pneumonia, Pneumocystis, Prednisone, Risk Factors, Tuberculosis, Tumor Necrosis Factor Inhibitors
Show Abstract · Added March 25, 2020
OBJECTIVE - To identify predictors of the receipt of medical care, including the receipt of pre-drug screening, for diagnostically targeted fungal or mycobacterial infections among patients prescribed a tumor necrosis factor inhibitor (TNFi).
METHODS - We conducted a case-control study using deidentified patient health claims information from a data set representing a commercially insured US population of 15 million patients annually from January 1, 2007 to December 31, 2009. Descriptive statistics as well as a 2-sample t-test, chi-square test of association, Fisher's exact test, and multivariate logistic regression were used for data analysis.
RESULTS - A total of 30,772 patients received a TNFi during the study period. Of these, 158 patients (0.51%) developed targeted fungal and/or mycobacterial infections (cases). The median number of infections per case was 1.0 (interquartile range 1.0-2.0). Tuberculosis was diagnosed in 61% of cases, followed by histoplasmosis in 60%, nontuberculous mycobacterial infections in 11%, coccidioidomycosis in 10%, unspecified fungal infection in 8%, blastomycosis in 4%, cryptococcal infection in 3%, and pneumocystosis in 2%. Compared to controls (n = 474), a higher proportion of cases were prescribed prednisone (55% versus 37%; P < 0.001). Patients who were prescribed prednisone during the study period were twice as likely as those not taking prednisone to seek medical care attributable to a targeted fungal or mycobacterial infection (odds ratio 2.03; P < 0.001).
CONCLUSION - Development of a targeted fungal or mycobacterial infection among patients taking a TNFi is rare. Concomitant use of prednisone predicted development of such infections.
© 2016, American College of Rheumatology.
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Nondisseminated histoplasmosis of the trachea.
Bhojwani N, Hartman JB, Taylor DC, Herbert M, Corriveau M
(2016) Clin Respir J 10: 255-8
MeSH Terms: Administration, Intravenous, Aged, Amphotericin B, Antifungal Agents, Diagnosis, Differential, Female, Histoplasma, Histoplasmosis, Humans, Itraconazole, Trachea, Treatment Outcome
Show Abstract · Added January 1, 2016
Histoplasma capsulatum can rarely affect the trachea. We report the case of a 68-year-old woman with rheumatoid arthritis on immunosuppressive therapy who presented with fevers, worsening shortness of breath, nonproductive cough and subjective throat hoarseness and fullness. Chest computed tomography demonstrated no tracheal findings. Bronchoscopy found mucosal irregularity, nodularity and vesicular regions in the proximal trachea extending seven centimeters distal to the vocal cords. Also seen was an edematous, exudative left vocal cord with polyps and an ulcerative lesion. Silver staining and culture and wash of the tracheal biopsy revealed Histoplasma capsulatum. She was treated with oral itraconazole then briefly on intravenous amphotericin for rising Histoplasma urinary antigen levels. She continued treatment 24 months following diagnosis with minimal dyspnea. Histoplasma tracheitis has been proposed as an indicator of disseminated infection. However, our patient did not demonstrate other organ manifestations. Histoplasma tracheitis should be considered in a differential diagnosis of tracheal lesions even in the absence of systemic involvement.
© 2014 John Wiley & Sons Ltd.
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12 MeSH Terms
The leukotriene B₄/BLT₁ axis is a key determinant in susceptibility and resistance to histoplasmosis.
Secatto A, Soares EM, Locachevic GA, Assis PA, Paula-Silva FW, Serezani CH, de Medeiros AI, Faccioli LH
(2014) PLoS One 9: e85083
MeSH Terms: Animals, Arachidonate 5-Lipoxygenase, Disease Susceptibility, Enzyme Inhibitors, Gene Expression, Histoplasma, Histoplasmosis, Host Specificity, Host-Pathogen Interactions, Leukotriene B4, Lung, Macrophages, Mice, Mice, 129 Strain, Mice, Inbred C57BL, Phagocytosis, Receptors, Leukotriene B4, Rodent Diseases, Signal Transduction, Spleen
Show Abstract · Added May 4, 2017
The bioactive lipid mediator leukotriene B4 (LTB4) greatly enhances phagocyte antimicrobial functions against a myriad of pathogens. In murine histoplasmosis, inhibition of the LT-generating enzyme 5-lypoxigenase (5-LO) increases the susceptibility of the host to infection. In this study, we investigated whether murine resistance or susceptibility to Histoplasma capsulatum infection is associated with leukotriene production and an enhancement of in vivo and/or in vitro antimicrobial effector function. We show that susceptible C57BL/6 mice exhibit a higher fungal burden in the lung and spleen, increased mortality, lower expression levels of 5-LO and leukotriene B4 receptor 1 (BLT1) and decreased LTB4 production compared to the resistant 129/Sv mice. Moreover, we demonstrate that endogenous and exogenous LTs are required for the optimal phagocytosis of H. capsulatum by macrophages from both murine strains, although C57BL/6 macrophages are more sensitive to the effects of LTB4 than 129/Sv macrophages. Therefore, our results provide novel evidence that LTB4 production and BLT1 signaling are required for a histoplasmosis-resistant phenotype.
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20 MeSH Terms
Histoplasmomas of uncommon size.
Richmond BW, Worrell JA, Bastarache JA, Gervich DH, Slattery WR, Loyd JE
(2013) Chest 143: 1795-1798
MeSH Terms: Adolescent, Child, Combined Modality Therapy, Diagnosis, Differential, Female, Histoplasmosis, Humans, Lung Diseases, Male, Middle Aged
Show Abstract · Added March 7, 2014
Histoplasma capsulatum infection demonstrates a broad spectrum of acute and chronic clinical manifestations. Unlike the acute reaction to proliferating organisms, the chronic complications are often the result of excessive or prolonged host response with a paucity of organisms. Lung nodules (histoplasmomas) may be noted decades after initial infection and present a challenging clinical problem, as they can be difficult to distinguish from malignancy or tuberculomas. Typically, histoplasmomas are small (<1 cm), asymptomatic, and may be stable in size or slowly enlarge over time. Here we report three patients with unusually large, or giant, histoplasmomas (>3 cm) and describe their extreme phenotype. Importantly, two of the patients presented with subacute symptomatic disease, a presentation that is very atypical for histoplasmoma. The term "buckshot" calcification has been used to describe dozens of small (2-4 mm) calcified nodules, so it may be appropriate to label masses that exceed 3 cm as "cannonball" histoplasmoma.
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10 MeSH Terms
5-Lipoxygenase deficiency impairs innate and adaptive immune responses during fungal infection.
Secatto A, Rodrigues LC, Serezani CH, Ramos SG, Dias-Baruffi M, Faccioli LH, Medeiros AI
(2012) PLoS One 7: e31701
MeSH Terms: Animals, Arachidonate 5-Lipoxygenase, Cell Proliferation, Cells, Cultured, Cytotoxicity, Immunologic, Flow Cytometry, Histoplasma, Histoplasmosis, Immunity, Humoral, Immunity, Innate, Leukotriene B4, Leukotriene C4, Lung, Lymphocyte Activation, Macrophages, Peritoneal, Mice, Mice, Knockout, Nitric Oxide, Phagocytosis, Survival Rate, T-Lymphocytes
Show Abstract · Added May 4, 2017
5-Lipoxygenase-derived products have been implicated in both the inhibition and promotion of chronic infection. Here, we sought to investigate the roles of endogenous 5-lipoxygenase products and exogenous leukotrienes during Histoplasma capsulatum infection in vivo and in vitro. 5-LO deficiency led to increased lung CFU, decreased nitric oxide production and a deficient primary immune response during active fungal infection. Moreover, H. capsulatum-infected 5-LO(-/-) mice showed an intense influx of neutrophils and an impaired ability to generate and recruit effector T cells to the lung. The fungal susceptibility of 5-LO(-/-) mice correlated with a lower rate of macrophage ingestion of IgG-H. capsulatum relative to WT macrophages. Conversely, exogenous LTB4 and LTC4 restored macrophage phagocytosis in 5-LO deficient mice. Our results demonstrate that leukotrienes are required to control chronic fungal infection by amplifying both the innate and adaptive immune response during histoplasmosis.
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21 MeSH Terms
A case series and review of histoplasmosis infection in the neck.
Johnson JA, Loyd JE, Wheat LJ, Netterville JL
(2010) Arch Otolaryngol Head Neck Surg 136: 916-9
MeSH Terms: Adolescent, Adult, Aged, Child, Female, Histoplasmosis, Humans, Middle Aged, Neck, Young Adult
Added March 5, 2014
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10 MeSH Terms
Leukotrienes are potent adjuvant during fungal infection: effects on memory T cells.
Medeiros AI, Sá-Nunes A, Turato WM, Secatto A, Frantz FG, Sorgi CA, Serezani CH, Deepe GS, Faccioli LH
(2008) J Immunol 181: 8544-51
MeSH Terms: Adjuvants, Immunologic, Animals, Antigens, Fungal, Cell Movement, Cytokines, Fungal Vaccines, Histoplasma, Histoplasmosis, Humans, Immunity, Innate, Immunization, Secondary, Immunologic Memory, Leukotriene B4, Lung Diseases, Fungal, Mice, Mice, Inbred C57BL, Mice, Knockout, T-Lymphocyte Subsets
Show Abstract · Added May 4, 2017
Leukotrienes (LTs) are potent lipid mediators involved in the control of host defense. LTB(4) induces leukocyte accumulation, enhances phagocytosis and bacterial clearance, and increases NO synthesis. LTB(4) is also important in early effector T cell recruitment that is mediated by LTB(4) receptor 1, the high-affinity receptor for LTB(4). The aims of this study were to evaluate whether LTs are involved in the secondary immune response to vaccination in a murine model of Histoplasma capsulatum infection. Our results demonstrate that protection of wild-type mice immunized with cell-free Ags from H. capsulatum against histoplasmosis was associated with increased LTB(4) and IFN-gamma production as well as recruitment of memory T cells into the lungs. In contrast, cell-free Ag-immunized mice lacking 5-lipoxygenase(-/-), a critical enzyme involved in LT synthesis, displayed a marked decrease on recruitment of memory T cells to the lungs associated with increased synthesis of TGF-beta as well as IL-10. Strikingly, these effects were associated with increased mortality to 5-lipoxygenase(-/-)-infected mice. These data establish an important immunomodulatory role of LTs, in both the primary and secondary immune responses to histoplasmosis.
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18 MeSH Terms
Peripapillary Hemorrhage.
Knopf HL, Carter K, Council MD, Brantley MA
(2007) Compr Ophthalmol Update 8: 53-4
MeSH Terms: Diagnosis, Differential, Eye Infections, Fungal, Female, Fluorescein Angiography, Fundus Oculi, Histoplasmosis, Humans, Middle Aged, Retinal Hemorrhage
Added December 10, 2013
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9 MeSH Terms
Percutaneous pulmonary artery and vein stenting: a novel treatment for mediastinal fibrosis.
Doyle TP, Loyd JE, Robbins IM
(2001) Am J Respir Crit Care Med 164: 657-60
MeSH Terms: Adult, Angiography, Cardiac Catheterization, Constriction, Pathologic, Exercise Test, Female, Fibrosis, Follow-Up Studies, Histoplasmosis, Humans, Male, Mediastinal Diseases, Mediastinum, Middle Aged, Phlebography, Pulmonary Artery, Pulmonary Veins, Severity of Illness Index, Stents, Treatment Outcome
Show Abstract · Added March 8, 2020
Mediastinal fibrosis is a rare consequence of infection with the fungus Histoplasma capsulatum that can lead to occlusion of large pulmonary arteries and veins and mainstem bronchi. Medical and surgical treatments for this disorder have been ineffective. We describe successful treatment for central pulmonary arterial and venous obstruction due to mediastinal fibrosis in four patients using percutaneously placed intravascular stents. Patients were severely limited, World Health Organization functional class III or IV. At the time of right and left heart catheterization, stents were placed in pulmonary arteries (n = 1), veins (n = 2), or both (n = 1) to relieve vascular obstruction resulting from mediastinal fibrosis. Immediate hemodynamic and clinical improvement was observed in all patients. Three of the four patients have had sustained improvement in exercise tolerance, from 3.5 mo to 4.5 yr after stent placement. The only complication was a self-limited pulmonary hemorrhage in one patient. Our initial experience suggests that percutaneous stent placement to relieve central pulmonary arterial or venous obstruction due to mediastinal fibrosis is an effective new treatment modality.
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