Why Expertise Matters in Managing Histoplasmosis?

Why Expertise Matters in Managing Histoplasmosis

Histoplasmosis is a lung infection caused when you breathe in tiny spores of the fungus Histoplasma capsulatum. The disease-causing dimorphic fungus lives across the globe in pockets of endemicity. Spores grow in soil containing bird or bat droppings, especially near river valleys. The Indian researchers found 426 cases between 1954 and 2018. In 2025, the increase in prevalence of Histoplasmosis was highly noticed in regions like the Gangetic Plain.

SRM Global Hospitals stands with its pioneering medical excellence in Chennai, providing advanced care for complex fungal infections. Understanding Histoplasmosis is a practical step to staying healthy.

Histoplasmosis- Forms

A 2025 clinical study in New Delhi found that 90.9% of patients with this fungus were male, with a mean age was about 48 years.

Most people who breathe in the spores do not get sick. Medical professionals call these individuals asymptomatic patients. Experts estimate that 75% of adults in endemic areas have had the infection without knowing. Up to 90% of individuals who inhale these spores experience no symptoms.

In most people, the immune system can destroy the fungus or wall it off with granulomas before symptoms develop. For others, the common infection types could be,

  • Acute Pulmonary Histoplasmosis: A sudden lung infection with symptoms similar to pneumonia. These include fever, cough, and shortness of breath. Symptoms usually appear 3 to 17 days after breathing in the spores. Patients with severe pneumonia may need immediate help.
  • Chronic Cavitary Pulmonary Histoplasmosis: It is a long-lasting illness that primarily affects individuals with underlying lung diseases and can cause permanent lung scarring. Night sweats and weight loss are common symptoms in this form can lead to severe respiratory dysfunction if untreated.
  • Progressive Disseminated Histoplasmosis: In this case, it spreads from the lungs to other parts of the body, like the brain, liver, or bone marrow. This severe form primarily affects infants and immunocompromised patients.

Histoplasmosis in Immunocompromised Patients

People with weakened immune systems face the highest risk. Groups at risk include solid organ transplant recipients and people with human immunodeficiency virus (HIV). Progressive disseminated Histoplasmosis is a defining opportunistic infection for patients with advanced HIV infection.

Immunosuppressed patients struggle to fight the acute infection. Patients with advanced HIV may experience severe acute pneumonia along with other complications. The fungus can reach the central nervous system, causing central nervous system histoplasmosis. It primarily affects the brain and can lead to meningitis or focal brain lesions.

Cutaneous lesions are more common in this group and can appear in various forms. Despite these risks, the majority of physicians do not recommend screening for Histoplasmosis before starting immunosuppressive therapy.

Symptoms of Histoplasmosis

The clinical characteristics of this disease vary. A high clinical suspicion is necessary because symptoms are often nonspecific. However, symptomatic patients report:

  1. High fever and chills.
  2. Pulmonary symptoms like shortness of breath. Histoplasmosis can also lead to granulomatous inflammation in the lungs, which often looks like pulmonary tuberculosis on scans.
  3. Fatigue, weight loss, and skin ulcers.
  4. Swollen liver or spleen.

The fungus sometimes affects the eyes, which is called ocular Histoplasmosis or presumed ocular Histoplasmosis. It is associated with prior exposure to the fungus and can result in chorioretinal scarring. It can lead to choroidal neovascularisation secondary to the infection, which harms vision.

Expert Diagnosis of Histoplasmosis

Doctors at SRM Global Hospitals use a mix of clinical suspicion and lab tests to find the fungus. High clinical suspicion is necessary because symptoms are not always apparent.

  1. Imaging Studies: Chest radiography or CT scans show the extent of the lung infection.
  2. Antigen Detection: The enzyme immunoassay (EIA) urine antigen test is best for confirming the disease. Histoplasma antigen stays in the blood in 80% of patients with disseminated disease. It appears in the urine of over 90% of these patients.
  3. Histopathology: Microscopic study of lung tissue strongly suggests the diagnosis. It is especially true in patients with advanced HIV. Doctors may use bronchoalveolar lavage or tissue biopsy to get samples.
  4. Fungal Culture: Culturing H. capsulatum is helpful but dangerous. The fungus poses a biohazard to lab staff. Doctors must notify the lab when they suspect this fungus.

Histoplasmosis Treatment and Management

The Indian Council of Medical Research and the Infectious Diseases Society of America provide clinical practice guidelines for recovery. The goal of histoplasmosis treatment is to kill the fungus.

  • Mild Cases: No treatment is needed for asymptomatic pulmonary nodules or mild, acute, self-limited infection in immunocompetent patients. Acute primary Histoplasmosis usually resolves without help within two weeks.
  • Moderate Cases: Doctors typically treat these with oral Itraconazole.
  • Severe Cases: For severe disseminated Histoplasmosis, IV liposomal amphotericin B is given for 2 weeks or until the patient is stable. Oral Itraconazole follows this phase.
  • Chronic Cavitary Histoplasmosis: Patients take oral Itraconazole for 12 to 24 months to prevent further lung damage.

Doctors recommend monitoring itraconazole levels in the blood during therapy. Newer options like posaconazole and isavuconazonium show promise against H. capsulatum.

Risk Factors and Disease Control

Prevention is the best disease control strategy because Histoplasmosis is not contagious and cannot spread between people. Immunocompetent patients often recover alone without medical help. However, acute respiratory distress syndrome is a severe complication that requires immediate hospital help. You should also be aware that heavy, prolonged exposure and age over 55 are major risk factors for developing severe Histoplasmosis.

Environmental exposure increases when you disturb soil during farming, construction, or cleaning. Bat cave-associated outbreaks occur sporadically across the world. To stay safe, wear masks and protective gear when moving in potentially contaminated soil.

True healing begins here!

Early diagnosis using antigen detection and antifungal therapy saves lives in cases of Histoplasmosis, which is a serious threat to those with weakened immune systems.

SRM Global Hospitals uses clinical trial group data for your safety, combined with advanced diagnostics and multispecialty expertise. If you have a cough, chest pain, or fever after visiting caves, seek help. Our infectious disease physicians are here to help you recover from these infections.

FAQs on Histoplasmosis

1. I just spent the week cleaning an old chicken coop, and now I have a fever and cough. Could this be the fungus causing Histoplasmosis I heard about?

Since you disturbed soil in an endemic area, you may have acute Histoplasmosis. Most people show mild symptoms, but we must maintain a high clinical suspicion because pulmonary fungal disease often looks like a typical flu or pneumonia.

2. My uncle has had a cough and night sweats for months, and his X-ray shows holes in his lungs. Is this tuberculosis or Histoplasmosis?

While it looks like TB, these cavitary lesions are common in chronic pulmonary Histoplasmosis. We need a clinical and laboratory update to confirm this pulmonary disease, as long-term antifungal treatment is required to prevent lung scarring.

3. I am HIV positive; why are my doctors so worried about me catching Histoplasmosis?

In patients with acquired immunodeficiency syndrome, the fungus can cause progressive disease that spreads to the liver and bone marrow. We manage this severe infection with induction therapy followed by highly active antiretroviral therapy to boost your immune system.

4. I take medicine for my rheumatoid arthritis. Does that put me at a higher risk for fungal infections such as Histoplasmosis?

Yes, drugs like tumor necrosis factor inhibitors weaken your ability to wall off the fungus. If you develop fatigue or skin ulcers, we must check for progressive disseminated Histoplasmosis immediately to start antifungal medications.

5. I have been on Itraconazole for a while now. Do I really need to keep coming in for blood and urine tests?

Regular monitoring is vital for managing disseminated Histoplasmosis safely. We check your blood to ensure antifungal medications are at the right level and test your urine for the Histoplasma antigen to confirm the antifungal treatment is working.