Indigenous Case of Disseminated Histoplasmosis, Taiwan
Chung-Hsu Lai,* Chun-Kai Huang,† Chuen Chin,* Ya-Ting Yang,* Hsiu-Fang Lin,* and Hsi-Hsun Lin*
*E-Da Hospital and I-Shou University, Kaohsiung County, Taiwan, Republic of
China; and †Taichung Hospital of Department of Health, Taiwan, Republic of
China
Vol. 13, No. 1 • January 2007
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| Appendix Table. Clinical characteristics of cases of histoplasmosis reported in Taiwan* | |||||||||||
| Ref | Age (y)/sex |
Year of diagnosis |
Manifestation |
Signs and symptoms |
Chest radiograph |
Laboratory examination |
Underlying disease |
Diagnostic methods |
Travel history |
Treatment |
Outcome |
| (2) | 32/M |
1977 |
Disseminated histoplasmosis |
Cough, backache, neck LAP, anorexia, bodyweight loss |
Enlarged hilar lymph nodes |
Leukocytosis |
None† |
Lymph node biopsy only |
None |
Anti-TB drugs |
Died |
| (3) | 77/M |
1994 |
Laryngeal histoplasmosis |
Sore throat, hoarseness |
NA |
Normal |
Old pulmonary TB, adrenal insufficiency |
Laryngeal biopsy and fungal culture |
Europe, Indonesia, People's Republic of China, Saudi Arabia, |
Ketoconazole |
Survived |
| (3) | 37/M |
1996 |
Disseminated histoplasmosis (skin, blood, bone marrow) |
Fever and multiple papular skin rash |
Normal |
Pancytopenia |
AIDS (CD4 count: NA), old pulmonary TB, cerebral toxoplasmosis |
Skin, bone marrow, liver biopsy and fungal culture |
Myanmar |
Fluconazole |
Died |
| (4) | 27/M |
1997 |
Gastrointestinal histoplasmosis |
Fever, abdominal pain, watery diarrhea, bodyweight loss |
Normal |
Leukopenic, hypoalbuminemia |
AIDS (CD4 count: 200/μL) |
Colon tumor biopsy and fungal culture |
Thailand, Malaysia, Singapore, |
AmB |
Survived |
| (5) | 46/M |
1999 |
Disseminated histoplasmosis (skin, blood, pleural effusion) |
Fever, skin ulcers, prolonged diarrhea, jaundice, hepatosplenomegaly |
Bilateral pleural effusion |
Leukocytosis, anemia, thrombocytopenia, hypercalcemia |
Nontyphoid salmonellosis |
Skin biopsy and skin, blood, and pleural fungal culture; AccuProbe for pathogen identification |
Indonesia |
AmB |
Died |
| (6) | 30/M |
2000 |
Disseminated histoplasmosis |
Abdominal pain, generalized LAP, hepatosplenomegaly |
Normal |
Anemia, thrombocytopenia |
AIDS (CD4 count: 76/mL) |
Stomach and lymph node biopsy |
Unknown, but he was a sailor |
AmB |
Died |
| (7) | 55/M |
2004 |
CNS histoplasmosis and disseminated TB |
Fever, bodyweight loss, and poor appetite, hepatosplenomegaly |
Bilateral numerous nodules |
Pancytopenia |
AIDS (CD4 count: 2/mL) |
CSF fungal culture |
Myanmar, People's Republic of China |
AmB |
Died |
| PR | 78/M |
2006 |
Disseminated histoplasmosis |
Fever, general weakness, anorexia, splenomegaly |
Interstitial micronodules |
Anemia, thrombocytopenia |
Rheumatoidarthritis treated with methotrexate and prednisolone |
Bone marrow aspiration biopsy and culture; PCR assay for pathogen identification |
None |
AmB |
Survived |
| *Ref, reference; LAP, lymphadenopathy; TB, tuberculosis; NA, data not available; AmB, amphotericin B; CNS, central nervous system; CSF, cerebrospinal fluid; PR, present report. | |||||||||||
| †HIV examination was not available in Taiwan until the 1980s. | |||||||||||
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References
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