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- Title
Endovascular Infections Caused by Histoplasma capsulatum: A Case Series and Review of the Literature.
- Authors
Ledtke, Christopher; Rehm, Susan J.; Fraser, Thomas G.; Shrestha, Nabin K.; Tan, Carmela D.; Rodriguez, E. Rene; Tomford, J. Walton; Jain, Anil; Lytle, Bruce; Johnston, Douglas; Sabik, Joseph; Gordon, Steven M.; van Duin, David
- Abstract
Context.-Endovascular infection is an uncommon but devastating manifestation of histoplasmosis, which is often diagnosed late in disease.Objectives.-To evaluate the clinical and pathologic characteristic of patients with endovascular infections caused by Histoplasma capsulatum.Design.-All cases of patients with documented endovascularhistoplasmosis at a single tertiary care center in an endemic region during the period 1993-2010 were reviewed.Results.-Patients presented with a subacute febrile illness and a history of endovascular devices. All patients had positive Histoplasma serology. Routine bacterial culture results were negative for all patients. In addition to yeast forms typical of histoplasmosis, pathologic findings also revealed mycelial forms in 4 of 5 patients. Inflammation was scant. Urinary antigen detection was positive in 4 of 5patients and Histoplasma blood culture results were positive for 3 of 5 patients. Four patients were treated with a combination of surgical and medical therapy, which consisted of amphotericin B followed by itraconazole; these4 patients had complete resolution of symptoms and no documented relapse.One patient died before planned surgery.Conclusions.-Histoplasma capsulatum endovascular infections are clinically characterized by a subacute febrile illness with negative bacterial cultures in patients with prosthetic end grafts or valves. Non-invasive diagnostics are often the initial clue to the diagnosis. Combined medical and surgical treatment is associated with survival. Onhistopathologic examination both mycelial and yeast forms are often observed, with absent to minimal tissue inflammatory reaction
- Subjects
DIAGNOSIS of endocarditis; ENDOCARDITIS; FUNGI; PROSTHETIC heart valves; CASE studies; INFECTION; COMPLICATIONS of prosthesis; RETROSPECTIVE studies; DIAGNOSIS
- Publication
Archives of Pathology & Laboratory Medicine, 2012, Vol 136, Issue 6, p640
- ISSN
0003-9985
- Publication type
Article
- DOI
10.5858/arpa.2011-0050-OA