Histoplasmosis encompasses a spectrum of clinical manifestations in the fewer
than 5% of infected persons who are symptomatic.
manifestations may be classified according to:
extrapulmonary, or disseminated)
duration of infection (acute,
pattern of infection (primary
Acute pulmonary histoplasmosis
is an influenza-like illness that is characterized by nonpleuritic chest pain,
pulmonary infiltrates, and hilar adenopathy. Symptoms persist for 2 or 3 days
to 2 weeks.
nodosum can occur in adolescents, but erythema nodosum and chronic pulmonary
histoplasmosis are uncommon in children. Primary cutaneous infections can
occur after trauma.
histoplasmosis is most common in children whose cell-mediated immunity is
immunodeficiency virus (HIV) infection
solid-organ transplant recipients
younger than 1 year of age.
include prolonged fever, failure to thrive, cough, hepatosplenomegaly,
adenopathy, pneumonia, skin lesions, and pancytopenia. Central nervous system
involvement is common.
Chronic disseminated infection
Histoplasmosis may reactivate years after primary infection in isolated
tissues, particularly in the central nervous system, adrenal glands, and
mucocutaneous surfaces, as well as in other sites.
Disseminated or extrapulmonary
histoplasmosis is an acquired immunodeficiency syndrome–defining condition in
an HIV-infected person. Histoplasmosis may be diagnosed by culture,
antigen detection in body fluids, or serology. The histoplasmin skin test is
used primarily for epidemiologic purposes.
American Academy of Pediatrics. Histoplasmosis. In: Pickering LK, ed.
2000 Red Book: Report of the Committee on Infectious Diseases. 25th
ed. Elk Grove Village, Ill: American Academy of Pediatrics;