Acute pulmonary histoplasmosis: a case series from an outbreak in Southeastern Brazil

Souza, Danyelle Cristina de; Rodrigues-Neto, Antonio Augusto; Monnerat, Graziela Mululo Bianco; Sardou, Mayra; Hottz, Patrícia Lima; Oliveira, Josiana de; McBenedict, Billy; Vilte, Remberto Maurício de La Cruz Vargas; Fonseca, Sandra Costa; Martins, Ezequias Batista

doi:10.1590/S1678-9946202365045

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CASE REPORT • Rev. Inst. Med. trop. S. Paulo 65 • 2023 • https://doi.org/10.1590/S1678-9946202365045 copy

Acute pulmonary histoplasmosis: a case series from an outbreak in Southeastern Brazil

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Histoplasmosis is a systemic mycosis prevalent in the Americas. Humans become infected via the respiratory route by inhaling aerosols from soil contaminated with bird and bat excretions. Acute pulmonary histoplasmosis is usually asymptomatic and is more often a self-limiting illness. We report a series of seven acute pulmonary cases in adults during an outbreak in Nova Friburgo city, Rio de Janeiro State, Brazil, in a group of volunteers who were cleaning an old, abandoned house without using personal protective equipment. The patients had a favorable evolution after suitable treatment, but all required hospitalization.

Histoplasmosis; Histoplasma capsulatum; Diagnosis; Outbreak; Brazil

ADMISSION (1 to 7 days from symptom onset)
Laboratory test	Patient 1	Patient 2	Patient 3	Patient 4	Patient 5	Patient 6	Patient 7
Hemoglobin (g/dL)	15.6	13.2	12.5	13.6	14.1	11.7	11.4
Hematocrit (%)	45.0	39.0	36.0	40.0	41.0	35.0	34.0
WBC (x10³/µL)	12,200	9,600	5,500	9,600	8,300	8,300	5,200
Platelets (x10³/µL)	208,000	163,000	172,000	223,000	244,000	168,000	199,000
AST (IU/L)	60	50	17	23	NO	NO	23
ALT (IU/L)	71	74	14	35	NO	NO	34
Creatinine (mg/dL)	1.20	1.60	0.80	0.70	1.20	1.90	1.00
CRP (mg/dL)	435.80	81.30	174.70	103.00	23.50	25.40	69.20
ELISA test antibody histoplasmosis	Positive	Positive	Positive	Positive	Positive	Positive	Positive
(after onset of symptoms)	6^th day	10^th day	10^th day	10^th day	29^th day	3^rd day	10^th day
HOSPITAL DISCHARGE
Laboratory test	Patient 1	Patient 2	Patient 3	Patient 4	Patient 5	Patient 6	Patient 7
Hemoglobin (g/dL)	12.6	9.6	11.2	13.3	12.7	11.2	13.6
Hematocrit (%)	36.0	29.0	32.0	37.0	36.0	33.0	39.0
WBC (x10³/µL)	15,500	6,800	8,600	14,700	14,900	11,800	10,100
Platelets (x10³/µL)	317,000	282,000	279,000	361,000	276,000	246,000	240,000
AST (IU/L)	40	13	17	NO	NO	NO	NO
ALT (IU/L)	65	14	14	NO	NO	NO	NO
Creatinine (mg/dL)	2.40	1.70	0.90	1.10	1.00	2.10	NO
CRP (mg/dL)	0.10	52.30	2.00	8.40	11.40	NO	NO

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[1] Correspondence to: Ezequias Batista Martins Universidade Federal Fluminense, Faculdade de Medicina, Departamento de Medicina Clínica, Av. Marquês do Paraná, 303, Centro, CEP 24220-000, Niterói, RJ, Brazil Tel: +55 21 2629-9317 E-mail: ezequiasm@id.uff.br