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Histoplasma capsulatum Histoplasma duboisii

HISTOPLASMA is a genus of dimorphic fungi commonly found in guano (the feces of birds and bats ) and in soil where guano falls. In modern taxonomy , the genus contains a single species , Histoplasma capsulatum, that has several infraspecific varieties. The normal variety is the causative agent of classic histoplasmosis ; Histoplasma capsulatum var. duboisii causes African histoplasmosis; and Histoplasma capsulatum var. farciminosum causes epizootic lymphangitis in horses. The duboisii and farciminosum varieties have each formerly been classified as separate species, Histoplasma duboisii and Histoplasma
Histoplasma
farciminosum.

Histoplasma capsulatum is "distributed worldwide, except in Antarctica, but most often associated with river valleys " and occurs chiefly in the "central and eastern United States " followed by "Central and South America
South America
, and other areas of the world" It is most prevalent in the Ohio
Ohio
and Mississippi
Mississippi
river valleys. It was discovered by Samuel Taylor Darling in 1906.

CONTENTS

* 1 Growth and morphology * 2 Geographic distribution * 3 Spectrum of disease * 4 Ecology and epidemiology * 5 Additional images * 6 See also * 7 References * 8 External links

GROWTH AND MORPHOLOGY

Histoplasma capsulatum is an ascomycetous fungus closely related to Blastomyces dermatitidis . It is potentially sexual, and its sexual state, Ajellomyces capsulatus, can readily be produced in culture, though it has not been directly observed in nature. As mentioned above, H. capsulatum groups with B. dermatitidis and the South American pathogen Paracoccidioides brasiliensis in the recently recognized fungal family Ajellomycetaceae . It is dimorphic and switches from a mould-like (filamentous) growth form in the natural habitat to a small budding yeast form in the warm-blooded animal host.

Histoplasma capsulatum has two mating types "+" and "–", as with B. dermatitidis. The great majority of North American isolates belong to a single genetic type but a study of multiple genes suggests a recombining, sexual population. A recent analysis has suggested that the prevalent North American genetic type and a less common type should be considered separate phylogenetic species, distinct from H. capsulatum isolates obtained in Central and South America
South America
and other parts of the world. These entities are temporarily designated NAm1 (the rare type, which includes a famous experimental isolate designated "the Downs strain") and NAm2 (the common type). There is as yet no well established clinical or geographic distinction among these two genetic groups.

In its asexual form, the fungus grows as a colonial microfungus strongly similar in macromorphology to B. dermatitidis. A microscopic examination shows a marked distinction: H. capsulatum produces two types of conidia, globose macroconidia, 8–15 µm, with distinctive tuberculate or finger-like cell wall ornamentation, and ovoid microconidia, 2–4 µm, which appear smooth or finely roughened. It is not clear whether one or both of these conidial types is more important than the other as the principal main infectious particles. They form on individual short stalks and readily become airborne when the colony is disturbed. Ascomata of the sexual state are 80–250 µm, and are very similar in appearance and anatomy to those described above for B. dermatitidis. The ascospores are similarly minute, averaging 1.5 µm.

The budding yeast cells formed in infected tissues are small (ca. 2–4 µm) and are characteristically seen forming in clusters within phagocytic cells, including histiocytes and other macrophages, as well as monocytes. An African phylogenetic species, H. duboisii , often but not always forms larger yeast cells to 15 µm.

GEOGRAPHIC DISTRIBUTION

Histoplasma capsulatum is "distributed worldwide, except in Antarctica, but most often associated with river valleys " and occurs chiefly in the "central and eastern United States " followed by "Central and South America
South America
, and other areas of the world" It is most prevalent in the Ohio
Ohio
and Mississippi
Mississippi
river valleys.

The enzootic and endemic zones of H. capsulatum can be roughly divided into core areas, where the fungus occurs widely in soil or on vegetation contaminated by bird droppings or equivalent organic inputs, and peripheral areas, where the fungus occurs relatively rarely in association with soil but is still found abundantly in heavy accumulations of bat or bird guano in enclosed spaces such as caves, buildings, and hollow trees. The principal core area for this species includes the valleys of the Mississippi
Mississippi
, Ohio
Ohio
and Potomac rivers in the USA as well as a wide span of adjacent areas extending from Kansas , Illinois
Illinois
, Indiana
Indiana
and Ohio
Ohio
in the north to Mississippi
Mississippi
, Louisiana and Texas
Texas
in the south. In some areas, such as Kansas
Kansas
City , skin testing with the histoplasmin antigen preparation shows that 80–90 % of the resident population have an antibody reaction to H. capsulatum, probably indicating prior subclinical infection. Northern U.S. states such as Minnesota
Minnesota
, Michigan
Michigan
, New York and Vermont
Vermont
are peripheral areas for histoplasmosis, but have scattered counties where 5–19 % of lifetime residents show exposure to H. capsulatum. One New York county, St. Lawrence county (across the St. Lawrence River
St. Lawrence River
from the Cornwall – Preston – Brockville area of Ontario, Canada
Ontario, Canada
) shows exposures over 20%.

The distribution of H. capsulatum in Canada is not as well documented as in the US. The St. Lawrence Valley is probably the best known endemic region based both on case reports and on a number of skin test reaction studies that were done between 1945 and 1970. The Montreal area is a particularly well documented endemic focus, not just in the agricultural regions surrounding the city but also within the city itself. The Mount Royal
Mount Royal
area in central Montreal, especially the north and east sides of Mt. Royal Park, showed exposure rates between 20 and 50% in schoolchildren and locally lifetime-resident university students. A particularly high rate of 79.3% exposure was shown in St. Thomas, Ontario , south of London, Ontario
London, Ontario
, after 7 local residents had died of histoplasmosis in 1957 Based on numerous small regional studies, histoplasmin skin test reactors form ca. 10–50 % of the population in much of southern Ontario and in Quebec’s St. Lawrence Valley, ca. 5% in southern Manitoba and some northerly parts of Quebec (e.g., Abitibi-Témiscamingue ), and ca. 1% in Nova Scotia
Nova Scotia
. Exposure of aboriginal Canadians occurs remarkably far north in Quebec, but has not been reported in similar boreal biogeoclimatic zones in many other parts of Canada. Recently and remarkably, a cluster of four indigenously acquired cases of histoplasmosis was shown to be associated with a golf course in suburban Edmonton, Alberta . Examination suggested that local soil was the source.

SPECTRUM OF DISEASE

Histoplasmosis
Histoplasmosis
is usually a subclinical infection that does not come to the attention of the person involved. The organism tends to remain alive in the scattered pulmonary calcifications; therefore, some cases are detected by emergence of serious infection when a patient becomes immunocompromised, perhaps decades later. Frank cases are most often seen as acute pulmonary histoplasmosis, a disease that resembles acute pneumonia but is usually self-limited. It is most often seen in children newly exposed to H. capsulatum or in heavily exposed individuals. Erythematous skin conditions arising from antigen reactions may complicate the disease, as may myalgias, arthralgias, and rarely, arthritic conditions. Emphysema sufferers may contract chronic cavitary pulmonary histoplasmosis as a disease complication; eventually the cavity formed may be occupied by an Aspergillus
Aspergillus
fungus ball (aspergilloma ), potentially leading to massive hemoptysis. Another uncommon form of histoplasmosis is a slowly progressing condition known as granulomatous mediastinitis, in which the lymph nodes in the mediastinal cavity between the lungs become inflamed and ultimately necrotic; the swollen nodes or draining fluid may ultimately affect the bronchi, the superior vena cava, the esophagus or the pericardium. A particularly dangerous condition is mediastinal fibrosis, in which a subset of individuals with granulomatous mediastinitis develop an uncontrolled fibrotic reaction that may press on the lungs or the bronchi, or may cause right heart failure. There are a number of other rare pulmonary manifestations of histoplasmosis.

Histoplasmosis, like blastomycosis, may disseminate haematogenously to infect internal organs and tissues, but it does so in a very low proportion of cases, and half or more of these dissemination cases involve immunocompromise. Unlike blastomycosis, histoplasmosis is a recognized AIDS -defining illness in people with HIV infection; disseminated histoplasmosis affects approximately 5% of AIDS patients with CD4 + cell counts

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