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[Audio] Histoplasmosis disease. Patient case report of a female with acute Pulmonary Histoplasmosis..

STUDENT DETAILS. JS MNGUNI 220254160 OF DISAITSANYENG 223105165 TM MATTHEUS 223167985.

[Audio] Histoplasmosis is a fungal infection endemic to El Salvador, and it is also highly prevalent in the Ohio and Mississippi valleys. Histoplasma capsulatum survives for many years in soil nourished by bird or bat droppings. Infection may occur when there is exposure to spores released from disturbed contaminated soil..

[Audio] PATIENT CASE PRESENTATION Background of Current Illness: After being admitted to the general medical/surgical hospital ward, a 33-year-old white female patient Ms. ZZ arrives with her main complaint being shortness of breath with exercise. She claims that six months ago, she visited her primary care doctor's office for treatment of a similar set of symptoms. She was given an acute bronchitis diagnosis at the time and was treated with bronchodilators, empiric antibiotics, and a short-term oral steroid taper. Her symptoms did not improve under this therapy, and over the course of six months, she progressively got worse. Over the previous year, she claims to have intentionally lost 20 pounds (9 kg). She denies going camping, caving, or hunting. She disputes having any contacts with sick people A quick check of the systems reveals no signs of fever, palpitations, night sweats, chest pain, nausea, vomiting, or diarrhea. , increased bruising or bleeding, constipation, stomach pain, neural sensory changes, muscle changes, and abdominal pain. She acknowledges having a cough, breathing difficulties, and breathing problems with exertion.

[Audio] CLINICAL MANIFESTATIONS Allergies: No known medicine, food, or environmental allergies. Past Medical History: Hypertension Past Surgical History: Cholecystectomy Medications: Lisinopril 10 mg by mouth every day SOCIAL AND FAMILY HISTORY: Her tobacco use is 33 pack-years; however, she quit smoking shortly prior to the onset of symptoms, six months ago. She denies alcohol and illicit drug use. She is in a married, monogamous relationship and has three children aged 15 months to 5 years. She is employed in a cookie bakery. She has two pet doves. She traveled to Mexico for a one-week vacation one year ago. Symptoms shown were fever, malaise, cough, headache, chest pain, chills, and myalgias..

[Audio] INVESTIGATION 1. History of Present Illness: • The patient presented with a chief complaint of shortness of breath on exertion and reported a previous diagnosis of acute bronchitis six months ago. • The initial treatment with bronchodilators, antibiotics, and steroids did not improve her symptoms, and she experienced a gradual worsening over the past six months. • Additional symptoms included a 20-pound intentional weight loss and a persistent cough. 2. Physical Examination: • The patient appeared well but anxious, with respiratory distress causing her to stop midsentence. • Respiratory examination revealed diffuse rales and mild wheezing, with tachypnea. • Cardiovascular and gastrointestinal examinations were unremarkable..

[Audio] 3. Laboratory Studies: • Initial laboratory work-up showed pancytopenia (low platelet count of 74,000/mm3) and mild transaminase elevation. • Blood cultures were negative for bacterial growth or Gram staining. 4. Chest X-ray: • The chest X-ray revealed mild interstitial pneumonitis. 5. Confirmatory Evaluation: • A CT scan of the chest was performed, showing a diffuse centrilobular micronodular pattern without focal consolidation. • Based on the CT findings, a bronchoscopy with bronchoalveolar lavage was performed to investigate atypical or rare infections and rule out malignancy..

[Audio] DIAGNOSIS Physical examination reveals diffuse rales, mild wheezing, and tachypnea. Laboratory studies show pancytopenia, mild transaminase elevation, and a chest X-ray reveals mild interstitial pneumonitis. A CT scan of the chest shows a diffuse centrilobular micronodular pattern without focal consolidation. Bronchoalveolar lavage reveals a cloudy and muddy fluid with Histoplasma capsulatum identified on cytology. A diagnosis of acute pulmonary histoplasmosis in an immunocompetent patient was made..

[Audio] AETIOLOGY AND EPIDEMIOLOGY Etiology: The patient was diagnosed with acute pulmonary histoplasmosis. Histoplasmosis is caused by inhaling the microconidia of the dimorphic fungi Histoplasma capsulatum into the lungs. The mycelial phase of the fungus is present in the environment, particularly in soil enriched with bird or bat excrement. Upon exposure to the host's lungs, the mycelial phase transitions into budding yeast cells. Inhalation from soil is the major route of transmission, and human-to-human transmission is not reported. In this case, the patient's travel history to Mexico and ownership of two pet doves were identified as risk factors for histoplasmosis..

[Audio] Epidemiology: Histoplasmosis is commonly found in the Ohio, Missouri, and Mississippi River valleys of the United States, where the soil is rich in the fungus. It is endemic in these regions, and individuals living or traveling to these areas are at risk of exposure. Spelunking in caves with bat guano and ownership of pet birds are known to increase the risk of infection. The patient's travel to Mexico and ownership of doves further supports the likelihood of exposure. The incidence and prevalence of histoplasmosis vary depending on geographic location and environmental factors..

[Audio] PATHOGENESIS Histoplasmosis is caused by inhaling the microconidia of Histoplasma spp. fungus into the lungs. The infection occurs after exposure to soil containing infectious yeast, which is commonly found in areas with bird or bat excrement. The fungus undergoes a transition from the mycelial phase to the yeast phase at 37°C, such as in the host's lungs. In immunocompetent individuals, the infection is typically self-limited and presents as a respiratory illness. However, in immunocompromised hosts, the infection can progress aggressively and disseminate to other organs. The patient's symptoms and findings were consistent with pulmonary histoplasmosis, likely acquired through exposure to soil containing infectious yeast from her travel history and ownership of pet birds. The treatment approach for symptomatic pulmonary histoplasmosis depends on the severity and duration of symptoms. Mild cases may only require close monitoring, while moderate to severe cases or those lasting more than four weeks may require treatment with itraconazole for 6 to 12 weeks. In cases of severe or unresponsive disease, amphotericin B may be necessary, and corticosteroids can be used to reduce inflammation. Follow-up and observation for recurrence are important..

[Audio] In conclusion, the pathogenesis of the patient's condition involves inhalation of Histoplasma spp. microconidia, which leads to acute pulmonary histoplasmosis. The infection can progress to a disseminated form in immunocompromised individuals. The diagnosis was confirmed through bronchoscopy with bronchoalveolar lavage, which revealed the presence of Histoplasma capsulatum. Treatment options depend on the severity and duration of symptoms, with antifungal therapy being the mainstay. An interprofessional healthcare team, including clinicians, specialists, nurses, pharmacists, and laboratory technicians, should collaborate to ensure accurate diagnosis and appropriate management, ultimately improving patient outcomes..

[Audio] DISEASE PROGRESSION Acute pulmonary histoplasmosis is a fungal infection caused by inhalation of Histoplasma capsulatum spores. The progression of this disease can vary from mild, self-limiting flu-like symptoms to severe, life-threatening pneumonia. Pathological Progression: The infection begins after a person inhales spores of the fungus from contaminated soil. The spores enter the lungs and are immersed by macrophages, but instead of being destroyed, they replicate inside the macrophages. This leads to an inflammatory response, with the recruitment of neutrophils and other immune cells to the site of infection. Nodules may form in the lung tissue as the infection progress. These nodules can fuse and form areas of consolidation. The lesions may be focal or diffuse, and in severe cases, can lead to diffuse alveolar damage. Histology of the lung tissue may reveal granulomatous inflammation with concentration necrosis, or may show diffuse interstitial pneumonitis with alveolar infiltrates of neutrophils and lymphocytes..

[Audio] Clinical Progression: Acute pulmonary histoplasmosis can take different clinical courses. In some cases, the infection may be asymptomatic or may cause mild symptoms that go away on their own without treatment. However, in others, the disease can become more severe and lead to respiratory failure or disseminated infection. The initial symptoms of the disease are flu-like, with fever, chills, headache, and muscle aches. Within a few days, symptoms such as a dry cough, chest pain, and shortness of breath may develop. In severe cases, patients may experience coughing up of blood, respiratory distress, and cyanosis.Individuals with weakened immune systems, such as those with HIV/AIDS or undergoing chemotherapy, are at a higher risk for severe acute pulmonary histoplasmosis. This infection can rapidly progress to severe acute respiratory distress syndrome, requiring mechanical ventilation, and even death if left untreated. Disseminated histoplasmosis can occur when the infection spreads to other organs, such as the liver, spleen, or bone marrow. This can lead to generalized symptoms such as fever, fatigue, weight loss, and abdominal pain. In addition to respiratory symptoms, acute pulmonary histoplasmosis can cause other complications. Cardiac complications such as pericarditis or endocarditis, along with central nervous system complications such as meningitis, encephalitis, or brain abscess, have been reported in some cases..

[Audio] TREATMENT Pharmacological treatment: The first-line treatment for respiratory histoplasmosis is antifungal medication. Antifungal drugs such as itraconazole, amphotericin B, and fluconazole are the most commonly used drugs. These drugs can be administered orally or intravenously depending on the severity of the infection. In the majority of cases of acute pulmonary histoplasmosis, oral itraconazole is the first-line treatment. The dose and duration of treatment depend on the severity of the infection and the patient's immune status. Typically, treatment duration ranges from six to twelve weeks. For severe or disseminated histoplasmosis, intravenous antifungal medications such as amphotericin B or lipid formulations of amphotericin B may be necessary to control the infection. Non-pharmacological treatment: There are no specific non-pharmacological treatments for acute pulmonary histoplasmosis. However, supportive care can help manage symptoms and alleviate discomfort. Supplemental oxygen is commonly used in individuals with respiratory distress related to pulmonary histoplasmosis. Regular monitoring of blood oxygen levels may be necessary to ensure that oxygen supplementation is adequate. In addition to oxygen, fluids may be administered intravenously to prevent dehydration and maintain electrolyte balance. Bed rest is also important during the acute phase of the disease to conserve energy and prevent dehydration. In summary, acute pulmonary histoplasmosis is treated with antifungal medication, typically itraconazole or amphotericin B. Additionally, supportive care such as supplemental oxygen, intravenous fluids, and bed rest may also be necessary to manage symptoms and complications..

[Audio] DISCUSSION Acute pulmonary histoplasmosis is a fungal infection caused by the inhalation of Histoplasma capsulatum spores found in soil and bird droppings. The fungus is endemic in certain regions of the world and is particularly prevalent in the Ohio and Mississippi River valleys of the United States. While most people who become infected with the fungus do not experience any symptoms or mild flu-like symptoms that resolve on their own, some people can experience severe respiratory symptoms. These symptoms can include cough, chest pain, fever, and shortness of breath. The disease can become severe and lead to respiratory failure or disseminated infection in immunocompromised individuals. Acute pulmonary histoplasmosis is diagnosed based on clinical findings and laboratory tests, including fungal cultures, histopathology studies, and serology testing. Treatment typically involves antifungal medication such as itraconazole, amphotericin B, or fluconazole. Supportive care such as supplemental oxygen and intravenous fluids may also be necessary. One of the challenges in managing acute pulmonary histoplasmosis is that it can be difficult to differentiate from other causes of respiratory infection, such as bacterial or viral pneumonia. This can lead to delayed diagnosis and treatment, which can in turn increase the risk of complications and poorer outcomes. Prevention of acute pulmonary histoplasmosis is focused on reducing exposure to Histoplasma spores. This includes the use of personal protective equipment when working with contaminated materials, such as soil or bird droppings. Proper sanitation measures in poultry houses and other environments where Histoplasma spores may be present can also help reduce the risk of exposure. Overall, acute pulmonary histoplasmosis is a complex disease that is still not fully understood. Further research is needed to better understand the pathogenesis of the disease, improve diagnostic methods, and develop more effective treatments. In the meantime, medical professionals and public health officials must work together to raise awareness of the disease and implement effective prevention strategies to reduce the risk of infection..

[Audio] CONCLUSION To diagnose acute pulmonary histoplasmosis you need to do tests, these tests can be done by clinical technologists. Clinical technologists are responsible for performing various laboratory tests to identify the presence of the Histoplasma capsulatum fungus and monitor the progression of the disease. They collect and process samples of sputum, bronchoalveolar lavage fluid, or tissue specimens from biopsy or autopsy, and inoculate them onto culture media. They can also perform microscopic examinations of the specimens to identify the characteristic morphology of the Histoplasma yeast cells and assess the degree of inflammation and tissue damage. Clinical technologists can also perform serological tests to detect antibodies to Histoplasma antigens in the blood. These tests are especially useful for patients with disseminated histoplasmosis, as fungal cultures may be negative in these cases. Once they found the diagnosis they assist in monitoring the effectiveness of treatment through follow-up of fungal cultures, histopathology studies, and serology testing. They can also provide assistance to clinicians in choosing the appropriate antifungal therapy based on culture and sensitivity data. In addition, clinical technologists can play a role in education and prevention efforts to reduce the risk of contracting acute pulmonary histoplasmosis. They can provide guidance on the proper use of personal protective equipment, such as masks, gloves, and gowns when working with contaminated materials, and recommend measures for reducing exposure to Histoplasma spores in the environment..

[Audio] Thank you all so much for watching!. REFERENCES.

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