Oral histoplasmosis in HIV-infected patients A report of two cases

Histoplasmosis is a fungal infection found worldwide caused by the organism Histoplasma capsulatum. Disseminated disease usually occurs in immunosuppressed patients or in patients with chronic illness. Patients with AIDS who live in endemic areas are at increased risk for disseminated disease because of frequent environmental exposure. 1 Histoplasmosis in patients with AIDS is not unknown but is relatively infrequent and is probably a reflection of the geographic epidemiology of AIDS. The majority of cases of AIDS have occurred in large cities such as San Francisco, New York City, and Los Angeles, outside of H. capsulatum-endemic areas. 2 In endemic areas such as Indiana, disseminated histoplasmosis is a common opportunistic fungal pathogen in patients with AIDS. 3 Of the first 15 AIDS patients seen in Indianapolis, six had disseminated histoplasmosis. The clinical syndrome in these patients was more severe than in other immunocompromised patients with disseminated infection. Of these six AIDS patients, four had a clinical syndrome resembling sepsis that included disseminated intravascular coagulation, leukopenia, adult respiratory distress syndrome, and acute renal failure. Other case reports and series document fatal disseminated histoplasmosis in patients with AIDS.4 Approximately 250 cases of histoplasmosis with HIV infection have been reported in the medical literature. 5