HISTOPLASMOSIS

Wisconsin Division of Public Health Disease Surveillance Manual (EpiNet, Feb 2005)

I. IDENTIFICATION

A. CLINICAL DESCRIPTION: A systemic fungal infection of varying severity caused by Histoplasma capsulatum. Infection may be asymptomatic or take one of four clinical forms:

1) Acute benign respiratory - mild respiratory illness with general malaise, fever, chills, headache, myalgia, chest pains, nonproductive cough and scattered small calcifications of the lung.

2) Acute disseminated - debilitating fever, GI symptoms, bone marrow suppression, lymphadenopathy. Most frequent in children and immunosuppressed; fatal if not treated.

3) Chronic pulmonary - clinically and radiologically resembles chronic pulmonary tuberculosis with cavitations, usually in middle-aged and elderly persons with underlying emphysema.

4) Chronic disseminated - low-grade fever, weight loss, weakness, liver and spleen enlargement, mucosal ulcers, subacute course with slow progression; fatal if not treated.

B. REPORTING CRITERIA: Laboratory diagnosis.

C. LABORATORY CRITERIA FOR CONFIRMATION:

• Isolation of H. capsulatum from culture of bone marrow, sputum, or lesions, OR
• Histologic demonstration of intracellular yeast cells from bone marrow or tissue biopsy, OR
• Detection of H. capsulatum polysaccharide antigen in urine or serum, OR
• Rise in CF titers to either histoplasmin or yeast-phase antigen.
• Positive histoplasmin skin test IS NOT sufficient evidence.

D. WISCONSIN CASE DEFINITION: Laboratory confirmed infection and clinically compatible illness.

II. ACTIONS REQUIRED / PREVENTION MEASURES

A. WISCONSIN DISEASE SURVEILLANCE CATEGORY II: Report to the patient's local health officer on an Acute and Communicable Disease Case Report (DPH 4151) or other means within 72 hours of the identification of a case or suspected case.

B. EPIDEMIOLOGY REPORTS REQUESTED: Acute and Communicable Diseases Case Report (DPH 4151).

C. PUBLIC HEALTH INTERVENTION:

• Minimize exposure to dust in areas contaminated by bird droppings such as chicken or pigeon coops, bird or bat roosts and surrounding soil.
• Surfaces can be sprayed with water to reduce dust, protective masks should be worn during cleaning. Areas may be chemically decontaminated.
• Identify and decontaminate infectious foci (e.g., attics, bird roosts, barns, etc.).
• No public health intervention for sporadic cases.
   

III. CONTACTS FOR CONSULTATION

A. BCDP / COMMUNICABLE DISEASE EPIDEMIOLOGY SECTION: (608) 266-5326.

B. REGIONAL STAFF: See Epinet Introduction: “REGIONAL OFFICE CONTACTS”.

C. WSLH / MYCOLOGY UNIT: (608) 224-6261.

IV. RELATED REFERENCES

1. “Histoplasmosis” DPH Disease Fact Sheet Series: View a list of all current Communicable Disease Fact Sheets

2. Heymann DL, ed. HISTOPLASMOSIS . In: Control of Communicable Diseases Manual. 18 th ed. Washington , DC : American Public Health Association, 2004:273-276.

V. DISEASE TRENDS