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03 RandhawaOccurrence or Histoplasmosis
03 RandhawaOccurrence or Histoplasmosis
Harbans S Randhawa* and Harish C Gugnani** ISSN : 2162-6391 (Print) 2162-6375 (Online)
ABSTRACT
The occurrence of histoplasmosis and its environmental sources of infection are reviewed. It covers the regional distribution of 388 cases of histoplasmosis
reported since 1995 to till date. The highest number of cases occurred in West Bengal, followed by Uttar Pradesh, Delhi Union territory (UT), Rajasthan,
Maharashtra, Haryana, and Bihar. A sharp rising trend in reporting cases observed in recent years is particularly noteworthy. Also, discussed are the variable
clinico-pathological manifestations of 388 cases from India, 20 from Bangladesh, five from Nepal, four from Pakistan, and three from Sri Lanka. Being a primary
pathogen, the etiological agent Histoplasma capsulatum can infect immunocompetent as well as the immunocompromised patients. The disease is fatal unless
diagnosed early and treated with specific antifungal drugs. It has a predilection for reticuloendothelial system, leading to hepatosplenomegaly, a prominent
feature of disseminated histoplasmosis. It poses an ever-increasing threat to public health due to burgeoning population of immunocompromised patients
resulting from the spread of AIDS and immunosuppressive therapy in patients undergoing organs transplantation. Non-recognition of the true burden of
histoplasmosis in the Indian sub-continent is attributed to possible misdiagnosis as tuberculosis, malignancy or other diseases, and to lack of awareness and
inadequate mycological diagnostic facilities. The need for exploring the natural foci of H. capsulatum infections, using molecular techniques, and delineating
the endemic zones of histoplasmosis is strongly emphasized.
Core tip Nomenclature of Histoplasma, its ecology, pathogenesis, clinical spectrum and laboratory diagnosis, and regional distribution of histoplasmosis in
India are described. The highest number of cases of the disease occurred in West Bengal. The varying clinical manifestations of 388 cases from India, 20 from
Bangladesh, five from Nepal, four from Pakistan, and three from Sri Lanka are described. The decade-wise occurrence of histoplasmosis in India showed a rising
trend of reporting 200 cases being recorded during the period 2004–2013, and 161 cases from 2014 to till date. In view of the available evidence, histoplas-
mosis is endemic in the subcontinent. However, supportive scientific evidence like demonstration of natural reservoirs of the pathogen and its occurrence in the
local animal populations remains largely unexplored.
KEYWORDS histoplasmosis, Histoplasma capsulatum var. capsulatum, Indian, subcontinent, update
INTRODUCTION
histoplasmosis. The organism may also enter the body
Histoplasmosis is a non-contagious systemic fungal through the mouth, and from there can cause infec-
infection of worldwide distribution, caused by a ther- tion in the intestines1,2. Histoplasmosis in humans has
mally dimorphic fungus, Histoplasma capsulatum which two clinical entities: Histoplasmosis capsulati caused by
thrives in a warm and humid environment such as soils H. capsulatum var. capsulatum (Darling’s disease,
enriched with nitrogenous compounds and phosphates American histoplasmosis, classical histoplasmosis, small
derived from avian excreta and bat guano. The microco- form histoplasmosis), and Histoplasmosis duboisii caused
nidia and short hyphal fragments of Histoplasma when by H. capsulatum var. duboisii, commonly called African
inhaled by mammalian hosts reach the alveoli, followed histoplasmosis (large form histoplasmosis). Investigators
by the rapid conversion to its yeast form that can per- linked to the division of medical mycology, VPCI, have
sist in host tissues and may disseminate through the been interested since 1960 in clinical and epidemiologi-
bloodstream and lymphatics to other organs, causing cal aspects of histoplasmosis3. The first case of histoplas-
mosis from India was reported in 1954 by Panja and Sen4
*
I/4"&NFSJUVT4DJFOUJTUFY%JSFDUPS
from Kolkata. A survey on skin testing with histoplasmin
**
3FUE1SPGFTTPS)FBE
%JWJTJPOPG.FEJDBM.ZDPMPHZ
%FQBSUNFOUPG.JDSPCJPMPHZ
on small segments of population residing in rural, urban
7BMMBCICIBJ1BUFM$IFTU*OTUJUVUF 71$*
6OJWFSTJUZPG%FMIJ
%FMIJ
*OEJB and riverine area was performed by Viswanathan et al.5
Corresponding author: 1SPG 3FUE
Harish C Gugnani during the period 1957–1959. The prevalence of 12.3%
J 3/45, Rajouri Garden, New Delhi 110027, India. histoplasmin sensitivity found in the riverine area was
Email: harish.gugnani@gmail.com the highest reported from any part of India. However,
Conflicts of interest: None. no case of histoplasmosis was detected among the pos-
Source of funding: None. itive reactors. Data on histoplasmin sensitivity in other
Author contribution: Both authors contributed equally. parts of India have been reviewed by Randhawa and
Khan6. Since then, the disease has been the subject of a temperature of 22–29°C and relative humidity of 67–97%
large number of case reports7–9, and several reviews10–12. for optimum growth. Activities such as cleaning of chicken
A rare case of epididymal histoplasmosis masquerad- coops, visiting bat-infested caves or other such sites, exca-
ing as tuberculosis diagnosed by culture of semen was vation, demolition and remodeling of old buildings, and
reported by Randhawa et al.13 This paper reviews the cutting of dead trees lead to disruption of soil containing
clinico-pathological and epidemiological features of the organism, and aerosolization of microconidia2.
the 388 cases of histoplasmosis, reported in India since
1995, and also those reported from Bangladesh, Nepal, Clinical spectrum and laboratory diagnosis
Pakistan, and Sri Lanka.
Histoplasmosis caused by H. capsulatum var. capsulatum
METHODS is a disease of reticuloendothelial system. A majority
(50–90%) of the infections result in clinically insignifi-
All publications on histoplasmosis in the Indian sub- cant respiratory disease or mild influenza-like illness.
continent were scanned by thorough search of the litera- Some infections may cause acute pulmonary histoplas-
ture, using PubMed, MEDLINE, Biomed Lib, Med Facts, mosis, manifested by non-productive cough, dyspnea,
and different sets of keywords, viz. India, Bangladesh, hoarseness, chest pain, cyanosis associated with fever,
Pakistan, Nepal, Sri Lanka, Bhutan, histoplasmosis, sys- night sweats, muscle/joint pain, weight loss, malaise, and
temic/deep mycoses, etc. Besides, cross-references in the fatigue. Acute pulmonary histoplasmosis may be con-
papers collected were accessed. All of the papers were fused with tuberculosis/miliary tuberculosis2, although
critically reviewed to extract relevant clinico-pathological involvement of upper lobes and pleural effusion is more
features and demographic data of each case. Cases diag- common in the latter1,2. Chest X-ray findings in most
nosed solely on clinical suspicion without histopatholog- patients with asymptomatic pulmonary histoplasmo-
ical evidence or positive cultures were excluded. sis are normal. A single pulmonary nodule is, however,
frequently seen. Most patients recover within 2 weeks
OBSERVATIONS of onset of symptoms, although fatigue may persist
longer. Progressive disseminated histoplasmosis occurs
Nomenclature of Histoplasma and its ecology
in approximately 10% of the patients with hepatospleno-
Histoplasmosis has three clinical entities with separate megaly, fever, anemia, leukopenia, weight loss, and gen-
etiologic agents (Table 1). Based on phenotypic char- eralized lymphadenopathy, pulmonary symptoms being
acters, Histoplasma is divided into three varieties, viz. less prominent2. Males are more frequently affected than
H. capsulatum var. capsulatum, H. capsulatum var. duboi- females by 4:1 ratio. Patients with AIDS are at high risk
sii and H. capsulatum var. farciminosum. The commonest for disseminated histoplasmosis; prevalence rates range
environmental sources of H. capsulatum var. capsulatum is 2–27% in United States and 29% in India1,6.
are soil around chicken houses, under roosting gregarious Laboratory diagnosis of histoplasmosis is based on
birds such as starlings, blackbirds, and soil of bat-infested histopathology/cytopathology, recovery of Histoplasma
caves or old buildings (CFU can exceed 105/g of soil/bat in culture from clinical samples, serological tests for
guano)1,2. Birds cannot be infected by the fungus and do antibodies, and antigen detection. Cultures are 58–85%
not transmit the disease. However, avian excreta contam- positive in cases of disseminated and chronic forms of
inate the soil, thereby providing an enriched medium for histoplasmosis; usually, up to 4 weeks is required to iso-
growth of the fungus. On the other hand, bats can get late the organism in culture2. Several culture media have
infected and transmit H. capsulatum to new sites through been used for recovery of H. capsulatum var. capsulatum
their droppings1,2. The fungus is found in the upper 15 cm from clinical specimens. In our experience, brain-heart
of soil, never deeper than 22.5 cm, and requires a mean infusion (BHI) biphasic medium appears to be the best
occurrence of any case from the States of Arunachal adrenal insufficiency, and renal transplant. It is notewor-
Pradesh, Goa, Mizoram, Nagaland, and Sikkim, and the thy that adrenal histoplasmosis was frequently observed
Union Territories of Daman and Diu, Dadra and Nagar in transplant recipients. Adrenal involvement also seems
Haveli and Pondicherry, and Andaman and Nicobar, and to be common in immunocompetent patients with dis-
Lakshadweep islands. Histoplasmosis possibly occurs in seminated histoplasmosis. Sometimes cutaneous lesions
these areas but has not been detected due to lack of aware- were the only sign of serious systemic histoplasmosis in
ness among the physicians and paucity of laboratory post-transplant patients. A number of cases occurred
diagnostic facilities. It is noteworthy that a large number in association with hemophagocytic lymphocyto-
of cases of oral and adrenal histoplasmosis (mostly in sis29,43,62,169,178,180; other unusual comorbidities included
renal transplant recipients) have been documented hairy cell leukemia with ascites28, juvenile SLE38, lym-
during the period under review. The decade-wise occur- phoidal co-infection with cryptococcosis55, CMV infec-
rence of histoplasmosis is shown in Table 3 and depicted tion58, aplastic anaemia74, Coomb’s positive hemolytic
in Fig. 2. Notably, the number of cases reported during anaemia90, myelodysplastic syndrome/myeloproliferative
the period 1954–1993 was 37, followed by a sharp rising neoplasm (MDS/MPN)128, mixed phenotype leukemia129
trend of reporting. Thus, 200 cases were recorded during and BK virus nephropathy194. Another unusual case of
the period 2004–2013, and 161 during the period from comorbidity was the occurrence of rectal histoplasmosis
2014 to till date. This significant change can be attributed in a patient with Job’s syndrome51. A few cases of oral his-
to increased awareness among clinicians, pathologists toplasmosis simulated carcinoma111,122,149, whereas some
and microbiologists, and their collaboration. The avail- laryngeal/pulmonary/disseminated cases mimicked lung
ability of enhanced laboratory facilities in many medi- and laryngeal carcinoma79,95,110,143,159,181. Likewise, one
cal colleges and hospitals in some parts of the country is each case simulated lepromatous leprosy82, non-Hodgkin
another contributing factor for increased reporting from lymphoma83, idiopathic thrombocytopenic purpura89,
those areas. abdominal tuberculosis98,187, Langerhans cell histiocyto-
The predominant clinical features and the involve- sis134, and two cases of eyelid involvement simulated basal
ment of different organs in the cases reviewed were cell carcinoma109,152. Some other unusual presentations of
essentially the same as described previously2.6,7,11,12. The histoplasmosis were parenchymal diseases with ascites24,
commonest comorbidities were HIV infection, diabetes, colonic pseudotumors67, portal hypertension with bone
involvement105, pancreatic head mass with gastric outlet
TABLE 3 Data on decade-wise occurrence of histoplasmosis in India, obstruction114, and epididymitis and prostatitis148. The
showing a sharp rising trend in its reporting during the decade 2004–2013, frequent involvement of gastrointestinal tract in several
and thereafter during the period of 2014-to-date. cases as observed in the current review points out the
Period No. of cases need for considering gastrointestinal histoplasmosis in
the differential diagnosis of malignancy, inflammatory
1954–1963 4
bowel disease, and intestinal tuberculosis. Oral lesions
1964–1973 14 were common in the series of cases in our review, involv-
1974–1983 12 ing several sites, viz. buccal mucosa, tongue, gingivae,
1984–1993 7 and palate; in many of the cases there was no indication
of pulmonary lesions. However, the prior occurrence of
1994–2003 28
self-resolving pulmonary histoplasmosis cannot be ruled
2004–2013 200 out. In tuberculosis-endemic regions as in the Indian
2014-to-date 161 sub-continent, disseminated histoplasmosis can easily
Total 426 be mistaken for tuberculosis owing to its similar clini-
cal presentation. Presence of military shadows in chest
X-ray is frequently attributed to tuberculosis without
further etiological investigation1,2. In patients with pro-
longed fever, hepatosplenomegaly, and lymphadenopa-
thy, histoplasmosis must be considered in the differential
diagnosis, particularly, if there is no response to empir-
ical anti-tubercular therapy (ATT). Further, in patients
of pulmonary histoplasmosis with pre-existing lung dis-
ease, hilar, and peripheral lymphadenopathy, radiologi-
cal signs suggestive of histoplasmosis may not be present.
Also, several cases of histoplasmosis in the subcontinent
may present as non-healing oral ulcers mimicking muco-
cutaneous leishmaniasis. It needs to be emphasized that
Fig. 2 %BUBPOEFDBEFXJTFPDDVSSFODFPGIJTUPQMBTNPTJTJO*OEJB
TIPXJOH histoplasmosis should be considered in the differen-
BTIBSQSJTJOHUSFOEJOJUTSFQPSUJOHEVSJOHUIFEFDBEF
BOE tial diagnosis of patients with mucocutaneous lesions,
UIFSFBGUFS UPEBUF
.
J Med Res Prac | Volume 07 | Issue 03 | 71–83
Histoplasmosis in the Indian subcontinent 75
8 45 M Dhaka Generalized lymphadenopathy, oral ulcers, odynophagia Shamin Ahmad Md et al. BSMMU J. 2010;3:
fever, ascites, weight loss 44–46
9 56 M Dhaka Respiratory distress, fever disorientation, cough Mehbub Md S et al. J Med. 2010;11:70–73
10 32 M Not given Supraclavicular lymphadenitis, multiple ulcers in nasopharynx, fever, Parvez Md M et al. Health Popul Nutr.
weight loss, anorexia 2010;28:305–307.
11 75 Gopalganj Bilateral adrenomegaly, partial adrenal insufficiency, anorexia, Sarwar-e-Alam AMB et al. J Bangladesh Coll Phys
evening fever with chills, weight loss Surg. 2011;235–240.
12 60 M Dhaka Oral ulcers, bilateral sub-mandibular lymphadenopathy, odynophagia Sadat SMA et al. J Bangladesh Coll Phys Surg.
2012;30:229–233.
were disseminated, involving the lung, liver and spleen, of Maharashtra. Investigation of 630 small wild animals
or adrenal glands; the fifth had multiple discharging belonging to 11 species and 10 genera from different
lesions on the anterior chest wall for the last 6 years. parts of India by Gugnani207 did not yield any isolation
Four of the patients were males and one female. One of of this fungus. Epizootic lymphangitis caused by H. cap-
the males, a 14-year-old boy was persistently exposed sulatum var. farciminosum has been reported in equines
to chickens, and had a history of rheumatic heart dis- and camels from several countries15 including India208.
ease, complicated by severe mitral stenosis. Two of
the patients were farmers, one of whom (Sr. no 4) had SOIL AS NATURAL HABITAT OF H. CAPSULATUM VAR.
recently migrated to New York, United States. CAPSULATUM
agents. Histoplasma capsulatum var. capsulatum has a 10. Misra SK, Sandhu RS. Deep mycoses in India: a critical review. Mycopathol
predilection for the reticuloendothelial system. Hence, Mycol Appl. 1972;48:339–365.
hepatosplenomegaly is a prominent feature of dissemi- 11. Kathuria, S, Capoor MR, Yadav S, Singh A, Ramesh V. Disseminated histo-
nated histoplasmosis. plasmosis in an apparently immunocompetent individual from north India:
A sharp rising trend in the number of histoplasmosis a case report and review of literature. Med Mycol. 2013;51:774–778.
cases reported in recent years is a notable observation. 12. Gupta A, Ghosh A, Singh G, Xess I. A twenty-first-century perspective of
This is attributable to increased awareness apart from disseminated histoplasmosis in India: literature review and retrospective
further development and expansion of mycological diag- analysis of published and unpublished cases at a tertiary care hospital in
nostic facilities. Although its occurrence is widespread, North India. Mycopathologia. 2017. doi:10.1007/s11046-017-0191-z
the burden of disease in the subcontinent remains unde- (published online).
termined due to paucity of systematic and comprehensive 13. Randhawa HS, Chaturvedi S, Khan ZU, Chaturvedi VP, Jain SK, Jain RC, et al.
studies, using recently introduced molecular techniques. Epididymal histoplqsmosis diagnosed by isolation of Histoplasma capsula-
Considering that an overwhelming number of the cases tum from semen. Mycopathologia. 1995;131:173–177.
had not traveled abroad to the endemic areas of the dis- 14. Kasuga T, White TJ, Koenig G, McEwen J, Restrepo A, Castaneda E, et al.
ease in North America, the disease is endemic in the Phylogeography of the fungal pathogen Histoplasma capsulatum. Mol Ecol.
subcontinent. However, supportive scientific evidence 2003;12:3383–3401.
like the demonstration of natural reservoirs of the patho- 15. Teixeira Mde M, Patané JS, Taylor ML, Gómez BL, Theodoro RC, de Hoog S,
gen and its occurrence in the local animal populations et al. Worldwide phylogenetic distributions and population dynamics of the
remains largely unexplored. To sum up, our current genus Histoplasma. PLoS Negl Trop Dis. 2016;10:e0004732. doi:10.1371/
knowledge of the global geographic distribution of his- journal.pntd.0004732
toplasmosis and other systemic mycoses is far from ade- 16. Duraiswami R, Diwan RN, Kalghatgi, AT, Mukerjee B. Unusual pathogens
quate. We strongly uphold the observation made in 1966 in HIV cases. A report of two cases. Med J Armed Forces India. 1998;54:
by Ainsworth213 that the available literature reflects the 170–172.
distribution of mycologists more accurately than it does 17. Goswami PB, Pramanik N, Banerjee D, Raza MM, Guha SK, Maiti PK.
the distribution of mycoses and their relative importance Histoplasmosis in Eastern India: the tip of the iceberg? Trans Roy Soc Trop
in a given area. Med Hyg. 1999;3:540–542.
18. Datta S, Pal SK, Kundu AK, Saha AK, Bandhopadhya SK, Karthik RO, et al.
ACKNOWLEDGMENT Primary cutaneous histoplasmosis in acquired immunodeficiency. JAPI.
2006;54:202-203.
The authors are grateful to Monika Sardana, Architect, 19. Arghya B, Kaushi M, Mimi G, Subrata C. Cytodiagnosis of cutaneous his-
Gensler ARC, Houston, Texas (USA) for the preparation toplasmosis in HIV patient presenting with multiple umbilicated dissem-
of Fig. 1. inated skin nodules. Diagn Cytopathol. 2013;41:459–462.
20. Roychowdhury A, Bandyapadhyay A, Bhattacharya P, Sinha A. Primary
REFERENCES cutaneous histoplasmosis in a skin scrape cytology. Ann Trop Med Public
Health. 2012;5:400–402.
1. Kauffman CA. Histoplasmosis: a clinical and laboratory update. Clin 21. Gopalakrishnan R, Nambi PS, Ramasubramanian V, Abdul Ghafur K,
Microbiol Rev 2007;20:115. doi:10.1128/CMR.00027-0 Parameswaran A. Histoplasmosis in India: truly uncommon or uncom-
2. Wheat LJ, Azar MM, Bahr NC, Speck A, Relich RH, Hage C. Histoplasmosis. monly recognized. J Assoc Physicians India. 2012;60:25–28.
J infect Dis Clin North Am. 2016;30:207–227. 22. Shringarpure S, Thachil JV, Gaffur A, Geetha. A case of clinically inapparent
3. Randhawa HS, Choudhary A. Medical mycology in India (1957–2007) bilateral adrenal histoplasmosis in an immunocompetent person. Ann Trop
contributions by the VPCI mycoses group. Indian J Chest All Dis. 2008;50: Med Public Health. 2013;6:479–481.
19–32. 23. Pal N, Adhikary M. Cutaneous histoplasmosis in a HIV seronegative patient.
4. Panja G, Sen S. A unique case of histoplasmosis. J Indian Med Assoc. J Nat Sci Biol Med. 2013;4:477–479. Available from: http://www.jnsbm.
1954;23:257–258. org/text.asp?2013/4/2/477/116980.
5. Viswanathan R, Chakravarty SC, Randhawa HS, deMonte AJH. Pilot histo- 24. Banerjee A. Progressive disseminated histoplasmosis presenting like paren-
plasmosis survey in Delhi area. Br Med J. 1960;1:399–400. chymal disease with ascites. A rare report and discussion. Int J Res Med Sci.
6. Randhawa HS, Khan ZU Histoplasmosis in India. Current status. Indian 2014;2:1699–1701.
J Chest Dis Allied Sci. 1994,36:193–213. 25. Koley S, Mandal RK, Khan K. Choudhary S, Banerjee S. Disseminated cuta-
7. Padhye AA, Pathak AA, Katkar VJ, Hazare VK, Kaufman L. Oral histoplas- neous histoplasmosis, an initial manifestation of HIV, diagnosed with fine
mosis in India: a case report and an overview of cases reported during needle aspiration cytology. Indian J Dermatol. 2014;59:182–185.
1968–92. J Med Vet Mycol. 1994;32:92–103. 26. Sarkar S, Saha K, Maji A, Kundu A. Non-resolving pneumonia: a rare
8. Chakravarty SC, Damodaran VN, Abraham S. Histoplasmosis in childhood presentation of progressive disseminated histoplasmosis. Lung India.
in India (a case report with family study). Indian J Chest Dis. 1968;10: 2014;31:73–75.
204–207. 27. Bhattacharya J, Goswami BK, Banerjee A, Bhattacharya R, Chakrabarti I,
9. Subramanian S, Abraham OC, Rupali P, Zachariah A, Mathews MS, Mathai Giri A. A clinicopathological study of masses arising from nasosinal tract
D. Disseminated histoplasmosis. J Assoc Physicians India. 2005;53: and nasopharynx in North Bengal population with special reference to neo-
185–189. plasms. Egypt J Otolryngol. 2015;31:98–104.
28. Arora N, Mishra A, Santra P, Nair R. Hairy cell leukemia with ascites and 47. Jaiswal S, Vij M, Chand G, Misra R, Pandey R. Diagnosis of adrenal histoplas-
coexistent histoplasmosis. Indian J Pathol Microbiol. 2015;58:125–126. mosis by fine needle aspiration cytology: an analysis based on five cases.
29. Mukherjee T, Basu A. Disseminated histoplasmosis presenting as a case Cytopathology. 2011;22:323–328.
of erythema nodosum and hemophagocytic lymphohistiocytosis. Med J 48. Sharma S, Gupta P. Histoplasma capsulatum in the peripheral blood smear
Armed Forces India. 2015;71:S598–S600. of a patient with AIDS. Indian J Path Microbiol. 2011;54:211–213.
30. De. D, Nath UK. Disseminated histoplasmosis in immunocompetent 49. Rana C, Kumari N, Krishnani N. Adrenal histoplasmosis a diagnosis on fine
individuals- not a so rare entity, in India. Mediterr J Hematol Infect Dis. needle aspiration cytology. Diagn Cytopathol. 2011;39:436–442.
2015;7:e2015028. doi:10.4084/MJHID.2015.02 50. Baradkar VP, Tendolkar U, Baveja S, Kamath S. A rare case of Histoplasma
31. Lakshman A, Dhir V, Kumar N, Singhal M. Miliary tuberculosis in an Indian fungemia in an AIDS patient. Indian J Med Microbiol. 2011;29:188–191.
lady: looking beyond military tuberculosis. Lung India. 2015;32:492–494. 51. Rana C, Krishnani N, Kumari N, Shastri S, Poddar U. Rectal histoplasmosis
32. Mandal R, Mondal K, Datta S, Chakrabarti I, Giri A, Goswami BK. in Job’s syndrome. Indian J Gastroenterol. 2013;32:64–65. doi:10.1007/
A clinico-pathological study of peripheral lymph nodes in HIV-infected s12664-012-02750
patients with special reference to CD4+ T-cell counts: experience from a 52. Ecka RS, Sharma M, Tomar V. Disseminated histoplasmosis in an immu-
tertiary care institution in Darjeeling (India). Diagn Cytopathol. 2015;43: nocompetent haweli dweller: a diagnosis and follow-up by endoscopic
971–977. ultrasound-guided fine-needle aspiration. J Cytol. 2015;32:142–144.
33. George AA, Bindra M, Mohanraj P. Rare presentation of disseminated doi:10.4103/0970-9371.160597
histoplasmosis in an immunocompetent host. Am J Trop Med Hyg. 53. Agarwal P, Capoor MR, Singh M, Gupta A, Chhakchhuak A, Debatta P. An
2015;93:1125–1127. unusual presentation of disseminated histoplasmosis. Case report and
34. Rit K, Naha A, Saha R. Adrenal histoplasmosis with disseminated cutaneous review of pediatric immunocompetent patients from India. Mycopathologia.
manifestations in an immunocompetent patient: a case report. Muller J 2015;180:359–362.
Med Sci Res. 2015;6:72–74. 54. Jain V, Tejan N, Nayani A, Singh A, Marack R, Dixit A. Disseminated histo-
35. Mandal RK, Sardar SK, Koley S. Persistent skin-colored papules over plasmosis in North India : cases series of 3 diabetic males. Sanjay Gandhi
face in an immunocompromised patient. Indian J Dermatol. 2016;61: Postgraduate Institute Of Medical Sciences, Lucknow.
116–117. 55. Ghosh A, Tilak R, Bhushan R, Dhameja N, Chakravarty J. Lymphnodal
36. Das TC, Maiti A, Basu AK, Sinha A, Dey L, Devarbhavi P, et al. Adrenal histo- co-infection of Cryptococcus and Histoplasma in a HIV-infected patient
plasmosis in an immunocompetent individual - a rare case report. Int J Med and review of published reports. Mycopathologia. 2015;180:105–110.
Res Rev. 2016;4:1773–1777. doi:10:17511/liimrr.2016.1.10.11 doi:10.1007/s11046-015-9882-5. Epub 2015 Mar 6.
37. Ghosh R, Mishra P, Sen S, Maiti PK, Chatterjee G. Experience of varied 56. Khanna S, Priya R, Bhartiya SK, Basu S, Shukla VS. Adrenal tumors: an experi-
presentation of chronic progressive disseminated histoplasmo- ence of 10 years in a single surgical unit. Indian J Cancer. 2015;52:475–478.
sis in immunocompetent patients: a diagnostic conundrum. Indian J 57. Ansari HA, Saeed N, Khan N, Hasan N. Laryngeal histoplasmosis. BMJ Case
Dermatol. 2016;61:580–582. Available from: http://www.eijd.org/text. Rep. 2016;2016:17. pii: bcr2016216423. doi:10.1136/bcr-2016-216423
asp?2016/61/5/580/190128. 58. Nasa M, Patel N, Lip L, Sud R. Gastrointestinal histoplasmosis and CMV coinfec-
38. Sarkar P, Basu K, Mallick Sinha MG. A rare case of juvenile systemic lupus tion in an immunocompetent host. J Assoc Physicians India. 2017;65:94–95.
erythematosus with disseminated histoplasmosis. Indian J Dermatol. 59. Mahto SK, Gupta PK, Sareen S, Balakrishna AM, Suman SK. A rare case of pro-
2016;61:700–703. gressive disseminated histoplasmosis with bone marrow involvement in an
39. Mukherjee A, Talukdar P, Karak A, Talukdar A. Disseminated histoplas- immunocompetent patient. Int J Res Med Sci. 2017;5:4636–4639.
mosis in an immunocompetent individual: a myth or reality? Trop Doct. 60. Sharma R, Lipi L, Gajendra S, Mohapatra I, Goel RK, Duggal R, et al.
2016;46:117–118. Gastrointestinal histoplasmosis: a case series. Int J Surg Pathol. 2017;7:592–
40. Jha V, Sree Krishna V, Varma N, Varma S, Chakrabarti A, Kohli HS, et al. 598. doi:10.1177/1066896917709945a
Disseminated histoplasmosis 19 years after renal transplantation. Clin 61. Pandit S, Singh P, Kumar N, Bansal S, Gupta RJ. Disseminated histoplasmo-
Nephrol. 1999;51:373–378. sis in an immunocompetent host presenting as pyrexia of unknown origin.
41. Singh SK, Bhadada SK, Singh SK, Sharma OP, Arya NC, Shukla, VK, et al. J Adv Res Med. 2017;4:10–13.
Histoplasmosis: an unusual presentation. J Assoc Physicians India. 62. Kumar N, Jain S, Singh ZN. Disseminated histoplasmosis with reactive
2000;48:923–925. hemophagocytosis: aspiration cytology findings in two cases. Diagn
42. Nand N, Aggarwal HK, Singh M, Arora BR, Sen J. Renal failure in a case of Cytopathol. 2000;23:422–424.
histoplasmosis. J Assoc Physicians India. 2000;49:833–834. 63. Sayal SK, Prasad PS, Mehta A, Sanghi S. Disseminated histoplas-
43. Saluja S, Bhasin S, Gupta DK, Gupta B, Kataria SP, Sharma M. Disseminated mosis cutaneous presentation. Indian J Dermatol Venereol Leprol.
histoplasmosis with reactive haemophagocytosis presenting as PUO in an 2003;69(Suppl S1):90–91. Available from: http://www.ijdvl.com/text.
immunocompetent host. J Assoc Physicians India. 2005;53:906–907. asp?2003/69/7/90/5874.
44. Sharma S, Kumari N, Gupta P, Aggarwal A. Disseminated histoplasmosis in 64. Grover SB, Midha N, Gupta M, Sharma U, Talib VH. Imaging spectrum in
an immunocompetent individual - a case report. Indian J Path Microbiol. disseminated histoplasmosis: case report and brief review. Australas Radiol.
2005;48:204–206. 2005;49:175–178.
45. Chaurasia D, Agrawal R, Misra V, Bhargava A. Penoscrotal histoplasmosis 65. Dutta AK, Sood R, Karak AK. Disseminated histoplasmosis-fulminant pre-
following bladder carcinoma. Int J Urol. 2007;14:571–572. sentation in an AIDS patient. J Indian Acad Clin Med. 2005;6:327–330.
46. Mukherjee A, Tangri R, Verma N, Gautam D. Chronic disseminated histo- 66. Nanda S, Grover C, Goel A, Kapoor D, Reddy BSN, Khurana N. Primary cuta-
plasmosis. Bone marrow involvement in an immunocompetent patient. neous histoplasmosis in an immunocompetent host from a non-endemic
Indian J Hematol Blood Transfus. 2010;26:65–67. area. Indian J Dermatol. 2006;51:63–65.
67. Sehgal S, Chawla R, Loomba PR, Mishra B. Histoplasmosis presenting as 86. Singhi MK, Gupta L, Bansal M, Garg D, Purohit SD. Asymptomatic nodules
colonic pseudotumor. Indian J Med Microbiol. 2008;17:107–109. over the face. Indian J Dermatol Venereol Leprol. 2004;70:391–392.
68. Narang V, Sinha T, Sandhu AS, Karan SC, Srivastava A, Sethi GS, et al. 87. Sonkhya N, Mehta R, Sonkhya S, Gupta S, Faujdar M. Primary histoplasmo-
Clinically inapparent bilateral adrenal masses due to histoplasmosis. Eur Urol. sis of larynx. A case series and review of literature. Int J Otolaryngol Head
2009;55:518–521. doi:10/1016jeuonro2008.09.05. Epub 2008 Sep 17. Neck Surg. 2013;2:47–51.
69. Siraj F, Manucha V. Pharyngeal histoplasmosis presenting as a tumor mass 88. Gupta GV, Kothati DC. Primary histoplasmosis of oral mucosa: a rare case
in an immunocompetent host. J Glob Infect Dis. 2010;2:70–71. report. Int J Dent Med Res. 2015;1:91–93.
70. Gopal K, Singh S, Gupta S. Fine needle aspiration cytology in bilateral adre- 89. Rughwani H, Anderpa M, Solanki BB. Chronic histoplasmosis masquerad-
nal masses in a 58-year old man. Acta Cytol. 2010;54:234–236. ing as chronic ITP. Gujarat Med J. 2015;70:98–100.
71. Dhawan J, Verma P, Sharma A, Ramam M, Kabra SK, Gupta S. Disseminated 90. Chejara RS, Nawal CL, Agrawal MK, Mittal P, Agrawal A, Agarwal S.
cutaneous histoplasmosis in an immunocompetent child, relapsed with Progressive disseminated histoplasmosis with Coomb’s positive hemo-
itraconazole, successfully treated with voriconazole. Pediatr Dermatol. lytic anemia in an immunocompetent host. J Assoc Physicians India.
2010;27:549–551. 2016;64:79–80.
72. Ahuja A, Mathur SR, Iyer VK, Sharma SK, Kumar N, Agarwal S. 91. Chatterjee D, Chatterjee A, Agarwal M, Mathur M, Mathur S, Mallikarjun R,
Histoplasmosis presenting as bilateral adrenal masses: cytomorphological et al. Disseminated histoplasmosis with oral manifestations in an immuno-
diagnosis of three cases. Diagn Cytopathol. 2012;40:729–731. competent host. Case Reports Dent. 2017. doi:10.1155/2017/1323514
73. Kothari D, Chopra S, Bhardwaj M, Ajmani AK, Kulshreshtha B. Persistence of 92. Sareen R, Kapil M, Gupta GN, Govil A. Disseminated histoplasmosis in an
Histoplasma in adrenals 7 years after antifungal therapy. Indian J Endocrinol immunocompetent individual presenting as oropharyngeal mass. Int J Oral
Metab. 2013;17:529–531. Health Sci. 2017;7:48–52.
74. Sharma SK, Gupta, S, Durgapal P, Mukherjee A, Seth T, Mishra P, et al. 93. Patel AK, Patel KK, Toshniwal H, Gohel S, Chakrabarti A. Histoplasmosis
Disseminated histoplasmosis in a patient with aplastic anemia. Indian in non-endemic North-Western part of India. Indian J Med Microbiol.
J Hematol Blood Transfus. 2014;30:143–144. doi:10.1007/s12288-012- 2018;36:61–64.
0198z 94. Gohar S, Sule A, Gaitonde S, Mittal G, Ejaz P, Mangat G, et al. Adrenal histo-
75. Sharma S, Sehgal S. Disseminated histoplasmosis diagnosed on plamosis. J Assoc Physicians India. 2001;49:916–991.
bone marrow aspiration in an immunocompetent patient. Blood Res. 95. Phatak AM, Bhattacharya I, Misra V, Prabhu AM, Natraj U. Disseminated
2015;50:179–182. histoplasmosis mimicking laryngeal carcinoma from central India - a case
76. Bharti P, Bala K, Gupta N. Cutaneous manifestation of underlying dissemi- report. Indian J Pathol Microbiol. 2006;49:452–454.
nated histoplasmosis in an immunocompetent host of non-endemic area 96. Joshi SA, Kagal AS, Bharadwaj RS, Kulkarni SS, Jadhav MV. Disseminated
with reversible CD4 cell depletion and its recovery on antifungal therapy. histoplamosis. Indian J Med Microbiol. 2006;24:297–298.
Mycopathologia. 2015;180:223–227. 97. Viswanathan S, Chawla N, D’Cruz, A, Kane SV. Head and neck histoplasmo-
77. Gupta P, Bharadwaj M. Cytodiagnosis of disseminated histoplasmosis in sis—a nightmare for clinicians and pathologists! Experience at a tertiary
an immunocompetent individual with molluscum contagiosum-like skin referral cancer centre. Head Neck Pathol. 2007;1:169–172.
lesions and lymphadenopathy. J Cytol. 2016;33:163–165. 98. Parikh F, Londhe VA, Khude S, Kamat R, Sandhya A. Gastrointestinal his-
78. Sahoo MK, Tripathy M, Deepak M, Gupta RK, Damle N, Bal C. Disseminated toplasmosis mimicking abdominal tuberculosis. J Assoc Physicians India.
histoplasmosis demonstrated on F18-fluorodeoxyglucose positron emis- 2009;57:76–78.
sion tomography/computed tomography in a renal transplant recipient. 99. Shah BK, Serban K, Tandon M. Diagnosis of progressive disseminated histo-
Indian J Nucl Med. 2016;31:162–164. doi:10.4103/0972-3919.178342 plasmosis on bone marrow biopsy. Int J Hematol. 2009;90:433–434.
79. Goswami M. Primary vocal cord histoplasmosis: a rare presentation imper- 100. Chande C, Menon S, Gohil A, Lilani S, Bade J, Mohammed S, et al. Cutaneous
sonating laryngeal malignancy. Ann Pathol Lab Med. 2016;3:L22–L23. histoplasmosis in AIDS. Indian J Med Microbiol. 2010;28:404–406.
80. Malhotra S, Dhundial R, Kaur NJK, Kaushal M, Duggal N. Cutaneous his- 101. Mehta A, Desai S, Desai N, Mookerjee A. Disseminated histoplasmosis:
toplasmosis and role of direct microscopy - a case report. Clin Microbiol. Missed opportunistic infection in a HIV-infected patient. BMJ Case Rep.
2017;6:276. doi:10.4172/2327-5073.1000276 2013;2013. pii: bcr2013201062.
81. Kumari M, Udyayakumar M, Kaushal M, Madan GB. Unusual presentation 102. Lobo V, Joshi AP, Khatavkar P, Kale MK. Pulmonary histoplasmosis in a renal
of disseminated histoplasmosis in an immunocompetent patient. Diagn allograft recipient. Indian J Nephrol. 2014;24:120–123.
Cytopathol. 2017;45:848–850. doi:10.1002/dc.23742 103. Agnihotri M, Naik L, Fernades G, Kothari K, Ojha S. Diagnosis of histoplas-
82. Bhattacharya JP, Rani P, Aggarwal R, Kaushal S. Cutaneous histoplasmo- mosis on lymph node fine needle aspiration cytology utilizing Giemsa stain:
sis masquerading as lepromatous leprosy. J Clin Diagn Res. 2017;11: a report of three cases. Anal Quant Cytopathol Histopathol. 2014;36:299–
ED01–ED02. 302.
83. Bhari N, Pahadyia P, Arava S, Gupta S. Histoplasmosis mimicking 104. Sarkar A, Patrikar A, Joshi A, Bothale K, Loney G, Mahore S. Cutaneous his-
non-Hodgkin lymphoma in a 40-year-old man with AIDS. Int J STD AIDS. toplasmosis - a case report. IJAMSCR. 2015;3:217–220.
2017;28:312–314. 105. Shukla A, Shah C, Hardik P. Gupte P. A probable case of histoplasmosis
84. Nijhawan M, Nijhawan S, Vijayvergiya R, Agarwal S. Oral histoplasmosis. presenting as portal hypertension and bone lesion in a case of common
J Assoc Physicians India. 2001;49:925–926. variable immunodeficiency syndrome. J Postgrad Med. 2015;61:49–50.
85. Singhi MK, Gupta L, Kacchawa, D, Gupta D. Disseminated primary cuta- 106. Kalgutkar AD, Saraf S, Pagare S, Patil MV. Autopsy report of disseminated
neous histoplasmosis successfully treated with itraconazole. Indian histoplasmosis, an important differential of adrenal enlargement. Med J DY
J Dermatol Venerol Leprol. 2003;69:405–407. Patil Univ. 2015;8:775–778.
107. Bhoweer A, Ranpise SG. Oral lesions leading to diagnosis of histoplasmosis. 128. Rastogi P, Sharma P, Kumar N, Rudramurthy SM, Verma N, Verma S. A case of
IJSS Case Rep Rev. 2016;3:4–8. histoplasmosis in a patient with MDS/MPN. Blood Res. 2016;51:206–207.
108. Kriplani DM, Kante KA, Maniar JK, Khubchandani SR. Histoplasmosis 129. Sharma S, Singh P, Sahu KK, Rajwanshi A, Malhotra P, Naseem S.
in an immunocompetent host: a rare case report. Int J Res Med Sci. Histoplasmosis in pleural effusion in a 23-year-old man with mixed-
2017;5:1148–1150. phenotype acute leukemia. Lab Med. 2017;48:249–252.
109. Gupta H, Tankhiwale SS. A case of bilateral eyelid histoplasmosis mistaken 130. Kumar N, Singh S, Govil S. Adrenal histoplasmosis: clinical presentation and
as basal cell carcinoma. Can J Ophthalmol. 2017;52:e45–e46. imaging features in nine cases. Abdom Imaging. 2003;28:703–708.
110. Gulati SP, Gupta A, Wadhera A, Deep A, Kalra R. Histoplasmosis of larynx 131. Vijayan C, Suprakasan S, Kumar GN, Nair PS, Jayapalan S. Primary muco-
in immunocompetent patients mimicking carcinoma: report of two cases. cutaneous histoplasmosis presents as oral ulcer. Indian J Dermatol Venerol
J Infect Dis Antimicrob Agents. 2008;25:145–149. Leprol. 2007;73:209–212.
111. Garg A, Wadhera R, Gulati SP, Kalra R. Singh S. Tongue histoplasmosis mim- 132. Vishwanath S, Girish N, Mukhyprana P, Madhusadan S, Balasubramanian
icking malignancy. J Assoc Physicians India. 2011;59:591–592. R, Manna V, et al. Disseminated histoplasmosis in an AIDS patient: a rare
112. Singh, S, Kalra R, Chhabra S, Agarwal R, Garg, S, Mathur SK. Variable case from southern India. Trop Doctr. 2009;39:247–248. doi:10.1258/
clinical presentations of histoplasmosis: a report of six cases. Trop Doct. td.2009.09001
2012;42:32–34. 133. Ganesan N, Sharma R, Phanasalkar MD, Vergheese RB. Disseminated his-
113. Singh V, Gupta P, Khatana S, Bhagol A, Gupta A. A non-healing ulcer of toplasmosis in an immunocompetent patient diagnosed on bone marrow
mandibular alveolar ridge. Oral Surg Oral Med Oral Pathol Oral Radiol. aspirate - a rare presentation from a non-endemic area. J Clin Diagn Res.
2014;117:272–276. 2015;9(12):ED07–ED08. doi:10.7860/JCDR/2015/14655.6894 (Published
114. Choudhary NS, Puri R, Paliwal M, Guleria M, Sud R. Histoplasmosis present- online 2015 Dec 10).
ing as pancreatic head mass and gastric outlet obstruction in an immuo- 134. Mathews DM, John R, Verghese V, Parmar H, Chaudhary N, Mishra S, et al.
competent host. Endoscopy. 2014;46(Suppl 1):E411–E412. Histoplasma capsulatum infection with extensive lytic bone lesions mim-
115. Choudhary N, Bansal RK, Puri R, Singh RR, Nasa M, Shah V, et al. Impact and icking LCH. J Trop Pediatr. 2016;62:496–499.
safety of endoscopic ultrasound guided fine needle aspiration on patients 135. Mohanchand R, Singh AP, Salopal TK. Histoplasmosis in acquired immuno-
with cirrhosis and pyrexia of unknown origin in India. Endosc Int Open. deficiency syndrome. Med J Armed Forces India. 2000;56:167–168.
2016;4:E953–E956. 136. Sud A, Rajwanshi A, Sehgal S, Chakravarti A, Wanchu A, Bambheri P, et al.
116. Sethi SK, Wadhvani N, Jha P, Duggal R, Sharma R, Bansal S, et al. Uncommon Disseminated histoplasmosis as an acquired immunodeficiency syndrome
cause of fever in a pediatric kidney transplant recipient. Pediatr Nephrol. defining disease. J Assoc Physicians India. 2000;48:435–436.
2016. doi:10.1007/s00467-016-3548-5 137. Goswami T, Dihingia P, Dutta A, Nath R, Das S. Adrenal histoplasmosis
117. Arora BB, Maheshwari M, Arora DR. Disseminated histoplasmosis present- not so rare? - a case report with review of literature. ISRO J Dent Med Sci.
ing as skin nodules. Br J Med Res. 2016;1:1–5. 2016;15:37–39.
118. Singh JI, Ghosh I, Singh SP, Khanna SK. Unusual fungal infection in post 138. Nair SP, Vijayadharan M, Vincet M. Primary cutaneous histoplasmosis.
renal transplant. Indian J Transplant. 2016;10:104. Indian J Dermatol Venerol Leprol. 2000;66:151–153.
119. Arora S. Rana D, Dawson L, Verma AK. Disseminted histopalsmosis with 139. Anza K, Mamatha G, Sandhya G, Uma R, Muhammed K. Syphilis of fungal
hyperglobulinemia in a rare subtype of severe combined immunodefi- world: novel skin manifestations of histoplasmosis in an immunocompe-
ciency. a case report of a 7-year-old child. Int J Acad Med. 2018;4;72–77. tent host. Indian J Dermatol. 2012;57:504.
120. Mahajan R, Sharma U, Trivedi N, Prasad M, Kansra U, Bhandari S. et al. 140. Vidyanath S, Shameena PM, Sudha S, Nair RG. Disseminated histoplas-
Histoplasma capsulatum in adrenal gland aspirate—a case report. Indian J mosis with oral and cutaneous manifestations. J Oral Maxillofac Pathol.
Path Microbiol. 2000;43:165–168. 2013;17:139–142. doi:10.4103/0973-029X.110722
121. Sood N, Gugnani HC, Batra R, Ramesh V, Padhye AA. Mucocutaneous nasal 141. Mansoor CA, Bhargavan V, Rajanish R, Nair LR. Disseminated histoplas-
histoplasmosis in an immunocompetent young adult. Indian J Dermatol mosis. Indian J Orthopathol. 2013;47:639–642. doi:10.4103/0019-
Venerol Leprol. 2007;73:182–184. 5413.121601
122. Arundhati, Kumar A. Oral histoplasmosis masquerading as squamous cell 142. Ramadevi S. Histoplasmosis: an emerging infection. J Acad Clin Microbiol.
carcinoma. Int J Dental Res Oral Sci. 2017;2:75–78. 2014;16:70–76.
123. Mehra R, Singh GN, Agrawal P. Adrenal histoplasmosis: clinical, imaging 143. George P, Nayak N, Anoop TM, Gopi N, Vikram HP, Sankar A. Pulmonary his-
and correlation. Indian J Res. 2017;6:48–49. toplasmosis mimicking carcinoma lung. Lung India. 2015;32:663–666.
124. Saikia UN, Dey P, Jindal B, Saikia B. Fine needle aspiration cytology in 144. Sitalakshmi S, Shantala Devi AMS, Damodar P, D’Souza GA. Disseminated
lymphadenopathy of HIV-positive cases. Acta Cytol. 2001;45:6589–6592. histoplasmosis in an AIDS patient diagnosed on bone marrow. Indian J Path
125. Gupta N, Arora SK, Rajwanshi A, Nijhawan R, Srinivasan R. Histoplasmosis: Microbiol. 2002;45:333–334.
cytodiagnosis and review of literature with special emphasis on differential 145. Bhagwat P, Hanumanthaya K, Tophakhane RS, Rathod RM. Two unusual
diagnosis on cytomorphology. Cytopathology. 2010;2:240–244. cases of histoplasmosis in human immunodeficiency virus-infected indi-
126. Vyas S, Kalra N, Das PJ, Lal A, Radhika A, Bhansali A, et al. Adrenal histo- viduals. Indian J Dermatol Venerol Leprol. 2009;75:173–176.
plasmosis: an unusual cause of adrenomegaly. Indian J Nephrol. 2011;21: 146. Patil K, Mahima VG, Prathibha Rani RM. Oral histoplasmosis. J Indian Soc
283–285. Periodontol. 2009;13:157–159. doi:10.4103/0972-124X.60230
127. Bhansali A, Das S, Dutta P, Walia R, Nahar U, Singh SK, et al. Adrenal his- 147. Shirali A, Kini J, Vuputturi A, Kuruvila M, Prabhu MV. Disseminated his-
toplasmosis: unusual presentations. J Assoc Physicians India. 2012;60: toplasmosis with conjunctival involvement. Indian J Sex Transm Dis.
54–58. 2010;31:35–38.
148. Baig WW, Attur RP, Chawla A, Reddy S, Pillai L, Rao K, et al. Epididymal and 168. Mishra DP, Ramamurthy S, Behera SK. Histoplasmosis presenting as isolated
prostatic histoplasmosis in a renal transplant recipient from southern India. cervical lymphadenopathy: a rare presentation. J Cytol. 2015;32:188–190.
Transpl Infect Dis. 2011;13:489–491. doi:10.04.103/109871-68856
149. Mohammed S, Sinha M, Chavan P, Premalata CS, Rudhramurthy SM, 169. Mohanty P, Bhuyan P, Kar A, Behera PK, Mohapatra CS. SLE associated
Jayshree RS, et al. Oral histoplasmosis masquerading as oral cancer in HIV- hemophagocytic lymphohistiocytosis with disseminated histoplasmosis
infected patient: a case report. Med Mycol Case Rep. 2012;1:85–87. in a HIV seropositive patient. J Evid Based Med Health. 2016;3(80):4374–
150. Chawla A, Chawla K, Thomas G. Genitourinary histoplasmosis in post- 4376. doi:10.18410/jebmh/2016/930
renal transplant patient: diagnostic dilemma. Indian J Urol. 2012;28: 170. Samantaray S, Panda S, Dash S, Rout N. Role of fine-needle aspiration
359–361. cytology in diagnosis of disseminated histoplasmosis in an immunocom-
151. Mehta KD, Harshan A, Gulikari GK, Kaul R. Non-healing tongue ulcer in an petent patient: a case report. J Cytol. 2017;34:156–158. doi:10.4103/JOC.
Indian man. JAMA Dermatol. 2015;151:333–334. JOC_74_16
152. Radhakrishnan S, Adulkar NG, Kim U. Primary cutaneous histoplasmosis 171. Sharma M, Dogra M, Tomar M. FNAC Diagnosis of disseminated histo-
mimicking basal cell carcinoma of the eyelid: a case report and review of plasmosis, a rare entity. Poster Presentation. 2012 (Dept. of Pathology,
literature. Indian J Path Microbial. 2016;59:227–228. Dr. RPGMC, Tanda, Himachal Pradesh).
153. Rao R. Recurrent primary cutaneous histoplasmosis in a post renal trans- 172. Kashyap R, Gupta D, Gupta N, Manchan P, Preyander R. Progressive dissem-
plant patient. J Nephrol Renal Transplant. 2008;1:53–58. inated histoplasmosis misdiagnosed as disseminated tuberculosis. JIACM.
154. Subbalaxmi MV, Umabala P, Roshni PB, Chandra N, Raju CYS, Rudramurthy 2014;15:78–79.
SM, et al. Caseating granulomatous inflammation, think beyond tuberculo- 173. John M, Koshy JM, Mohan S, Paul P. Histoplasmosis presenting as a
sis. Int J Phonosurg Laryngol. 2013;3:51–54. laryngeal ulcer in an immnocompetent host. J Assoc Physicians India.
155. Subbalaxmi MV, Umabala P, Paul R, Chandra N, Raju YS, Rudramurthy SM. 2016;63:69–71.
Rare presentation of progressive disseminated histoplasmosis in an immu- 174. Raina RK, Mahajan V, Sood A, Sharma S. Primary cutaneous histoplasmosis
nocompetent patient from a non-endemic region. Med Mycol Case Rep. in an immunocompetent host from a non-endemic area. Indian J Dermatol.
2013;2:103–107. 2016;61:467. doi:10.4103/0019-5154.185748h
156. Jawaid M, Rao R, Umabala P, Aruna S. Histoplasmosis presenting as an 175. Kumar R, Chhina DK, Gupta R, Chhina RS, Sandhu JS. Disseminated his-
adrenal mass in immunocompetent patient: a case report. Sch J Med Case toplasmosis in a patient with renal allograft: a case report. J Mycol Med.
Rep. 2015;3(10A):954–959. 2001;18:39–42.
157. Rathod D, Goyal R, Bhimani RK, Agarwal S, Patel R. Primary cutaneous his- 176. Tyagi R, Kaur A, Sethi PK, Puri HK, Sood N. Disseminated histoplasmosis: a
toplasmosis in a 56 years old male - a rare case report. Int J Curr Microbiol. fatal opportunistic infection in disguise. J Lab Physicians. 2016;8:129–131.
Sci. 2014;3:420–426. 177. Grover S, Sethi PK, Sood N, Sood R, Kaur H. “Polk Dot Macrophages”
158. Deshpande S, Murti P, Dhar A, Sharma AK, Dhar P. A case of disseminated on cytology of bilateral adrenal masses-nailing histoplasmosis. Diagn
histoplasmosis. Indian Med Gazzett. 1998;132:47–50. Cytopathol. 2017;45:1–4.
159. Pathak AM, Bhattacharya I, Misra V, Madan A, Prabhu SR, Natraj U. 178. Bommanan BKK, Naseem S, Verma N. Hemophagocytic lymphohistiocy-
Disseminated histoplasmosis mimicking laryngeal carcinoma from central tosis secondary to histoplasmosis. Blood Res. 2017;52:83. doi:10.5045/
India - a case report. Indian J Pathol Microbiol. 2006;49:450–452. br.2017.52.2.83
160. Verma SB. Chronic disseminated cutaneous histoplasmosis in an 179. Kalghatgi AT, Satyanarayana S, Gugnani HC, Malviya AK. Disseminated his-
immunocompetent individual - a case report. Int J Dermatol. 2006;45: toplasmosis in AIDS. Indian J Microbiol. 2000;18:42–43.
573–576. 180. Chandra H, Chandra S, Sharma A. Histoplasmosis on bone marrow aspirate
161. Harnalikar M, Kharkar V, Khopkar U. Disseminated cutaneous histoplasmo- cytological examination associated with hemophagocytosis and pancyto-
sis in an immunocompetent adult. Indian J Dermatol. 2012;57:206–209. penia in an AIDS patient. Korean J Hematol. 2012;47:77–79. doi:10.5045/
doi:10.4103/0019-5154.96194 kjh.2012.47.1.77
162. Sinha S, Sardana K, Garg VK. Photoletter to the editor: Disseminated his- 181. Bist SS, Sandhirr S, Shirazi N, Agarwal V, Bharti B. Primary histoplasmosis
toplasmosis with initial oral manifestations. J Dermatol Case Rep. 2013;7: of the larynx mimicking as laryngeal carcinoma. Int J Phonosurg Laryngol.
25–26. 2015;5:28–31.
163. Singh S, Singh Y, Singh I, Devi KHS, Muttam S, Singh S, et al. Acute dis- 182. Bist SS, Agrawal V, Shirazi N, Luthra M. Primary oropharyngeal and laryn-
seminated histoplasmosis in a patient with AIDS. Indian J Med Microbiol. geal histoplasmosis - a diagnostic challenge. Online J Health Allied Scs.
1996;4:23–24. 2015;14:12. Available at URL: http://www.ojhas.org/issue55/2015-3-12.
164. Devi KHS, Leifanbagam S, Sharma PS, Singh AM, Singh NK, Singh YM. html
Clinico-haematological profile of pancytopenia in Manipur, India. Kuwait 183. Goel D, Prayaga AK, Rao N, Damodaram P. Histoplasmosis as a cause of
Med J. 2008;40:221–224. nodular myositis in an AIDS Patient diagnosed on fine needle aspiration
165. Vasudevan B, Bahal A, Sagar A, Mohanty AP. Primary cutaneous histo- cytology. A case report. Acta Cytol. 2007;51:89–91.
plasmosis in a HIV-positive individual. J Glob Infect Dis. 2010;2112–115. 184. Agarwal VK, Prusty BSK, Preira KR. An uncommon presentation of dissemi-
doi:10.4103/0974-777X.62884 nated histoplasmosis. Ann Trop Med Public Health. 2016;9:279–282.
166. Devi S, Leifanbagam S, Singh NK, Doris E. Cytological study of cutaneous 185. Devana JV, Chakravarthi RM, Saleem M. A rare case of histoplasmosis in a
lesions in HIV-infected patients. J Med Soc. 2013;27:212–215. renal allograft recipient. J Acad Clin Microbiol. 2016;18:124–126.
167. Panda JK, Mohanty CBK, Sahoo P, Devi A, Sahu H. Cutaneous histoplasmo- 186. Ete T, Mondal S, Sinha D, Beyong T, Warjri SB, Pal J, et al. Idiopathic CD4
sis: an unusual case presentation. Indian J Path Microbiol. 2001;49: Poster lymphocytopenia with adrenal histoplasmosis. Int J Med Sci Public Health.
no 167 M Viswanathan Poster session. APICON - 2000 January 21st. 2014;3(12):1562–1564. doi:10.5455/ijmsph.2014.170920144
187. Burman B, Ele T, Mishra J, Jha P, Phukan P, Warjiri SB, et al. Abdominal his- needle aspiration: experience of 10 patients. Trop Gastroenterol. 2017;38:
toplasmosis mimicking tuberculosis in an immunocompromised. J Res Med 96–101.
Dent Sci. 2015;3:317–319. doi:10.4.DOI:10.1111/j.1365-2303.2010.00803 199. Sharma S, Gajendra S, Lipi L, Sachdev R. Tumiform laryngeal histoplasmo-
188. Dwivedi MK, Pipersania B, Issar P, Dewangan L. Disseminated histoplasmo- sis. Int J Surg Pathol. 2017;25:321–322.
sis of the adrenal gland. Indian J Radiol Imaging. 2006;16:651–652. 200. Islam N, Islam M, Muazzam MG. A histoplasmosis survey in East Pakistan.
189. Katoch P, Bhardwaj S. Primary laryngeal histoplasmosis. JK Sci. 2009;2: Trans Roy Soc Trop Med Hyg. 1962;56:246–249.
94–95. 201. Islam N, Sobhan MA. Sensitivity to histoplasmin, coccidioidin, blastomycin
190. Wadhwa A, Kaur R, Agarwal SK, Jain S, Bhalla P. AIDS-related opportunistic and tuberculin in East Pakistan. Am J Trop Med Hyg. 1971;20:621–624.
mycoses seen in a tertiary care hospital in North India. J Med Microbiol. 202. Siddiqi SH, Stauffer JC. Prevalence of histoplasmin sensitivity in Pakistan.
2007;56:1101–1106. Am J Trop Med Hyg. 1980;29:109–111.
191. Bhowmik D, Dinda AK, Xess I, Sethuraman G, Mahajan S, Gupta S, et al. 203. Uragoda CG, Wijenaike A, Han ES. Histoplasmin and coccidioidin sensitivity
Fungal panniculitis in renal transplant recipients. Transpl Infect Dis. in Ceylon. Bull World Health Organ. 1971;45:689–691.
2008;10:286–289. 204. Ravindran S, Sobhanakumari K, Celine M, Palakkal S. African histoplas-
192. Relia N, Kavimandan A, Sinha S, Sharma SK. Disseminated histoplasmosis mosis: the first report of an indigenous case in India. Int J Dermatol.
as the first presentation of idiopathic CD4+ T-lymphocytopenia. J Postgrad 2015;54:451–455. doi:1x11/ijd.12683. Epub 2014 Dec 17.
Med. 2010;56:39–40. 205. Emmons CW. Animal reservoirs and other sources in nature of the pathogenic
193. Jana M, Hari S, Arava SK. Disseminated histoplasmosis manifested by fungus, Histoplasma. Am J Public Health Nations Health. 1950. Available from:
laryngopharyngeal and adrenal lesions in an HIV-negative individual. http://ajph.aphapublications.org/doi/pdf/10.2105/AJPH.40.4.436
J Indian Med Assoc. 2010;108:615. 206. Kalra SL, Wanchoo SN. Parasitic, mycotic, and rickettsial infections in Poona
194. Sharma A, Gupta R, Ahuja A, Iyer VK, Bora M, Agarwal SK, et al. Renal rodents. Med J Armed Forces India. 1955;11:185–187.
allograft recipient with co-existing BK virus nephropathy and pulmonary 207. Gugnani HC. Fungi recovered from lungs of small mammals in India.
histoplasmosis: report of a case. Clin Exp Nephrol. 2010;14:641–644. Mykosen. 1972;15:479–485.
195. Deodhar D, Frenzen F, Rupali P, David T, Promila M, Ramya I, et al. 208. Singh T. Studies on epizootic lymphangitis. Study of clinical cases and
Disseminated histoplasmosis: a comparative study of the clinical features experimental transmission. Indian J Vet Sci. 1966;36:45–49.
and outcome among immunocompromised and immunocompetent 209. Sanyal M, Thammayya A. Histoplasma capsulatum in the soil of Gangetic
patients. Natl Med J India. 2013;26:214–215. Plain in India. Indian J Med Res. 1975;63:1020–1028.
196. Puri R, Thandassery RB, Choudhary NS, Kotecha H, Misra SR, Bhagat S, 210. Gugnani HC, Shrivastav JB. Occurrence of pathogenic fungi in soil in India.
et al. Endoscopic ultrasound-guided fine-needle aspiration of the adre- Indian J Med Res. 1972;60:40–47.
nal glands: analysis of 21 patients. Clin Endosc. 2015;48:165–170. 211. Gugnani HC, Paliwal-Joshi A, Rahman H, Padhye AA, Singh TS, Das TK, et al.
doi:10.5946/ce.2015.48.2.165 (Published online 2015 Mar 27). Occurrence of pathogenic fungi in soil of burrows of rats and of other sites
197. Gajendra S, Sharma R, Goel S, Goel R, Lipi L, Sarin H, et al. Adrenal his- in bamboo plantations in India and Nepal. Mycoses. 2007;50:507–511.
toplasmosis in immunocompetent patients presenting as adrenal insuffi- 212. Gugnani HC, Sandhu RS, Shome SK. Prevalence of Cryptococcus neoformans
ciency. Turk Petalogi Derg. 2016;32:105–111. in avian habitats in India. Mykosen. 1976;19:1983–1987.
198. Singh RR, Choudhary NS, Puri R, Guleria M, Sarin H, Nasa M, et al. 213. Ainsworth GC. The pattern of medical and veterinary mycological informa-
Adrenal histoplasmosis diagnosed by endoscopic ultrasound guided fine tion. Sabouraudia. 1967;5:81–86.