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• W2044108510 abstract "Endocarditis is a rare, occasionally solitary, manifestation of disseminated histoplasmosis. In the 28 cases described, the age has ranged between 17 and 74 years, with a mean of 48 years.1Goodwin RA Shapiro JL Thurman GH Thurman SS Des Prez RM Disseminated histoplasmosis: clinical and pathologic correlations.Medicine. 1980; 59: 1-33Crossref PubMed Scopus (493) Google Scholar, 2Blair TP Waugh RA Pollack M et al.Histoplasma capsulatum endocarditis.Am Heart J. 1980; 99: 783-789Abstract Full Text PDF PubMed Scopus (14) Google Scholar There has been a striking male preponderance (23 men, five women). All patients were inhabitants of the Ohio-Mississippi Valley region and the eastern United States. The presenting symptoms were the usual ones of subacute endocarditis: fever, chills, fatigue, malaise, anorexia, and embolic events. Physical examination results were remarkable for fever in 96 percent of the patients, a murmur in 76 percent, hepatomegaly and splenomegaly were each present in 48 percent, petechiae in 35 percent, and major artery embolization in 32 percent. Anemia was present in 71 percent. Leukopenia, which is common in chronic disseminated histoplasmosis, was present in 50 percent, and only 5 percent of the patients had leukocytosis on presentation. Aortic valve infection was most common (58 percent), and mitral (31 percent) and tricuspid (8 percent) valve involvement was less frequent. Two cases had infection of multiple valves. Underlying cardiac abnormalities were present in one-half of the cases. Rheumatic heart disease was the most common preexisting cardiac lesion, but individual cases of bicuspid aortic valves, atrial myxoma, and luetic aortic valvulitis have been reported. There have been two cases of endocarditis of prosthetic aortic valves. The difficulty in establishing an etiology was emphasized by the fact the average length of time to diagnosis was nine months, with a range of two to 37 months. Diagnosis has been established through biopsy specimens or cultures of liver, bone marrow, oropharyngeal ulcers, or urine. Only two patients had positive blood cultures. Cutaneous delayed hypersensitivity reaction to Histoplasma capsulatum antigen was of no diagnostic value. However, high titers of complement fixation serology (1:256 or greater) strongly suggested disseminated histoplasmosis and warranted therapy, in the appropriate clinical setting, without positive cultures. Vegetations, indistinguishable from those caused by bacteria, have been described by echocardiography. The difficulty in establishing the etiology has resulted in a high mortality rate. The overall survival has been 21 percent; the disease was uniformly fatal before the introduction of amphotericin B. However, 60 percent of cases treated with amphotericin B have survived. Furthermore, five of six patients receiving 2 g or greater of amphotericin B have survived, while three of four patients who received less than 2 g (including one who received two courses of 1.5 and 1.2 g, respectively) failed to survive. Two patients with prosthetic valve endocarditis died without adequate therapy. The indications for valve replacement are the same as in other forms of endocarditis: congestive heart failure not responding to medical therapy, uncontrollable infection, or recurrent emboli. Clinical suspension resulting in earlier diagnosis and adequate therapy with amphotericin B will result in substantial improvement in survival in a previously uniformly fatal disease." @default.
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• W2044108510 date "1981-06-01" @default.
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• W2044108510 title "Histoplasma capsulatum Endocarditis" @default.
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• W2044108510 doi "https://doi.org/10.1378/chest.79.6.620" @default.
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