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Year : 2011  |  Volume : 54  |  Issue : 1  |  Page : 212-213
Histoplasma capsulatum in the peripheral-blood smear in a patient with AIDS


Department of Pathology, SGPGIMS, Raebareli Road, Lucknow - 226 014, India

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Date of Web Publication7-Mar-2011
 

How to cite this article:
Sharma S, Gupta P. Histoplasma capsulatum in the peripheral-blood smear in a patient with AIDS. Indian J Pathol Microbiol 2011;54:212-3

How to cite this URL:
Sharma S, Gupta P. Histoplasma capsulatum in the peripheral-blood smear in a patient with AIDS. Indian J Pathol Microbiol [serial online] 2011 [cited 2019 Nov 15];54:212-3. Available from: http://www.ijpmonline.org/text.asp?2011/54/1/212/77413


HIV infection is often complicated by opportunistic infections such as Mycobacterium tuberculosis, Mycobacterium avium-intracelluare, Toxoplasma gondi, Histoplasma capsulatum and cytomegalovirus. These patients frequently present with fever and peripheral cytopenias. Detection of the pathogen in the peripheral blood nutrophils is a rare finding.

A 33-year-old male with acquired immunodeficiency syndrome presented with fever of 2 months duration with night sweats, weight loss and decreased appetite for 3 months, cough with scanty whitish expectoration and dysnea at rest for 3-4 days. On physical examination, he had cervical lymphadenopathy, hepatosplenomegaly and chest crepitations. His CD4 count was 37 cells/μ l. Peripheral blood examination revealed pancytopenia (hemoglobin 4.3 g/dl, total leukocyte count 1.3 × 10 3 /μ l and platelet count 24 × 10 6 /μ l).

His peripheral blood showed numerous intracellular yeast-like organisms, 2 to 4 μ m in diameter, with eccentric chromatin in neutrophils and monocytes [Figure 1]. The organisms were surrounded by an artifactual pseudocapsule caused by cytoplasmic shrinkage. These features are diagnostic of Histoplasma capsulatum. Subsequent bone marrow aspiration and biopsy also showed H. capsulatum [Figure 2]. The diagnosis was later confirmed by bone marrow culture. The patient was treated with antibiotics and intravenous amphoterecin B with transfusion support. But his condition deteriorated and he died of respiratory arrest after 4 days of hospitalization.
Figure 1: H. capsulatum in neutrophils in peripheral smear (Leishman, ×1000)

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Figure 2: H. capsulatum in bone marrow biopsy (Gomori's methenamine silver, ×1000)

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In our patient, the first diagnosis was suggested by a peripheral blood smear, which is not a classical biological diagnostic method for fungal infection. Presence of histoplasma in peripheral blood is associated with disseminated and fulminant infection and poor prognosis. [1],[2] The diagnostic interest and the frequency of positive peripheral blood smears in the course of disseminated histoplasmosis are probably underestimated.

H. capsulatum is acquired by the inhalation of conidia or mycelial fragments. Disseminated histoplasmosis is a severe and often-fatal opportunistic infection, when left untreated, among patients with acquired immune deficiency syndrome (AIDS). This infection should be suspected in patients with a CD4 cell count of <100 cells/μ l [3] presenting with nonspecific clinical signs such as fever, weight loss, and lymphadenopathy. We report our experience to increase the awareness that careful examination of peripheral blood smear may be of rapid diagnostic utility in disseminated histoplasmosis.

 
   References Top

1.Casanova-Cardiel LJ, Ruiz-Ordaz I. Histoplasma capsulatum in the peripheral blood of patients with AIDS. Report of 4 cases with an increase of lactate dehydrogenase. Rev Invest Clin 1993;45:67-70.  Back to cited text no. 1
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2.Kennedy GA, Curnow JL, Gooch J, Williams B, Wood P, Pitman C, et al. Histoplasma capsulatum in peripheral blood smears. Br J Haematol 2002;116:503.   Back to cited text no. 2
[PUBMED]    
3.Huang L, Crothers K. HIV-associated opportunistic pneumonias. Respirology 2009;14:474-85.  Back to cited text no. 3
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Correspondence Address:
Seema Sharma
Department of Pathology, SGPGIMS, Raebareli Road, Lucknow - 226 014
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0377-4929.77413

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    Figures

  [Figure 1], [Figure 2]

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2 Utility of fine needle aspiration cytology in the diagnosis of infective lesions
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3 Utility of fine needle aspiration cytology in the diagnosis of infective lesions
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