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Histoplasma capsulatum as a cause for prolonged pulmonary illness in an immunocompetent returning traveller from Bangladesh

Summary

A 57-year-old man returning from Bangladesh developed a severe lung infection that lasted several weeks and required hospitalization with breathing support. Doctors initially thought he had tuberculosis or bacterial pneumonia, but standard tests came back negative. Advanced fungal testing eventually identified the cause as histoplasmosis, a fungal infection he likely caught while supervising construction work. After treatment with antifungal medications, the patient recovered and was discharged to continue medication at home for a year.

Background

Fungal infections are rare causes of febrile illness in returning travellers and can be challenging to diagnose due to non-specific clinical manifestations. Histoplasma capsulatum is endemic mainly in the Americas but also in parts of Africa, Asia and Australia, and is typically seen as an imported disease in Europe. In immunocompetent individuals, histoplasmosis is usually self-limiting with pulmonary symptoms, while severe disseminated disease is more common in immunocompromised patients.

Objective

To present a case of progressive disseminated histoplasmosis in an immunocompetent returning traveller from Bangladesh with prolonged respiratory illness requiring mechanical ventilatory support. To highlight the diagnostic challenges and the utility of panfungal PCR in establishing the diagnosis.

Results

The patient was critically ill with bilateral airspace shadowing on chest X-ray and extensive ground glass opacification on CT scan. Serum 1-3-β-D-glucan was strongly positive (>500 pg/mL) and Aspergillus galactomannan was positive. Panfungal PCR on BAL fluid demonstrated Histoplasma capsulatum DNA on day 44, and serological testing for Histoplasma antibodies was positive. The patient was treated with liposomal amphotericin B followed by oral itraconazole and was discharged on day 80 on planned 12 months of antifungal therapy.

Conclusion

This case highlights that histoplasmosis should be considered in returning travellers with prolonged pulmonary illness even from non-classical endemic areas. The combination of newer diagnostic technologies such as panfungal PCR with thorough clinical history-taking and persistent clinical discussion was essential for diagnosis and successful patient outcomes.
  • Published in:Medical Mycology Case Reports,
  • Study Type:Case Report,
  • Source: PMID: 38634015, DOI: 10.1016/j.mmcr.2024.100647
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