1921
Volume 102, Issue 2
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645

Abstract

Abstract.

The incidence of tuberculosis in India is quite high. In such a situation, empirical antitubercular therapy (ATT) is often resorted to, when some of the investigation findings are clearly diagnostic of tuberculosis. This may mean missing out on coinfections. Whereas this is particularly true for immunosuppressed patients, rarely even immunocompetent patients may present with such diagnostic dilemmas. We present the case of an adolescent boy who had been previously asymptomatic and who presented with fever with lymphadenopathy, splenomegaly, and pancytopenia. Initially, ATT was administered based on the detection of acid-fast bacteria in lymph node, caseating granulomas with Langhans giant cells, and a positive cartridge-based nucleic acid amplification test specific for . However, when the patient failed to respond fully to the treatment, additional investigation in the form of bone marrow fungal culture led to the diagnosis of histoplasmosis.

Loading

Article metrics loading...

The graphs shown below represent data from March 2017
/content/journals/10.4269/ajtmh.19-0421
2019-11-25
2021-01-25
Loading full text...

Full text loading...

/deliver/fulltext/14761645/102/2/tpmd190421.html?itemId=/content/journals/10.4269/ajtmh.19-0421&mimeType=html&fmt=ahah

References

  1. World Health Organization, 2018. WHO Global Tuberculosis Report. Available at: https://www.who.int/tb/publications/global_report/en/. Accessed September 11, 2019.
    [Google Scholar]
  2. World Health Organization, 2014. Xpert MTB/RIF Implementation Manual, Technical and Operational ‘How To’ Practical Consideration. Available at: http://apps.who.int/iris/bitstream/10665/112469/1/9789241506700_eng.pdf?ua=1. Accessed September 11, 2019.
    [Google Scholar]
  3. Sharma SK, Kohli M, Yadav RN, Chaubey J, Bhasin D, Sreenivas V, Sharma R, Singh BK, 2015. Evaluating the diagnostic accuracy of Xpert MTB/RIF assay in pulmonary tuberculosis. PLoS One 10: e0141011.
    [Google Scholar]
  4. Central Tuberculosis Division, Government of India, 2016. Technical and Operational Guidelines for TB Control in India. Chapter 3: Case Finding & Diagnosis Strategy. Available at: https://tbcindia.gov.in/showfile.php?lid=3216. Accessed September 11, 2019.
    [Google Scholar]
  5. Sanyal M, Thammayya A, 1975. Histoplasma capsulatum in the soil of Gangetic Plain in India. Indian J Med Res 63: 10201028.
    [Google Scholar]
  6. Goswami RP, Pramanik N, Banerjee D, Raza MM, Guha SK, Maiti PK, 1999. Histoplasmosis in eastern India: the tip of the iceberg? Trans R Soc Trop Med Hyg 93: 540542.
    [Google Scholar]
  7. Pan B, Chen M, Pan W, Liao W, 2013. Histoplasmosis: a new endemic fungal infection in China? Review and analysis of cases. Mycoses 56: 212221.
    [Google Scholar]
  8. Gopalakrishnan R, Senthur Nambi P, Ramasubramanian V, Abdul Ghafur K, Parameswaran A, 2012. Histoplasmosis in India: truly uncommon or uncommonly recognized? J Assoc Phys India 60: 2528.
    [Google Scholar]
  9. Subramanian S, Abraham OC, Rupali P, Zachariah A, Matthews MS, Mathai D, 2005. Disseminated histoplasmosis. J Assoc Phys India 53: 185189.
    [Google Scholar]
  10. Mandengue CE, Denning DW, 2018. The burden of serious fungal infections in Cameroon. J Fungi (Basel) 4: E44.
    [Google Scholar]
  11. Lofgren SM et al., 2012. Histoplasmosis among hospitalized febrile patients in northern Tanzania. Trans R Soc Trop Med Hyg 106: 504507.
    [Google Scholar]
  12. Medina N, Samayoa B, Lau-Bonilla D, Denning DW, Herrera R, Mercado D, Guzmán B, Pérez JC, Arathoon E, 2017. Burden of serious fungal infections in Guatemala. Eur J Clin Microbiol Infect Dis 36: 965969.
    [Google Scholar]
  13. Drayton J, Dickinson G, Rinaldi MG, 1994. Coadministration of rifampin and itraconazole leads to undetectable levels of serum itraconazole. Clin Infect Dis 18: 266.
    [Google Scholar]
  14. Agudelo CA, Restrepo CA, Molina DA, Tobón AM, Kauffman CA, Murillo C, Restrepo A, 2012. Tuberculosis and histoplasmosis co-infection in AIDS patients. Am J Trop Med Hyg 87: 10941098.
    [Google Scholar]
  15. Munoz-Oca JE, Villarreal Morales ML, Rodriguez AN, Martinez-Bonilla L, 2017. Concomitant disseminated histoplasmosis and disseminated tuberculosis after tumor necrosis factor inhibitor treatment: a case report. BMC Infect Dis 17: 70.
    [Google Scholar]
  16. Valiathan R, Deeb K, Diamante M, Ashman M, Sachdeva N, Asthana D, 2014. Reference ranges of lymphocyte subsets in healthy adults and adolescents with special mention of T cell maturation subsets in adults of south Florida. Immunobiology 219: 487496.
    [Google Scholar]
  17. Sorensen RU, Moore C, 2000. Antibody deficiency syndromes. Pediatr Clin North Am 47: 12251252.
    [Google Scholar]
  18. Agarwal S, Cunningham-Rundles C, 2007. Assessment and clinical interpretation of reduced IgG values. Ann Allergy Asthma Immunol 99: 281283.
    [Google Scholar]
  19. Bousfiha A et al., 2018. The 2017 IUIS phenotypic classification for primary immunodeficiencies. J Clin Immunol 38: 129143.
    [Google Scholar]
  20. Quesada AE, Tholpady A, Wanger A, Nguyen AN, Chen L, 2015. Utility of bone marrow examination for workup of fever of unknown origin in patients with HIV/AIDS. J Clin Pathol 68: 241245.
    [Google Scholar]
http://instance.metastore.ingenta.com/content/journals/10.4269/ajtmh.19-0421
Loading
/content/journals/10.4269/ajtmh.19-0421
Loading

Data & Media loading...

  • Received : 02 Jun 2019
  • Accepted : 29 Oct 2019
  • Published online : 25 Nov 2019
This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error