Histoplasmosis is a fungal infection caused by the organism Histoplasma capsulatum (H. capsulatum). The infection is usually mild and asymptomatic, but in about 5% of cases it causes a sudden, short-term (up to 10 days), flu-like respiratory illness. In very rare cases (1 - 5%) it can produce serious syndromes that progress rapidly and may result in death. Because of the similarity in symptoms, histoplasmosis is sometimes mistaken for tuberculosis. About 500,000 people are exposed to H. capsulatum annually in the United States.

Most cases of histoplasmosis produce no symptoms or symptoms that are extremely mild. Signs and symptoms that occur in rare cases include the following:

• Acute, flu-like infection -- includes fever, chills, cough, chest pain, and headache
• Chronic lung infection -- develops gradually over weeks to months and produces a progressive, worsening cough, weight loss, night sweats, and possibly, shortness of breath

When the disease spreads throughout the body and affects many organ systems, a person may experience fever, chills, weight loss, enlarged liver and spleen, swollen lymph nodes, ulcers in the mouth, stomach ulcers that may bleed, infection of heart valves, meningitis (inflammation of the membranes of the brain and spinal cord), anemia, and elevated calcium levels.

The primary cause of histoplasmosis is exposure to the organism H. capsulatum, which is found primarily in mild climates worldwide. More people living in the Ohio and Mississippi river valleys of the United States have been infected with H. capsulatum than anywhere else in the world. H. capsulatum grows in moist soil that is rich in nitrogen or in areas contaminated with bird or bat droppings, such as attics, barns, caves, and city parks. The spores of H. capsulatum are inhaled into the lungs and transformed into the yeast form of the fungus. The yeast multiply in lung cells, but usually do not spread to other parts of the body in individuals with healthy immune systems. In those with weakened immune systems, the yeast may spread to the lymph nodes, liver, spleen, bone marrow, adrenal glands, and gastrointestinal tract.

The risk factors for histoplasmosis include:

• Exposure to soil contaminated with bird and bat droppings
• Residence in areas where histoplasmosis is prevalent
• Construction-related activities, such as bulldozing or demolition, that disturb contaminated soil
• Conditions that suppress the immune system, including AIDS, corticosteroid therapy, organ transplantation, and chemotherapy
• Lung disease
• Spelunking (exploring caves)
• Male gender -- males are four times more likely than women to become infected
• Very young or very old age
• Cigarette smoking

Because most cases of histoplasmosis produce no symptoms, the condition can be difficult to diagnose. In addition to a physical exam, a physician may perform the following tests to confirm the diagnosis:

• Blood test
• Mucus test
• Urine test
• Chest x-ray

The best solution to the problem of histoplasmosis is to avoid exposure to H. capsulatum, the organism that causes the infection. The following steps may help prevent the infection:

• Wear masks or respirators when exposed to areas contaminated by bird or bat droppings
• Spray contaminated areas with 3% formalin (this will kill the fungus)

Mild cases of histoplasmosis usually require minimal treatment, such as bed rest and analgesics (pain medication). More serious cases of histoplasmosis, with symptoms that include a high fever, respiratory distress, loss of appetite, and malaise, are treated with antifungal medications (medications that inhibit the growth of fungi).

Medications

Medications used to treat histoplasmosis inhibit the growth of fungi in the body. These medications are often used in severe cases when the infection has spread to various organs and tissues throughout the body.

• Amphotericin B (intravenous)
• Itraconazole (oral)
• Ketoconazole (oral)

Surgery and Other Procedures

Surgery is only necessary in rare cases when serious complications associated with the infection arise. Some surgical procedures include:

• Laser photocoagulation -- procedure used to prevent visual impairment when infection spreads to the eyes

• Surgical resection -- procedure used to remove heart valves infected with H. capsulatum

Nutrition and Dietary Supplements

A comprehensive treatment plan for histoplasmosis may include a range of complementary and alternative therapies. Preliminary studies suggest that nutritional supplements may reduce the symptoms of some histoplasmosis. Ask your team of health care providers about the best ways to incorporate these therapies into your overall treatment plan. Always tell your health care provider about the herbs and supplements you are using or considering using.

Following these nutritional tips may help reduce symptoms:

• Try to eliminate potential food allergens, including dairy, wheat (gluten), corn, preservatives, and food additives. Your health care provider may want to test for food sensitivities.
• Eat bitter and spicy foods, such as those containing turmeric (curries), cayenne peppers, green chillies, olives, figs, garlic, and ginger.
• Drink warm teas which contain spices such as cardamon, clove, and cinnamon.
• Eat antioxidant foods, including fruits (such as blueberries, cherries, and tomatoes) and vegetables (such as squash and bell peppers).
• Avoid refined foods, such as white breads, pastas, and especially sugar.
• Eat fewer red meats and more lean meats, cold-water fish, tofu (soy, if no allergy), or beans for protein.
• Use healthy oils in foods, such as olive oil or vegetable oil.
• Reduce or eliminate trans-fatty acids, found in commercially baked goods such as cookies, crackers, cakes, French fries, onion rings, donuts, processed foods, and margarine.
• Avoid coffee and other stimulants, alcohol, and tobacco.
• Drink 6 - 8 glasses of filtered water daily.
• Exercise at least 30 minutes daily, five days a week.

You may address nutritional deficiencies with the following supplements:

• A multivitamin daily, containing the antioxidant vitamins A, C, E, the B-complex vitamins, and trace minerals such as magnesium, calcium, zinc, and selenium.
• Omega-3 fatty acids, such as fish oil, 1 - 2 capsules or 1 - 3 tablespoonfuls oil, one to three times daily, to help decrease inflammation and help with immunity. Cold-water fish, such as salmon or halibut, are good sources, but are not substitutes for supplementation.
• Vitamin C, 500 - 1,000 mg one to three times daily, as an antioxidant, and for immune support.
• Grapefruit seed extract (Citrus paradisi), 100 mg capsule or 5 - 10 drops (in favorite beverage) three times daily when needed, for antibacterial, antifungal, and antiviral activity, and for immunity.
• N-acetyl cysteine, 200 mg daily, for antioxidant effects.
• Probiotic supplement (containing Lactobacillus acidophilus), 5 - 10 billion CFUs (colony forming units) a day, when needed for maintenance of gastrointestinal and immune health. You should refrigerate your probiotic supplements for best results.
• Coenzyme Q10, 100 - 200 mg at bedtime, for antioxidant and immune activity.

Herbs

Herbs are generally a safe way to strengthen and tone the body's systems. As with any therapy, you should work with your health care provider to get your problem diagnosed before starting any treatment. You may use herbs as dried extracts (capsules, powders, teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless otherwise indicated, you should make teas with 1 tsp. herb per cup of hot water. Steep covered 5 - 10 minutes for leaf or flowers, and 10 - 20 minutes for roots. Drink 2 - 4 cups per day. You may use tinctures alone or in combination as noted.

• Green tea (Camellia sinensis) standardized extract, 250 - 500 mg daily, for antioxidant, anti-inflammatory, and heart health effects. Use caffeine free products. You may also prepare teas from the leaf of this herb.
• Cat's claw (Uncaria tomentosa) standardized extract, 20 mg three times a day, for inflammation and antibacterial or antifungal activity.
• Reishi mushroom (Ganoderma lucidum), 150 - 300 mg two to three times daily, for inflammation and for immunity. You may also take a tincture of this mushroom extract, 30 - 60 drops two to three times a day.
• Olive leaf (Olea europaea) standardized extract, 250 - 500 mg one to three times daily, for antibacterial or antifungal activity and immunity. You may also prepare teas from the leaf of this herb.
• Garlic (Allium sativum), standardized extract, 400 mg two to three times daily, for antibacterial or antifungal and immune activity.

Warnings and Precautions

The medications used to treat histoplasmosis may interact adversely with the antihistamine medications terfenadine and astemizole, possibly producing abnormal heart rhythms.

Prognosis and Complications

Fortunately, serious complications associated with histoplasmosis are extremely rare. These complications may include:

• Formation of fibrous tissue in the lining of the chest wall cavity, which may compress the esophagus, heart, or lungs, affecting their ability to function properly
• Enlargement of lymph nodes -- may constrict airway, esophagus, or large blood vessels in the chest region
• Scar tissue in the lungs
• Blindness -- may occur if infection spreads to the eyes

Many cases of histoplasmosis are mild and resolve in 10 days without treatment. Occasionally, however, symptoms may persist for several weeks. In the most severe cases, particularly when the infection spreads to various organs throughout the body, long-term therapy with antifungal medications may be necessary. If left untreated, however, such severe cases generally result in death. Individuals who contract histoplasmosis in areas where infection is prevalent may experience a second infection -- even after adequate treatment -- but the second infection is usually milder than the first. Relapse is more likely in those with weakened immune systems, although it can happen in individuals with healthy immune systems as well. In general, however, histoplasmosis produces no long-term complications and is rarely fatal.

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