Table 1.
Demographical, clinical characteristics and antifungal treatment of the eight patients with disseminated histoplasmosis.
Table 2.
Results of the real-time PCR for Histoplasma and the Grocott-Gomori metenamine silver (GMS) stain in the eight cases of disseminated histoplasmosis.
Fig 1.
Autopsy findings in the lungs of patients with disseminated histoplasmosis.
(A) Formalin-fixed lung specimen showing countless yellowish nodular lesions. (B) Lung alveoli with two ill-defined granulomatous nodules with peripheric inflammatory infiltrate simulating tuberculous lesions (hematoxylin & eosin 200x). (C) Higher magnification of lung lesions shows granulomatous infiltrate with caseous-like necrosis; fungi are visible in the cytoplasm of the macrophages (hematoxylin & eosin 400x). (D) Grocott-Gomori stain highlights small-size yeast cells, morphologically characteristic of Histoplasma capsulatum (Grocott-Gomori stain 600x).
Fig 2.
The autopsy findings in extrapulmonary organs in disseminated histoplasmosis.
(A) Massive enlargement of mesenteric lymph nodes. No intestinal involvement by Histoplasma was observed in this case. (B) The microscopic liver lesions by Histoplasma: granule-laden macrophages in sinusoids and ill-defined granulomatous lesions (hematoxylin & eosin 400x). (C) Budding oval-shaped, mostly arranged in a grape cluster, Histoplasma yeasts positive for Grocott-Gomori stain (600x). (D) Pancreatic parenchyma showing easily identifiable, abundant fungal spores affecting acini and islet of Langerhans (hematoxylin & eosin 400x). (E) Large bowel wall with extensive submucosal involvement by visible fungal spores (hematoxylin & eosin 400x), highlighted with Grocott-Gomori stain (400x)(F). (G) and (H), Adrenal gland and lymph node, respectively, with the presence of dot-like, bluish structures, consistent with Histoplasma (hematoxylin & eosin 400x). (I) Isolated, paired and clustered budding of H. capsulatum yeasts stained positive with Grocott-Gomori stain (600x).
Fig 3.
Unrooted maximum likelihood tree of 255 Histoplasma sp. taxa.
Branch lengths are proportional to the number of nucleotide substitutions accumulated by every lineage (see the scale below the tree). The four genotyped strains (1 to 4) are highlighted in red and the main genetic clusters of the genus Histoplasma are shown. Nam2: North American class 2, Lam A2, LAmA1, Lam B: Latin American group A and group B, BAC: bat-associated cluster (BAC), BR: Brazil.
Table 3.
Demographical, clinical characteristics, prophylactic treatment, results of the real-time PCR for Histoplasma and the Grocott-Gomori metenamine silver (GMS) stain in the lungs of patients with localized pulmonary histoplasmosis (LPH) and patients with Histoplasma DNA detection (HDD) in the lungs without histological lesions.