Histoplasmosis on a small tuberculosis service in a general hospital.

The recognition of mycotic infections of the lungs is particularly desirable on a Tuberculosis Service so that patients with mycotic infections alone may avoid unnecessary exposure to tuberculosis. When pulmonary mycosis and pulmonary tuberculosis are present at the same time and are recognized, appropriate therapy for the mycotic infection may be added to the anti-tuberculosis treatment. Pulmonary histoplasmosis, like pulmonary tuberculosis, may occur either as a primary type with little or no symptomatology, or as a reinfection type1 which may result in progressive disease with fibrosis and cavity formation. As in tuberculosis, the primary infection results in hypersensitivity which may be demonstrated by the histoplasmin test. The hypersensitivity may remain for many years or possibly for life. The complement fixation test becomes positive, but is transitory and reverts in a period of months. There is ah excellent discussion of the diagnostic significance of these findings by Smith.2 A chronic progressive form of pulmonary histoplasmosis with cavity formation has been described by Furcolow and Brasher.3 In this form of the disease positive sputum cultures for the fungus usually are obtained without diffi. culty. This type of pulmonary histoplasmosis resembles the fibrocaseous reinfection type of pulmonary tuberculosis. There is no present satisfactory specific treatment for histoplasmosis and the treatment of the chronic progressive form of the disease is similar in many ways to that of tuberculosis before the discovery of anti-tuberculosis drugs. Furcolow and Brasher found 7.2 per cent of 600 patients at a tuberculosis sanatorium had positive serology (complement fixation or precipitin) for histoplasmosis. Thirty-three per cent of these cases with positive serology had either a positive culture for H. capsulatum or organisms typical of H. capsulatum. in tissues removed surgically or at autopsy. The coexistence of pulmonary mycosis and pulmonary tuberculosis has been reported many times. Meleney4 presented a series of cases in which pulmonary histoplasmosis and tuberculosis were present and active simultaneously. Three cases of pulmonary tuberculosis were reported by Larkin and Phillips1 with a different coexisting pulmonary mycosis in each case. Cryptococcus hominis was present in one, Coccidioides intmitis in the second and histoplasmosis in the third. All three ended