ABSTRACT
We report here one case of tularemia, one case of human monocytic ehrlichiosis, and one case of febrile illness most consistent with tularemia with titers suggestive of Rocky Mountain spotted fever in residents of three south-central Missouri counties. All three cases had with nonspecific symptoms of a febrile illness. All three patients had a history of a tick bite, common in south-central Missouri, but only two patients reported the tick bite when first seen. In these three cases, the severity of the illness provided a clue that led to a diagnosis of tick-borne febrile illnesses by confirmatory serology in two cases. It is very important that physicians be aware of these diseases in the spring and summer months.
Subject(s)
Tick-Borne Diseases/diagnosis , Aged , Anti-Bacterial Agents/administration & dosage , Doxycycline/administration & dosage , Ehrlichiosis/diagnosis , Female , Humans , Male , Middle Aged , Rocky Mountain Spotted Fever/diagnosis , Tick-Borne Diseases/drug therapy , Tularemia/diagnosisSubject(s)
Anti-Bacterial Agents/therapeutic use , Skin Diseases, Infectious/diagnosis , Skin Diseases, Infectious/drug therapy , Soft Tissue Infections/diagnosis , Soft Tissue Infections/drug therapy , Animals , Antifungal Agents/therapeutic use , Bacterial Infections/diagnosis , Bacterial Infections/drug therapy , Cats , Dogs , Humans , Immunocompromised Host , Mycoses/diagnosis , Mycoses/drug therapy , Skin Diseases, Infectious/microbiology , Soft Tissue Infections/microbiology , Wound Infection/diagnosis , Wound Infection/drug therapy , ZoonosesABSTRACT
We present 6 cases of infection with Histoplasma capsulatum that have been uncommonly or not previously reported. Our case reports include unusual manifestations of H. capsulatum presenting as meningitis, the immune reconstitution syndrome, relapsing pericarditis, and scleroconjunctivitis.
Subject(s)
Eye Infections, Fungal/diagnosis , Fungemia/diagnosis , Histoplasmosis/diagnosis , Meningitis, Fungal/diagnosis , Pericarditis/diagnosis , Adult , Aged , Aged, 80 and over , Antifungal Agents/therapeutic use , Biopsy, Needle , Endemic Diseases , Eye Infections, Fungal/drug therapy , Female , Follow-Up Studies , Fungemia/drug therapy , Histoplasma/isolation & purification , Histoplasmosis/drug therapy , Humans , Immunohistochemistry , Male , Meningitis, Fungal/drug therapy , Middle Aged , Missouri/epidemiology , Pericarditis/drug therapy , Risk Assessment , Sampling Studies , Severity of Illness Index , Treatment OutcomeABSTRACT
Although a healthy pregnancy seems to confer an increased susceptibility to systemic fungal infections, to our knowledge, no known association exists in the case of Histoplasma capsulatum. In addition, to our knowledge, transplacental transmission of H capsulatum has not been previously described. We describe a series of patients treated at our institutions between 1997 and 2000 with evidence of transplacental transmission of H capsulatum. Mechanisms of increased risk of histoplasmosis during pregnancy are proposed, although this risk has yet to be proved.
