The spectrum of histoplasmosis in a general hospital: a review of 55 cases diagnosed at Barnes Hospital between 1966 and 1977.

Between 1966 and 1977, 55 patients at Barnes Hospital were proven to have manifestations of histoplasmosis. Five patients had acute pulmonary histoplasmosis, four of whom demonstrated unusually severe disease. Disseminated histoplasmosis was documented in 19 cases. Four of these patients demonstrated dissemination during a severe and protracted but self-limited illness. The other 15 patients had progressive disease. Most of these patients were immune compromised and presented with fever of unknown origin. Therapy most benefited those who completed a course of greater than or equal to 1.5 gm of amphotericin B. Chronic pulmonary histoplasmosis was documented in 14 individuals. Large (> 1.5 cm), solitary pulmonary coin lesions, excised from 14 patients, were found to consist of exuberant granulomas containing yeast. Organisms were recovered from pleural effusions of two patients and demonstrated histologically in the tissue of one individual who presented with fibrosing mediastinitis.