ACUTE PULMONARY HISTOPLASMOSIS AND FIRST ISOLATION OF HISTOPLASMA CAPSULATUM FROM SOIL OF RIO GRANDE DO SUL, BRAZIL
L. C. S E V E R O (1), V. F. PETR1LLO, J. J. CAMARGO, G. R. G E Y E R a n d N . S. PORTO
S U M M A R Y
A case of acute pulmonary histoplasmosis, w h e r e the clinical histoiy and epidemiological data led to the identification of H . capsulatum n a t u r a l source, is described. Specimens of spleen and liver, obtained after intraperitonial inoculation in mice, grew H. capsulatum in culture from t h e soil of r u r a l a r e a of General Câmara, by the first time in Rio Grande do Sul.
KEY WORDS: H u m a n Histoplasmosis - - LUNG — Isolation of Histoplasma capsulatum from soil.
I N T R O D U C T I O N Histoplasma capsulatum distribution in
na-ture has received litte attention in B r a z i l1 0. The
fungus h a d been recovered from soil associated with chicken a n d b a t feces, in r u r a l a r e a s near rivers, in regions with high positivitiy of the skin t e s t t o histoplasmin a n d epidemics of the fungal infection (Table I ) .
A case of acute pulmonary histoplasmosis will be described where clinical history led to
the identification of Histoplasma c a p s u l a t u m n a t u r a l source.
CASE REPORT
A 23 year-old white m a n in a good health until March 22, w a s admitted in o u r service with thoracic pain, fever, cough with scant ex-pectoration, headache, anorexia, weight loss, prostation and malaise.
I n s t i t u t o d e P e s q u i s a s B i o l ó g i c a s , S e c r e t a r i a d a S a ú d e e d o M e i o A m b i e n t e a n d P a v i l h ã o P e r e i r a F i l h o , P o r t o A l e g r e , R S , B r a z i l
On íisical examination he seemed acutely
ill, with iiii axtlar temperature :tn.!r(\ pulse 82,
respiration 22. blood pressure of 100/60 mmHg. Without adenomegary neither hepatosplenome-galy. Chest X-rays showed nodules and micro-nodules disseminated in both lungs, mainly in
the lower 2/3 fields, and probable interlobular and paratracheal adenomegaly (Fig. 1). S p u t u m examination was negative t o acid-fast bacilli, fungus, and malignant cells. Hematocrit 33 m l / dl. hemoglobin 11 g ' d l , WBC 6.000 (eos 2. ban 4, seg 53. lynph 36, mon 5».
T\c \ — R a d i o l o g i c a s p a c t i o f m u l t i p l e m i l i a r y ni KIUIrs in b o t h l u n g s w i t h hilar a d e n o p a t h y
Fig 3 — P u l m o n a r y le-»lorw f r o m b i o p s y afl*r f i r m o l (nation: section *Tnon*trate d e n s * - h i t *
With presuntjve diagnosis of granuloma t o u s pulmonary infection (specially tuberculosis and histoplasmosis! the patient w a s submitted to an open lung biopsy A cuneiform fragment of linguia, measuring 2.5 x 2,2 x 1,0 cm, was tixed in formalin and sent to the pathologist (Pig. 2). Another fragment of tissue specimen was recovered in a sterile t u b e containing. 2.0 ml of sterile w a t e r and t r a n s p o r t e d t o the labo ratory.
Pathology — The lung tissue w a s grey, with white and h a r d nodules, measuring 0 5 cm (Pig. 2). The haematoxylin and eosin stained tissue section showed a tuberculoid granuloma with central caseous zone. The Gomori methenamine silver iGROCOTTi well demonstrated the one oudding yeast cells of Illstoplasma capsulatum. Acid-fast bacilli were not found.
Mycology — Under sterily conditions, with forcep and scalpel in a Petri disch a nodule was removed from the lung specimen. It was c u t into small fragments with scissor and forcep.
Some Of then were inoculated in Sabouraud and brain heart infusin agar and submitted to 25*C and 37*C, respectively. A direct smear of a small fragment of nodule i n 10% KOH. ob served by bright-field microscopy w a s without evidence of microorganisms, a s well a s the Ziehl-Neelsen and Cram-stained s m e a r s . One week after colony development was observed. Portion of both cultures (Pig. 3) was submitted to microscopic examination and reveled the H. capsulatum in it's dimorphism.
Mycoserology — S e r u m obtained after my-cological diagnosis, was sent t o Dr. Leo Kauf man (CDC. Atlanta. OA) who tested it for H . capsulatum antibodies by the immunodiffusion and complement fixation tests. Both were po sitive, with M b a n d and a t 1:64, respectively.
Epidemiology — The oriented clinical his tory revealed that the patient in March 9, forteen days before becoming ill, cleaned a chi cken house (Fig. 4) b y five hours in t h e rural area of General Câmara. Rio Grande d o Sul,
Fig. 3 — H . c a i H u U l u m Isolated f r o m p u l m o n a r y c a s e o u s g r a n u l o m a i n i t ' s d i m o r p h i s m
P i g . 4 — T h e p a t i e n t by h i s c h i c k e n S o u s e w e n b e c o n t r a c t e d
h i s t o p l a s m o s i s
near the Jacui river. We recovered soil samples from íhree p a r t s of this place and by intraperi-toneal inoculation in mice and posterior
culti-vation of spleen and liver f r a g m e n t s4 isolated
H. capsulatum. The mould-form-to-yeast-form conversion i n brain h e a r t infusion at 3TC was done.
Evolution — The patient r e t u r n e d one and
six m o n t h s later. He seemed to be improving symptomatically without treatment and the chest X-rays reveled marked improvement in both opportunity. Mycoserology showed n o changes in six months control.
COMMENTS
Histoplasmosis m u s t be an i m p o r t a n t public
health problem in B r a z i l7. I n Rio Grande do
Sul. beacuse of greater a w a r e n e s s0, there is an
increase in the r e p o r t of clinical cases 3 , 1 1 , 1 2 . 1 3 . and most of these cases come from the Jacui's river valley where the H. capsulatum w a s Isolated from soil and sensitization to
histo-plasmin is the highest. 39.1% 9. This r a t e of skin
t e s t positivity needs further c o n f i r m a t i o n9, but
is similar to Argentina's a n d Uruguay's valley of r i v e r s8.
It is interesting to note that in spite of Rio Grande do Sul h a s similar climatic
condi-tions a s does Uruguay, a c u t e pulmonary histo-plasmosis h a s never been reported in our
neighboring c o u n t r y2.
RESUMO
Histoplasmose pulmonar aguda e primeiro isolamento do Histoplasma capsulatum do solo
do Rio Grande do Sul, Brasil Apresenta-se um caso de histoplasmose pul-m o n a r aguda, onde a história clinica orientada levou a Identificação da fonte natural d o His-toplasma capsulatum. O fungo foi obtido em cultivo a p a r t i r d e fragmentos d e baço e fígado de ratos inoculados intraperitonealmente c o m solo da zona rural de General Câmara, pela primeira vez no Rio Grande do Sul.
ACKNOWLEDGEMENT
O u r sincere appreciation is expressed t o Dr Leo Kaufman (CDC, Atlanta, GA. U S A . ) for performing the mycoserology.
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