ASPEN, COLO. — Think of histoplasmosis pericarditis when encountering pericarditis in a patient who has been in an endemic area, Dr. Matthew Zahn said a conference on pediatric infectious diseases sponsored by Children's Hospital, Denver, and the University of Colorado.
Histoplasmosis accounts for up to one-quarter of all cases of pericarditis in the Ohio River Valley and other endemic regions, noted Dr. Zahn, a pediatrician who is medical director of the Louisville (Ky.) Metro Department of Public Health and Wellness.
Histoplasmosis is endemic in the central United States, including the Mississippi River Valley.
However, histoplasmosis pericarditis does not call for antifungal therapy.
Rather, it is a reactive inflammatory process that occurs weeks to months following acute pulmonary histoplasmosis with infection of the mediastinal lymph nodes, the pediatrician explained.
The appropriate treatment is an NSAID, added Dr. Zahn, who is also at the University of Louisville (Ky.).
“There are two aspects to histoplasmosis disease. There's the illness from the fungus itself, and then there's the immune response. And the immune response sometimes can be quite big. Pericarditis is one of the immune-response illnesses,” he explained. The other common and sometimes debilitating postinfectious complications of histoplasmosis are reactive arthritis, erythema multiforme, and erythema nodosum. None require treatment other than NSAIDs.
At least one-quarter of patients with histoplasmosis pericarditis present with tamponade.
Many will need drainage of the effusion.
Eventually 15% of patients with histoplasmosis pericarditis develop constrictive pericarditis.