Histoplasmosis

Histoplasmosis is an endemic systemic mycosis with a wide geographical distribution, but it predominates in the American continent. It can affect travelers mainly in two circumstances: When people from non-endemic areas visit endemic zones with massively infected foci, such as caves inhabited by bats, the other circumstance is observed in immigrants from endemic areas, who reactivate a latent infection when they are living in non-endemic countries. The first circumstance is more commonly observed in European travelers who visit Latin America and enter areas massively infected foci with bird guano or caves with bats. They present a respiratory disease of variable severity, such as flu-like symptoms or acute pneumonia. A variable number of persons are infected simultaneously and the majority of them suffer a mild respiratory illness. Most of these patients improve spontaneously and only some of them should be treated with oral itraconazole. In the second circumstance, they are usually Latin American or African immigrants living in Europe, most of them HIV-positive, who present disseminated subacute forms of histoplasmosis. This is a serious disease with multi-organ involvement, requiring rapid diagnosis and treatment with intravenous amphotericin B, followed by oral itraconazole. In this presentation, several studies of both types of traveler’s histoplasmosis are summarized, with the purpose of analyzing the clinical and radiological manifestations, the studies that lead to diagnosis, its treatment, and evolution.