Chronic pulmonary histoplasmosis in the state of Rio de Janeiro, Brazil

Three cases of chronic pulmonary histoplasmosis affecting aged patients wit h chronic obstructive pulmonary disease are reported. They had a history of recurrent episodes of respiratory infection and presented radiological lun g lesions inducing a misdiagnosis of chronic pulmonary tuberculosis of the adults. The diagnosis of histoplasmosis, suggested by the immunodiffusion t est and the detection of yeastlike cells in smeared and stained sputum, was confirmed by the isolation and identification of Histoplasma capsulatum va r. capsulatum in selective media. The treatment was carried out with amphot hericin B and ketoconazole or itraconazole. Clinical, radiologic, mycologic and serologic improvement was obtained in all the patients. However, relap ses occurred within a period of 1 to 18 months after the interruption of th e treatment. Mycological diagnosis and the difficulties observed in the tre tament were discussed. In addition data on the epidemiology of histoplasmos is in the state of Rio de Janeiro, Brazil, were presented.