{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T21:13:05Z","timestamp":1792271585125,"version":"4.4.0"},"reference-count":29,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2022,7,6]],"date-time":"2022-07-06T00:00:00Z","timestamp":1657065600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:p>Cases of empyema associated with <jats:italic>Histoplasma<\/jats:italic> infection are rarely reported. Here, we discuss a case of <jats:italic>Histoplasma<\/jats:italic>-associated empyema successfully treated with amphotericin B intravenous and pleural infusion therapy and multiple medical thoracoscopies. A 57-year-old Chinese woman with preexisting diabetes mellitus and gastric cancer had massive left-sided pleural effusion diagnosed by chest computed tomography. Her pleural effusion was purulent through pleural catheter drainage, and the culture of the pleural fluid showed <jats:italic>Escherichia coli<\/jats:italic> and Streptococcus constellation. Histopathology of the thoracoscopic pleural biopsy after hexamine silver and PAS staining supported <jats:italic>Histoplasma<\/jats:italic> infection. The patient was treated with intravenous injection and local thoracic irrigation of amphotericin B and continuous oral administration of itraconazole. At the same time, the patient received thoracic cannulation, daily thoracic lavage and thoracoscopy for purulent and necrotic tissue removal three times during hospitalization. The patient's pleural effusion and necrotic tissue in the pleural cavity were significantly reduced in a short time, and the clinical symptoms were significantly improved. After discharge, the patient recovered well and had no obvious complications or sequelae. Intravenous injection and local thoracic irrigation of amphotericin B are safe and effective drug therapies to treat fungal-associated empyema such as <jats:italic>Histoplasma<\/jats:italic>. Medical thoracoscopy effectively shortens the recovery time of empyema, improving the prognosis and reducing complications.<\/jats:p>","DOI":"10.3389\/fpubh.2022.914529","type":"journal-article","created":{"date-parts":[[2022,7,6]],"date-time":"2022-07-06T16:35:58Z","timestamp":1657125358000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":6,"title":["A Case Report of Histoplasma-Associated Empyema Treated With Intravenous Injection and Local Thoracic Irrigation of Amphotericin B Plus Medical Thoracoscopy"],"prefix":"10.3389","volume":"10","author":[{"given":"Ning","family":"Cui","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lijun","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jingming","family":"Zhao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2022,7,6]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"151","DOI":"10.1055\/s-2008-1063854","article-title":"Pulmonary histoplasmosis","volume":"29","author":"Hage","year":"2008","journal-title":"Semin Respir Crit Care Med."},{"key":"B2","first-page":"929","article-title":"State of the art: histoplasmosis","volume":"117","author":"Goodwin","year":"1978","journal-title":"Am Rev Respir Dis."},{"key":"B3","doi-asserted-by":"publisher","first-page":"159","DOI":"10.7326\/0003-4819-96-2-159","article-title":"Risk factors for disseminated or fatal histoplasmosis. Analysis of a large urban outbreak","volume":"96","author":"Wheat","year":"1982","journal-title":"Ann Intern Med."},{"key":"B4","doi-asserted-by":"publisher","first-page":"118","DOI":"10.1159\/000068426","article-title":"Pleural effusion due to Histoplasma capsulatum and idiopathic CD4 lymphocytopenia","volume":"70","author":"Kortsik","year":"2003","journal-title":"Respiration."},{"key":"B5","doi-asserted-by":"publisher","first-page":"76","DOI":"10.1378\/chest.58.1.76","article-title":"Pleural effusion due to infection with histoplasma capsulatum","volume":"58","author":"Brewer","year":"1970","journal-title":"Chest."},{"key":"B6","doi-asserted-by":"publisher","first-page":"e33","DOI":"10.1016\/j.chest.2017.04.187","article-title":"Right middle lobe collapse and pleural effusion in an 18-year-old man","volume":"152","author":"Patterson","year":"2017","journal-title":"Chest."},{"key":"B7","doi-asserted-by":"publisher","first-page":"622","DOI":"10.1016\/S0003-4975(10)65355-6","article-title":"Symptomatic histoplasmosis in children","volume":"15","author":"Kakos","year":"1973","journal-title":"Ann Thorac Surg."},{"key":"B8","first-page":"749","article-title":"Histoplasmosis: a review of one hundred consecutively hospitalized patients","volume":"77","author":"Curry","year":"1958","journal-title":"Am Rev Tuberc."},{"key":"B9","doi-asserted-by":"publisher","first-page":"415","DOI":"10.1097\/00006454-199305000-00018","article-title":"Pleural effusion associated with histoplasmosis","volume":"12","author":"Quasney","year":"1993","journal-title":"Pediatr Infect Dis J."},{"key":"B10","doi-asserted-by":"publisher","first-page":"1715","DOI":"10.1378\/chest.100.6.1715","article-title":"Recurrent massive pleural effusion due to pleural, pericardial, and epicardial fibrosis in histoplasmosis","volume":"100","author":"Kilburn","year":"1991","journal-title":"Chest."},{"key":"B11","doi-asserted-by":"publisher","first-page":"82","DOI":"10.1016\/0002-9149(76)90504-X","article-title":"Pericarditis caused by Histoplasma capsulatum","volume":"37","author":"Picardi","year":"1976","journal-title":"Am J Cardiol"},{"key":"B12","first-page":"225","article-title":"Pleural involvement in histoplasmosis","volume":"94","author":"Schub","year":"1966","journal-title":"Am Rev Respir Dis."},{"key":"B13","first-page":"502","article-title":"Histoplasmoma, pleural fibrosis, and slowly enlarging pleural effusion in an asymptomatic patient","volume":"135","author":"Swinburne","year":"1987","journal-title":"Am Rev Respir Dis."},{"key":"B14","doi-asserted-by":"publisher","first-page":"218","DOI":"10.1093\/milmed\/147.3.218","article-title":"Asymptomatic pleural effusion in histoplasmosis: case report","volume":"147","author":"Downey","year":"1982","journal-title":"Mil Med."},{"key":"B15","doi-asserted-by":"publisher","first-page":"249","DOI":"10.1093\/labmed\/lmx021","article-title":"Histoplasmosis in pleural effusion in a 23-year-old man with mixed-phenotype acute leukemia","volume":"48","author":"Sharma","year":"2017","journal-title":"Lab Med."},{"key":"B16","doi-asserted-by":"publisher","first-page":"98","DOI":"10.1097\/00000441-199008000-00005","article-title":"Histoplasmosis as a cause of pleural effusion in the acquired immunodeficiency syndrome","volume":"300","author":"Marshall","year":"1990","journal-title":"Am J Med Sci."},{"key":"B17","doi-asserted-by":"publisher","first-page":"545","DOI":"10.1086\/315717","article-title":"Amphotericin B combined with itraconazole or fluconazole for treatment of histoplasmosis","volume":"182","author":"Lemonte","year":"2000","journal-title":"J Infect Dis."},{"key":"B18","doi-asserted-by":"publisher","first-page":"247","DOI":"10.1128\/CMR.00053-10","article-title":"Histopathologic diagnosis of fungal infections in the 21st century","volume":"24","author":"Guarner","year":"2011","journal-title":"Clin Microbiol Rev."},{"key":"B19","doi-asserted-by":"publisher","first-page":"115","DOI":"10.1128\/CMR.00027-06","article-title":"Histoplasmosis: a clinical and laboratory update","volume":"20","author":"Kauffman","year":"2007","journal-title":"Clin Microbiol Rev."},{"key":"B20","doi-asserted-by":"publisher","first-page":"1367","DOI":"10.1093\/cid\/ciz1008","article-title":"Revision and update of the consensus definitions of invasive fungal disease from the European Organization for Research and Treatment of Cancer and the Mycoses Study Group Education and Research Consortium","volume":"71","author":"Donnelly","year":"2020","journal-title":"Clin Infect Dis."},{"key":"B21","doi-asserted-by":"publisher","first-page":"125","DOI":"10.1590\/s1806-37132012000100017","article-title":"Aspergillus fumigatus fungus ball in the pleural cavity","volume":"38","author":"Guazzelli","year":"2012","journal-title":"J Bras Pneumol"},{"key":"B22","doi-asserted-by":"publisher","first-page":"4211","DOI":"10.1128\/AAC.01087-07","article-title":"Penetration of amphotericin B lipid formulations into pleural effusion","volume":"51","author":"Weiler","year":"2007","journal-title":"Antimicrob Agents Chemother."},{"key":"B23","doi-asserted-by":"publisher","first-page":"689","DOI":"10.1093\/infdis\/156.4.689","article-title":"Treatment of pleural blastomycosis: penetration of amphotericin B into the pleural fluid","volume":"156","author":"Kutty","year":"1987","journal-title":"J Infect Dis."},{"key":"B24","doi-asserted-by":"publisher","first-page":"1633","DOI":"10.1128\/AAC.01438-09","article-title":"Pharmacokinetics of liposomal amphotericin B in pleural fluid","volume":"54","author":"Moriyama","year":"2010","journal-title":"Antimicrob Agents Chemother."},{"key":"B25","doi-asserted-by":"publisher","first-page":"2478","DOI":"10.1128\/AAC.01560-10","article-title":"Pharmacokinetics of anidulafungin in pleural fluid during the treatment of a patient with Candida empyema","volume":"55","author":"Moriyama","year":"2011","journal-title":"Antimicrob Agents Chemother."},{"key":"B26","doi-asserted-by":"publisher","first-page":"203","DOI":"10.1016\/0002-9343(85)90427-9","article-title":"Histoplasmosis in the acquired immune deficiency syndrome","volume":"78","author":"Wheat","year":"1985","journal-title":"Am J Med."},{"key":"B27","doi-asserted-by":"publisher","first-page":"152","DOI":"10.1016\/S0002-9343(88)80334-6","article-title":"Progressive disseminated histoplasmosis in patients with acquired immunodeficiency syndrome","volume":"85","author":"Johnson","year":"1988","journal-title":"Am J Med."},{"key":"B28","doi-asserted-by":"publisher","first-page":"807","DOI":"10.1086\/521259","article-title":"Clinical practice guidelines for the management of patients with histoplasmosis: 2007 update by the Infectious Diseases Society of America","volume":"45","author":"Wheat","year":"2007","journal-title":"Clin Infect Dis."},{"key":"B29","doi-asserted-by":"publisher","first-page":"1427","DOI":"10.1378\/chest.127.4.1427","article-title":"Video-assisted thoracoscopic surgery in the treatment of complicated parapneumonic effusions or empyemas: outcome of 234 patients","volume":"127","author":"Luh","year":"2005","journal-title":"Chest."}],"container-title":["Frontiers in Public Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2022.914529\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,7,6]],"date-time":"2022-07-06T16:36:03Z","timestamp":1657125363000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2022.914529\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,7,6]]},"references-count":29,"alternative-id":["10.3389\/fpubh.2022.914529"],"URL":"https:\/\/doi.org\/10.3389\/fpubh.2022.914529","relation":{},"ISSN":["2296-2565"],"issn-type":[{"value":"2296-2565","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,7,6]]},"article-number":"914529"}}