{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T20:43:51Z","timestamp":1793393031123,"version":"4.5.0"},"reference-count":31,"publisher":"American Society of Tropical Medicine and Hygiene","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2017,12,6]]},"abstract":"<jats:p>We describe four cases of histoplasmosis indigenous to Himachal Pradesh (India) that will be of considerable public health interest. A 48-year-old human immunodeficiency virus (HIV)-negative man with cervical and mediastinal lymphadenopathy, hepatosplenomegaly, adrenal mass, and bone marrow involvement was treated as disseminated tuberculosis without benefit. Progressive disseminated histoplasmosis was diagnosed from the fungus in smears from adrenal mass. Another 37-year-old HIV-positive man was on treatment of suspected pulmonary tuberculosis. He developed numerous erythema nodosum leprosum-like mucocutanous lesions accompanied by fever, generalized lymphadenopathy, and weight loss. Pulmonary histoplasmosis with cutaneous dissemination was diagnosed when skin lesions showed the fungus in smears, histopathology, and mycologic culture. Both were successfully treated with amphotericin B\/itraconazole. Third patient, a 46-year-old HIV-negative man, had oropharyngeal lesions, cervical lymphadenopathy, intermittent fever, hepatosplenomegaly, and deteriorating general health. Progressive disseminated oropharyngeal histoplasmosis was diagnosed from the fungus in smears and mycologic cultures from oropharyngeal lesions and cervical lymph node aspirates. He died despite initiating treatment with oral itraconazole. Another 32-year-old man 3 months after roadside trauma developed a large ulcer with exuberant granulation tissue over left thigh without evidence of immunosuppression\/systemic involvement. He was treated successfully with surgical excision of ulcer under amphotericin B\/itraconazole coverage as primary cutaneous histoplasmosis confirmed pathologically and mycologically. A clinical suspicion remains paramount for early diagnosis of histoplasmosis particularly in a nonendemic area. Most importantly, with such diverse clinical presentation and therapeutic outcome selection of an appropriate and customized treatment schedule is a discretion the treating clinicians need to make.<\/jats:p>","DOI":"10.4269\/ajtmh.17-0432","type":"journal-article","created":{"date-parts":[[2017,9,26]],"date-time":"2017-09-26T07:00:36Z","timestamp":1506409236000},"page":"1749-1756","source":"Crossref","is-referenced-by-count":31,"title":["Case Report: Histoplasmosis in Himachal Pradesh (India): An Emerging Endemic Focus"],"prefix":"10.4269","volume":"97","author":[{"given":"Vikram K.","family":"Mahajan","sequence":"first","affiliation":[{"name":"Department of Dermatology, Venereology and Leprosy, Dr. R. P. Govt. Medical College, Kangra (Tanda), Himachal Pradesh, India;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rashmi Kaul","family":"Raina","sequence":"additional","affiliation":[{"name":"Department of Pathology, Dr. R. P. Govt. Medical College, Kangra (Tanda), Himachal Pradesh, India;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Suman","family":"Singh","sequence":"additional","affiliation":[{"name":"Department of Pathology, Dr. R. P. Govt. Medical College, Kangra (Tanda), Himachal Pradesh, India;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rattan Sagar","family":"Rashpa","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Venereology and Leprosy, Dr. R. P. Govt. Medical College, Kangra (Tanda), Himachal Pradesh, India;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anuradha","family":"Sood","sequence":"additional","affiliation":[{"name":"Department of Microbiology, Dr. R. P. Govt. Medical College, Kangra (Tanda), Himachal Pradesh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pushpinder S.","family":"Chauhan","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Venereology and Leprosy, Dr. R. P. Govt. Medical College, Kangra (Tanda), Himachal Pradesh, India;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karaninder S.","family":"Mehta","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Venereology and Leprosy, Dr. R. P. Govt. Medical College, Kangra (Tanda), Himachal Pradesh, India;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ritu","family":"Rawat","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Venereology and Leprosy, Dr. R. P. Govt. Medical College, Kangra (Tanda), Himachal Pradesh, India;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vikas","family":"Sharma","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Venereology and Leprosy, Dr. R. P. Govt. Medical College, Kangra (Tanda), Himachal Pradesh, India;"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2795","reference":[{"key":"b1","series-title":"Mol Ecol","first-page":"3383","article-title":"Phylogeography of the fungal pathogen Histoplasma capsulatum","volume":"12","author":"Kasuga","year":"2003"},{"key":"b2","series-title":"PLoS Negl Trop Dis","first-page":"e0004732","article-title":"Worldwide phylogenetic distributions and population dynamics of the genus Histoplasma","volume":"10","author":"Teixeira Mde","year":"2016"},{"key":"b3","series-title":"Jpn J Med Mycol","first-page":"103","article-title":"Epidemiological survey of the imported mycoses in Japan","volume":"40","author":"Fujio","year":"1999"},{"key":"b4","series-title":"Med Mycol","first-page":"774","article-title":"Disseminated histoplasmosis in an apparently immunocompetent individual from north India: a case report and 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