Outside of mid-western United States,1 histoplasmosis is endemic in pockets of Asia (like Indonesia) and Europe (Italy, Hungary, Romania, Britain).2 It is caused by H. capsulatum, a fungus found in barns, old houses or soil contaminated with bird droppings. Airborne spores infect those who inhale it. Disease manifestation is myriad, ranging from a sub-clinical infection to an organ-specific disease, such as acute pulmonary syndrome, cavitatory lung disease to progressive disseminated histoplasmosis (PDH), the latter commonly seen in immunocompromised hosts, with human immunodeficiency syndrome.3,4
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