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Disseminated pulmonary histoplasmosis in immunocompetent patients: a common epidemiological exposure
  1. Michael Klein1,
  2. Mirza Khan2,
  3. Jorge L Salinas3 and
  4. Rolando Sanchez4
  1. 1 Department of Medicine - Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
  2. 2 Department of Medicine, Vanderbilt University Medical Center, Nashville, Iowa, USA
  3. 3 Department of Medicine - Infectious Diseases, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
  4. 4 Department of Medicine - Pulmonary & Critical Care, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
  1. Correspondence to Dr Rolando Sanchez, rolando-sanchez{at}


We describe the initial presentation, diagnostic work-up and treatment of three adult immunocompetent men who presented within a short time frame of each other to an academic medical centre with acute respiratory distress syndrome. Their presentation was found to be secondary to a large inoculum of histoplasmosis from remodelling a building with bat droppings infestation. We discuss the pathophysiology of histoplasmosis and highlight the importance of exposure history in patients with acute respiratory failure and why patients with the occupational risk of exposure to fungal inoculum should wear protective respirator gear.

  • occupational and environmental medicine
  • public health
  • pneumonia (respiratory medicine)

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  • Contributors Patient and case identification and image acquisition was performed by RS. Case write-ups, chart review, and introduction and conclusions write-ups were performed by MKl and MKh. Epidemiological and infectious disease perspectives were provided by JS. Manuscript editing was performed by all authors.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent for publication Obtained.