Clinical Presentation and Management of Histoplasmosis in Older Adults

Objectives To describe the influence of age on clinical features of histoplasmosis. Design Retrospective single‐center cohort study. Setting Large tertiary care center. Participants All individuals who met criteria for probable or proven histoplasmosis between 1998 and 2008. Measurements Participant...

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Veröffentlicht in:Journal of the American Geriatrics Society (JAGS) Jg. 60; H. 2; S. 265 - 270
Hauptverfasser: Ledtke, Christopher, Tomford, J. Walton, Jain, Anil, Isada, Carlos M., van Duin, David
Format: Journal Article
Sprache:Englisch
Veröffentlicht: Hoboken, NJ Blackwell Publishing Ltd 01.02.2012
Wiley-Blackwell
Wiley Subscription Services, Inc
Schlagworte:
Adolescent
Adult
Adults
Age
Age differences
Age Factors
Aged
Aged, 80 and over
Aging
Biological and medical sciences
Chest
Chest pain
Chronic pain
Classification
Clinical trials
Cohort analysis
Disease
endemic mycosis
Female
General aspects
Geriatrics
Histoplasmoses
Histoplasmosis
Histoplasmosis - diagnosis
Histoplasmosis - drug therapy
Human mycoses
Humans
imaging
Immune status
Infectious diseases
Lung
Lymphadenopathy
Male
Medical diagnosis
Medical imaging
Medical sciences
Middle Aged
Miscellaneous
Mortality
Mycoses
Older people
Pain
Public health. Hygiene
Public health. Hygiene-occupational medicine
Retrospective Studies
Tropical mycoses
Young Adult
Human
Histoplasmosis
Senescence
Mycosis
endemic mycosis
Ageing
Endemy
Infection
Symptomatology
Gerontology
Clinical management
aging
Elderly
Geriatrics
ISSN:0002-8614, 1532-5415, 1532-5415
Online-Zugang:Volltext
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Zusammenfassung:Objectives To describe the influence of age on clinical features of histoplasmosis. Design Retrospective single‐center cohort study. Setting Large tertiary care center. Participants All individuals who met criteria for probable or proven histoplasmosis between 1998 and 2008. Measurements Participants were divided into the following categories of histoplasmosis: acute pulmonary, chronic pulmonary, asymptomatic, disseminated, and other. Correcting for immune status, the influence of age at diagnosis on presentation, diagnosis, imaging, treatment, and all‐cause mortality was evaluated. Results In 347 participants with histoplasmosis, a number of characteristics were associated with age when evaluating participants according to diagnostic category. An age‐associated increase in asymptomatic histoplasmosis was observed (P < .001). In symptomatic pulmonary histoplasmosis, older adults were less likely to present with chest pain (P < .001) and less likely to have hilar lymphadenopathy on imaging (P = .04). Lower rates of seropositivity with older age were seen in asymptomatic (P = .04) but not other forms of histoplasmosis. Cavitary disease was associated with older age in chronic pulmonary histoplasmosis (P = .05). Treatment did not change with age. All‐cause mortality at 6 months was 4% and was associated with older age (P = .02). Conclusion Although most studied characteristics of histoplasmosis were similar, notable age‐related differences were present. Chronic cavitary disease and asymptomatic histoplasmosis were more common with older age. In acute histoplasmosis, the lack of chest pain and hilar lymphadenopathy may hinder diagnosis in older adults.
Bibliographie:istex:584D3F5763C4BF7942EBDD30CA0CA56B2CB329C3
ArticleID:JGS3825
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ISSN:0002-8614
1532-5415
1532-5415
DOI:10.1111/j.1532-5415.2011.03825.x