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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| Vydané v: | Journal of the American Geriatrics Society (JAGS) Ročník 60; číslo 2; s. 265 - 270 |
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| Hlavní autori: | , , , , |
| Médium: | Journal Article |
| Jazyk: | English |
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Hoboken, NJ
Blackwell Publishing Ltd
01.02.2012
Wiley-Blackwell Wiley Subscription Services, Inc |
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| ISSN: | 0002-8614, 1532-5415, 1532-5415 |
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| Abstract | 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. |
|---|---|
| AbstractList | 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. 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. To describe the influence of age on clinical features of histoplasmosis. 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. 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). 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.Original Abstract: Retrospective single-center cohort study. Large tertiary care center. All individuals who met criteria for probable or proven histoplasmosis between 1998 and 2008. To describe the influence of age on clinical features of histoplasmosis. Retrospective single-center cohort study. Large tertiary care center. All individuals who met criteria for probable or proven histoplasmosis between 1998 and 2008. 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. 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). 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. To describe the influence of age on clinical features of histoplasmosis.OBJECTIVESTo describe the influence of age on clinical features of histoplasmosis.Retrospective single-center cohort study.DESIGNRetrospective single-center cohort study.Large tertiary care center.SETTINGLarge tertiary care center.All individuals who met criteria for probable or proven histoplasmosis between 1998 and 2008.PARTICIPANTSAll individuals who met criteria for probable or proven histoplasmosis between 1998 and 2008.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.MEASUREMENTSParticipants 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.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).RESULTSIn 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).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.CONCLUSIONAlthough 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. |
| Author | Jain, Anil Tomford, J. Walton Ledtke, Christopher Isada, Carlos M. van Duin, David |
| Author_xml | – sequence: 1 givenname: Christopher surname: Ledtke fullname: Ledtke, Christopher organization: Department of Infectious Diseases, Cleveland Clinic, Ohio, Cleveland – sequence: 2 givenname: J. Walton surname: Tomford fullname: Tomford, J. Walton organization: Department of Infectious Diseases, Cleveland Clinic, Ohio, Cleveland – sequence: 3 givenname: Anil surname: Jain fullname: Jain, Anil organization: Explorys, Inc., Ohio, Cleveland – sequence: 4 givenname: Carlos M. surname: Isada fullname: Isada, Carlos M. organization: Department of Infectious Diseases, Cleveland Clinic, Ohio, Cleveland – sequence: 5 givenname: David surname: van Duin fullname: van Duin, David email: vanduid@ccf.org organization: Department of Infectious Diseases, Cleveland Clinic, Cleveland, Ohio |
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| Keywords | Human Histoplasmosis Senescence Mycosis endemic mycosis Ageing Endemy Infection Symptomatology Gerontology Clinical management aging Elderly Geriatrics |
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| References_xml | – reference: Brodsky AL, Gregg MB, Loewenstein MS et al. Outbreak of histoplasmosis associated with the 1970 Earth Day activities. Am J Med 1973;54:333-342. – reference: Leake JA, Mosley DG, England B et al. Risk factors for acute symptomatic coccidioidomycosis among elderly persons in Arizona, 1996-1997. J Infect Dis 2000;181:1435-1440. – reference: Blair JE, Mayer AP, Currier J et al. Coccidioidomycosis in elderly persons. Clin Infect Dis 2008;47:1513-1518. – reference: Cuellar-Rodriguez J, Avery RK, Lard M et al. Histoplasmosis in solid organ transplant recipients: 10 years of experience at a large transplant center in an endemic area. Clin Infect Dis 2009;49:710-716. – reference: Edwards PQ, Palmer CE. Nationwide histoplasmin sensitivity and histoplasmal infection. Public Health Rep 1963;78:241-260. – reference: Hof H. Mycoses in the elderly. Eur J Clin Microbiol Infect Dis 2010;29:5-13. – reference: Fernandez-Sabe N, Carratala J, Roson B et al. Community-acquired pneumonia in very elderly patients: Causative organisms, clinical characteristics, and outcomes. Medicine 2003;82:159-169. – reference: Assi MA, Sandid MS, Baddour LM et al. Risk factor analysis of histoplasma capsulatum fungemia. Med Mycol 2010;48:85-89. – reference: Gupta N, Fox CM, Grisolano SW. Disseminated histoplasmosis with colonic ulcers in a patient receiving infliximab. Gastrointest Endosc 2009;70:597-598. – reference: Christensen K, Doblhammer G, Rau R et al. Ageing populations: The challenges ahead. Lancet 2009;374:1196-1208. – reference: Kauffman CA. Fungal infections in older adults. Clin Infect Dis 2001;33:550-555. – reference: Huhn GD, Austin C, Carr M et al. Two outbreaks of occupationally acquired histoplasmosis: More than workers at risk. Environ Health Perspect 2005;113:585-589. – reference: Yoshikawa TT. Perspective: Aging and infectious diseases: Past, present, and future. J Infect Dis 1997;176:1053-1057. – reference: Kennedy CC, Limper AH. Redefining the clinical spectrum of chronic pulmonary histoplasmosis: A retrospective case series of 46 patients. Medicine 2007;86:252-258. – reference: Wheat LJ, Connolly-Stringfield PA, Baker RL et al. Disseminated histoplasmosis in the acquired immune deficiency syndrome: Clinical findings, diagnosis and treatment, and review of the literature. Medicine 1990;69:361-374. – reference: Gomez CR, Nomellini V, Faunce DE et al. Innate immunity and aging. Exp Gerontol 2008;43:718-728. – reference: Kralt D, Light B, Cheang M et al. Clinical characteristics and outcomes in patients with pulmonary blastomycosis. Mycopathologia 2009;167:115-124. – reference: Silveira FP, Husain S. Fungal infections in solid organ transplantation. Med Mycol 2007;45:305-320. – reference: Bauman DS, Smith CD. Comparison of immunodiffusion and complement fixation tests in the diagnosis of histoplasmosis. J Clin Microbiol 1975;2:77-80. – reference: Chu JH, Feudtner C, Heydon K et al. Hospitalizations for endemic mycoses: A population-based national study. Clin Infect Dis 2006;42:822-825. – reference: Frasca D, Blomberg BB. Effects of aging on B cell function. Curr Opinion Immunol 2009;21:425-430. – reference: Chamany S, Mirza SA, Fleming JW et al. A large histoplasmosis outbreak among high school students in Indiana, 2001. Pediatr Infect Dis J 2004;23:909-914. – reference: Grubeck-Loebenstein B, Wick G. The aging of the immune system. Advanc Immunol 2002;80:243-284. – reference: Kauffman CA. Endemic mycoses in patients with hematologic malignancies. Semin Respir Infect 2002;17:106-112. – reference: Haynes L, Maue AC. Effects of aging on T cell function. Curr Opin Immunol 2009;21:414-417. – reference: Kauffman CA. Histoplasmosis: A clinical and laboratory update. Clin Microbiol Rev 2007;20:115-132. – reference: Lesser JM, Hughes SV, Jemelka JR et al. Compiling a complete medical history: Challenges and strategies for taking a comprehensive history in the elderly. Geriatrics 2005;60:22-25. – reference: Bourre-Tessier J, Fortin C, Belisle A et al. Disseminated Histoplasma capsulatum infection presenting with panniculitis and focal myositis in rheumatoid arthritis treated with etanercept. Scand J Rheumatol 2009;14:1-6. – volume: 181 start-page: 1435 year: 2000 end-page: 1440 article-title: Risk factors for acute symptomatic coccidioidomycosis among elderly persons in Arizona, 1996–1997 publication-title: J Infect Dis – volume: 23 start-page: 909 year: 2004 end-page: 914 article-title: A large histoplasmosis outbreak among high school students in Indiana, 2001 publication-title: Pediatr Infect Dis J – volume: 43 start-page: 718 year: 2008 end-page: 728 article-title: Innate immunity and aging publication-title: Exp Gerontol – volume: 14 start-page: 1 year: 2009 end-page: 6 article-title: Disseminated Histoplasma capsulatum infection presenting with panniculitis and focal myositis in rheumatoid arthritis treated with etanercept publication-title: Scand J Rheumatol – volume: 20 start-page: 115 year: 2007 end-page: 132 article-title: Histoplasmosis: A clinical and laboratory update publication-title: Clin Microbiol Rev – volume: 374 start-page: 1196 year: 2009 end-page: 1208 article-title: Ageing populations: The challenges ahead publication-title: Lancet – volume: 21 start-page: 425 year: 2009 end-page: 430 article-title: Effects of aging on B cell function publication-title: Curr Opinion Immunol – volume: 167 start-page: 115 year: 2009 end-page: 124 article-title: Clinical characteristics and outcomes in patients with pulmonary blastomycosis publication-title: Mycopathologia – volume: 54 start-page: 333 year: 1973 end-page: 342 article-title: Outbreak of histoplasmosis associated with the 1970 Earth Day activities publication-title: Am J Med – volume: 60 start-page: 22 year: 2005 end-page: 25 article-title: Compiling a complete medical history: Challenges and strategies for taking a comprehensive history in the elderly publication-title: Geriatrics – volume: 45 start-page: 305 year: 2007 end-page: 320 article-title: Fungal infections in solid organ transplantation publication-title: Med Mycol – volume: 80 start-page: 243 year: 2002 end-page: 284 article-title: The aging of the immune system publication-title: Advanc Immunol – volume: 49 start-page: 710 year: 2009 end-page: 716 article-title: Histoplasmosis in solid organ transplant recipients: 10 years of experience at a large transplant center in an endemic area publication-title: Clin Infect Dis – volume: 42 start-page: 822 year: 2006 end-page: 825 article-title: Hospitalizations for endemic mycoses: A population‐based national study publication-title: Clin Infect Dis – volume: 70 start-page: 597 year: 2009 end-page: 598 article-title: Disseminated histoplasmosis with colonic ulcers in a patient receiving infliximab publication-title: Gastrointest Endosc – volume: 29 start-page: 5 year: 2010 end-page: 13 article-title: Mycoses in the elderly publication-title: Eur J Clin Microbiol Infect Dis – volume: 82 start-page: 159 year: 2003 end-page: 169 article-title: Community‐acquired pneumonia in very elderly patients: Causative organisms, clinical characteristics, and outcomes publication-title: Medicine – volume: 78 start-page: 241 year: 1963 end-page: 260 article-title: Nationwide histoplasmin sensitivity and histoplasmal infection publication-title: Public Health Rep – volume: 17 start-page: 106 year: 2002 end-page: 112 article-title: Endemic mycoses in patients with hematologic malignancies publication-title: Semin Respir Infect – volume: 2 start-page: 77 year: 1975 end-page: 80 article-title: Comparison of immunodiffusion and complement fixation tests in the diagnosis of histoplasmosis publication-title: J Clin Microbiol – volume: 33 start-page: 550 year: 2001 end-page: 555 article-title: Fungal infections in older adults publication-title: Clin Infect Dis – volume: 47 start-page: 1513 year: 2008 end-page: 1518 article-title: Coccidioidomycosis in elderly persons publication-title: Clin Infect Dis – volume: 176 start-page: 1053 year: 1997 end-page: 1057 article-title: Perspective: Aging and infectious diseases: Past, present, and future publication-title: J Infect Dis – volume: 113 start-page: 585 year: 2005 end-page: 589 article-title: Two outbreaks of occupationally acquired histoplasmosis: More than workers at risk publication-title: Environ Health Perspect – volume: 21 start-page: 414 year: 2009 end-page: 417 article-title: Effects of aging on T cell function publication-title: Curr Opin Immunol – volume: 69 start-page: 361 year: 1990 end-page: 374 article-title: Disseminated histoplasmosis in the acquired immune deficiency syndrome: Clinical findings, diagnosis and treatment, and review of the literature publication-title: Medicine – volume: 86 start-page: 252 year: 2007 end-page: 258 article-title: Redefining the clinical spectrum of chronic pulmonary histoplasmosis: A retrospective case series of 46 patients publication-title: Medicine – volume: 48 start-page: 85 year: 2010 end-page: 89 article-title: Risk factor analysis of histoplasma capsulatum fungemia publication-title: Med Mycol – ident: e_1_2_7_28_1 doi: 10.1086/593192 – ident: e_1_2_7_5_1 doi: 10.1289/ehp.7484 – volume: 14 start-page: 1 year: 2009 ident: e_1_2_7_11_1 article-title: Disseminated Histoplasma capsulatum infection presenting with panniculitis and focal myositis in rheumatoid arthritis treated with etanercept publication-title: Scand J Rheumatol – ident: e_1_2_7_2_1 doi: 10.1128/CMR.00027-06 – ident: e_1_2_7_13_1 doi: 10.1016/S0065-2776(02)80017-7 – ident: e_1_2_7_17_1 doi: 10.1086/322685 – ident: e_1_2_7_3_1 doi: 10.2307/4591764 – ident: e_1_2_7_16_1 doi: 10.1007/s10096-009-0822-5 – ident: e_1_2_7_6_1 doi: 10.1016/0002-9343(73)90028-4 – ident: e_1_2_7_15_1 doi: 10.1016/j.coi.2009.05.009 – ident: e_1_2_7_18_1 doi: 10.1097/MD.0b013e318144b1d9 – ident: e_1_2_7_4_1 doi: 10.1097/01.inf.0000141738.60845.da – ident: e_1_2_7_29_1 doi: 10.1007/s11046-008-9163-7 – ident: e_1_2_7_20_1 doi: 10.1016/S0140-6736(09)61460-4 – ident: e_1_2_7_25_1 doi: 10.3109/13693780902755299 – ident: e_1_2_7_21_1 doi: 10.1086/516547 – ident: e_1_2_7_8_1 doi: 10.1086/604712 – ident: e_1_2_7_10_1 doi: 10.1016/j.gie.2009.01.006 – ident: e_1_2_7_26_1 doi: 10.1016/j.coi.2009.06.001 – ident: e_1_2_7_23_1 doi: 10.1097/01.md.0000076005.64510.87 – ident: e_1_2_7_7_1 doi: 10.1080/13693780701200372 – ident: e_1_2_7_14_1 doi: 10.1016/j.exger.2008.05.016 – ident: e_1_2_7_27_1 doi: 10.1086/315400 – volume: 2 start-page: 77 year: 1975 ident: e_1_2_7_19_1 article-title: Comparison of immunodiffusion and complement fixation tests in the diagnosis of histoplasmosis publication-title: J Clin Microbiol doi: 10.1128/jcm.2.2.77-80.1975 – ident: e_1_2_7_12_1 doi: 10.1097/00005792-199011000-00004 – ident: e_1_2_7_9_1 doi: 10.1053/srin.2002.33442 – ident: e_1_2_7_22_1 doi: 10.1086/500405 – volume: 60 start-page: 22 year: 2005 ident: e_1_2_7_24_1 article-title: Compiling a complete medical history: Challenges and strategies for taking a comprehensive history in the elderly publication-title: Geriatrics |
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To describe the influence of age on clinical features of histoplasmosis.
Design
Retrospective single‐center cohort study.
Setting
Large tertiary... To describe the influence of age on clinical features of histoplasmosis. Retrospective single-center cohort study. Large tertiary care center. All individuals... Objectives To describe the influence of age on clinical features of histoplasmosis. Design Retrospective single-center cohort study. Setting Large tertiary... To describe the influence of age on clinical features of histoplasmosis. Participants were divided into the following categories of histoplasmosis: acute... To describe the influence of age on clinical features of histoplasmosis.OBJECTIVESTo describe the influence of age on clinical features of... |
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| SubjectTerms | 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 |
| Title | Clinical Presentation and Management of Histoplasmosis in Older Adults |
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