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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Vydáno v:	Journal of the American Geriatrics Society (JAGS) Ročník 60; číslo 2; s. 265 - 270
Hlavní autoři:	Ledtke, Christopher, Tomford, J. Walton, Jain, Anil, Isada, Carlos M., van Duin, David
Médium:	Journal Article
Jazyk:	angličtina
Vydáno:	Hoboken, NJ Blackwell Publishing Ltd 01.02.2012 Wiley-Blackwell Wiley Subscription Services, Inc
Témata:	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
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Shrnutí:	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.
Bibliografie:	istex:584D3F5763C4BF7942EBDD30CA0CA56B2CB329C3 ArticleID:JGS3825 ark:/67375/WNG-3XBS3FBD-S SourceType-Scholarly Journals-1 ObjectType-Feature-1 content type line 14 ObjectType-Article-2 content type line 23 ObjectType-Article-1 ObjectType-Feature-2
ISSN:	0002-8614 1532-5415 1532-5415
DOI:	10.1111/j.1532-5415.2011.03825.x