XXXX in Immunocompetent Individuals- not a so Rare Entity, in India.

@entity1 @entity3329 @entity353 @entity417 @entity9058 @entity2379 @entity1503 @entity364 @entity3218 @entity381 @entity3219 @entity3043 @entity5638 @entity2059
INTRODUCTION: @entity3219 is a rare @entity364 caused by dimorphic fungi @entity3218 . The causative fungus persists in soil, infects through inhalation and manifests in three main types-acute primary, chronic cavitary and progressive disseminated @entity3219 . @entity3219 ( @entity3219 ) is defined as a clinical condition where the fungus is present in more than one location. Among the forms of @entity3219 , @entity3219 is the rarest and mostly found in an immuno-compromised individual. Here we are presenting our experiences of the series of cases of @entity3219 in immuno-competent individuals who have been diagnosed in our institute in last 5 years. MATERIALS AND METHODS: This is a single centre retrospective observational study, conducted in Institute of Haematology and Transfusion Medicine, which is a referral centre for Eastern India, from May 2009 to April 2014. Only cases with @entity3219 in otherwise healthy immuno-competent individuals were included in the study. The @entity3219 was confirmed either by presence of Histoplasma in biopsy specimen from an extrapulmonary organ or by positive growth in fungal culture. RESULT: Total seven @entity1 met the inclusion criteria. Five out of 7 @entity1 were male. The mean age was 35 years. Five of the 7 @entity1 presented with fever for a long duration. Six @entity1 complained of significant @entity353 before diagnosis. On examination, one @entity1 had skin nodules, five @entity1 had hepato- @entity381 , and two @entity1 had @entity3329 . The laboratory investigations revealed @entity417 in six out of 7 @entity1 , and @entity3043 in 3 @entity1 . Two @entity1 had features of the @entity9058 in the bone marrow. All @entity1 were treated with conventional @entity2379 deoxycholate and @entity5638 antifungal. One @entity1 with adrenal involvement died in hospital. The @entity1 with skin nodule had recurrent relapses. The other @entity1 had resolution of symptoms and were clinically cured. CONCLUSION: @entity3219 is not an uncommon aetiology of fever of prolonged duration even in immuno-competent individual and should be kept as a differential diagnosis. Targeted investigation through early bone marrow biopsy and fungal culture may help in the diagnosis of @entity3219 . Imaging study to exclude adrenal involvement prevents case fatality. @entity1503 may be due to a secondary @entity9058 , which improves with anti-fungal therapy. Treatment with either @entity2379 or @entity2059 gives excellent outcome though therapy may have to be given for a prolonged period in case of relapses.
