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An interesting paper by Nicholas N. Horton of the London School of Hygiene & Tropical Medicine (Norton et al, 2011) notes an unusual case of histoplasmosis that involved a skin ulcer on the back of a young man. A skin swab from the lesion cultured the organism, identified it as H. capsulatum, and established that its origin was a thorn that had become embedded in his skin in Trinidad, where the patient was living.
Histoplasmosis is a fungal disease that is common in areas of North and Central America, and it is occasionally encountered in the UK and Ireland. It is one of the most common causes of disease in patients who are immunocompromised (e.g., due to HIV or cancer chemotherapy), though it has also been described in elderly people (Hulsey et al, 2007).
The occasional reports of histoplasmosis in people with no history of exposure to dust, soil, or bat or bird droppings have suggested that this infection may be acquired by inhalation of spores (Norton et al, 2011). Nevertheless, in our analysis of the natural history of histoplasmosis, most cases are attributed to reactivation of old infections acquired during childhood (Nieto et al, 1995). The people affected are often asymptomatic, but there have been reports of disseminated disease, with respiratory involvement (e.g., pneumonia), pan-potential disease, meningitis, and encephalitis (Brady, 1979).
The incidence of histoplasmosis in people with HIV infection is roughly 2-4% in North America, 6-15% in South America, and higher (20-50%) in Central America and the Caribbean (Marchetti et al, 2007). Histoplasmosis is a major cause of life-threatening illness in patients with AIDS (Veerman et al, 1990) and has been described in the literature as one of the most common causes of death in the context of AIDS (Marchetti et al, 1997).
The infection is caused by the organism H. capsulatum, which is also known as a yeast and as a mould.