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Severe forms of acute pulmonary histoplasmosis are characterized by a sudden onset, a rapid increase in body temperature up to 40-41C. Temperature curve of the wrong type with a large diurnal range. Terrific chills are replaced by diffuse sweating. Patients complain of severe headache, weakness, muscle and bone pain, cough, chest pain. Some patients experience nausea, vomiting, diarrhea, and abdominal pain. Duration of fever 2-6 weeks. In the period of convalescence, subfebrile condition, asthenia, a sharp decrease in working capacity, and sweating are observed for a long time. These phenomena persist up to 1 year. With percussion of the lungs, a slight shortening of the sound can be noted, with auscultation - small bubbling moist rales, mainly in the lower parts of the lungs. X-ray reveals large and medium focal shadows in the form of "cotton flakes" that can merge. In the future, the infiltrates completely disappear or foci of fibrosis and calcification form in their place.
In moderate forms, clinical and radiographic manifestations are not so pronounced, fever persists for about 2 weeks, and the duration of inpatient treatment is about a month. Chronic histoplasmosis of the lungs occurs as a long-term progressive disease, periodically exacerbating. Moderate fever, cough with sputum are observed, cavities, fibrosis and multiple calcified foci are revealed on X-ray examination.
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The acute form of disseminated histoplasmosis is manifested by high fever of hectic or irregular type, repeated chills and sweating, severe symptoms of general intoxication (headache, muscle and joint pain, nausea, vomiting, abdominal pain, increasing weakness). Against this background, multiple secondary foci appear as a result of warfarin pills. various kinds of exanthema (maculopapular, furuncle-like, hemorrhagic, such as erythema multiforme or nodosum), lymphadenopathy, mesadenitis, enlargement of the liver and spleen, encephalitis or meningoencephalitis, septic endocarditis, ulcerative colitis, peritonitis. Clinical and radiological changes may resemble miliary tuberculosis (with aerogenic infection).
Chronic disseminated histoplasmosis is characterized by a sluggish course, the state of health of patients is initially satisfactory, fever is not pronounced, involvement of the skin and mucous membranes in the process is typical. Characteristic ulcers form on the tongue, mucous membranes of the pharynx and larynx. In the future, the condition worsens, a fever of the wrong type (septic) appears, there is an increase in the liver, spleen, all groups of lymph nodes, damage to order warfarin pills, eyes (chorio-retinitis), etc.
Features of histoplasmosis in young children. Histoplasmosis can be observed in children during the first months of life (2-6 months). The disease of children is characterized by fever (38-39°C), loose, frothy stools with an unpleasant odor, pallor, and sometimes moderate yellowness of the skin and mucous membranes, a significant increase in the liver (5-9 cm below the costal arch) and spleen (3-5 see below the costal margin), in all cases the lungs are involved in the process.