The Intern At Work: Internal Medicine A ‘Darling’ Discovery: An Approach to Histoplasmosis and Blastomycosis
Oct 26, 2025
Discover the fascinating history and ecology of histoplasmosis and blastomycosis. The discussion dives into how these infections occur and the body’s response to them. Clinical presentations vary widely, with insights into the challenges of diagnosis. Key points include assessing patient history for fungal exposure and understanding the necessary lab tests. Treatment strategies are explored, including emerging data on one-day amphotericin therapy. Tune in for a blend of science and practical advice in the realm of infectious diseases!
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Darling's Historical Discovery
- Dr. Samuel Darling described histoplasmosis after investigating Panama Canal worker deaths in 1905.
- His observation led to naming and early characterization of Histoplasma capsulatum.
Pathogen Lifecycle And Immune Evasion
- Histoplasma capsulatum and Blastomyces dermatitidis are soil fungi that become yeasts in the human lung.
- Both survive inside macrophages, promote granuloma formation, and risk dissemination when T-cell immunity fails.
Most Cases Are Mild; Chronic Mimics TB
- Most exposed patients (~90%) are asymptomatic or self-limited, but chronic cavitary disease mimics TB in smokers or COPD patients.
- Progressive symptoms and weight loss should raise concern for chronic pulmonary histoplasmosis.