Snapshot A 38-year-old man presents to an urgent care clinic in Ohio for a 3-week cough. He reports having fevers, chills, and fatigue. He recently went on a local hiking trip that included waterfalls, freshwater lakes, and caves. He reports his cough was worse in the beginning but has lingered. He denies any rashes, vomiting, or diarrhea. A chest radiograph shows patchy pulmonary infiltrates and hilar lymphadenopathy. A sputum sample under microscopy shows macrophages with intracellular yeast cells. (Histoplasmosis) Introduction Introduction login to view 11 more bullets Overview of Systemic Mycoses Clinical Syndrome Histoplasmosis Coccidioidomycosis Blastomycosis Paracoccidioidomycosis Organism Histoplasma capsulatum Coccidioides immitis Coccidioides posadasii Blastomyces dermatitidis Paracoccidioides brasiliensis Paracoccidioides lutzii Demographics Mississippi Ohio River Valley Southwestern US California Eastern US Central US Latin America Skin manifestations Ulcers on oral mucosa Erythema nodosum Erythema multiforme Verrucous skin lesions Verrucous skin lesions Histology Macrophages filled with fungus cells Spherules (larger than red blood cells (RBCs)) filled with endospores Broad-based budding yeast (same size as RBCs) Budding yeast larger than RBCs Differential login to view 4 more bullets Treatment login to view 4 more bullets EPIDEMIOLOGY demographics login to view 1 more bullet transmission login to view 2 more bullets ETIOLOGY pathogenesis login to view 5 more bullets Histoplasmosis Histoplasma capsulatum login to view 8 more bullets Presentation login to view 7 more bullets Imaging login to view 2 more bullets Studies login to view 3 more bullets Coccidioidomycosis Coccidioides immitis or Coccidioides posadasii login to view 6 more bullets Presentation login to view 8 more bullets Imaging login to view 4 more bullets Studies login to view 4 more bullets Blastomycosis Blastomyces dermatitidis login to view 5 more bullets Presentation login to view 7 more bullets Imaging login to view 3 more bullets Studies login to view 3 more bullets Paracoccidioidomycosis Paracoccidioides brasiliensis or Paracoccidioides lutzii login to view 6 more bullets Presentation login to view 6 more bullets Imaging login to view 2 more bullets Studies login to view 4 more bullets Sporothrix schenckii login to view 2 more bullets