The published reports of patients with the
acquired immunodeficiency syndrome (
AIDS) with
disseminated histoplasmosis come mostly from institutions located in endemic areas for
histoplasmosis, where disease is thought to occur by either primary
infection or reactivation. The characteristics of reactivation disease are not well delineated. We describe the clinical features of reactivation
disseminated histoplasmosis in 46 residents of San Francisco, California, with
AIDS who did not report recent travel to an area endemic for
histoplasmosis. Patients presented with illness lasting days to months, manifested most frequently by
fever,
chills, sweats,
cough or
dyspnea, gastrointestinal complaints, malaise, and
weight loss. Physical examination and imaging studies were notable for hepatosplenomegaly,
lymphadenopathy, or abnormal pulmonary findings in more than half of patients. Laboratory studies revealed a high rate of
cytopenia, elevated serum
lactate dehydrogenase levels, abnormal liver function test values,
respiratory alkalosis with
hypoxemia, and a median CD4 lymphocyte count of 36 x 10(9) per liter. The clinical presentation of reactivation
disseminated histoplasmosis in patients with
AIDS living in San Francisco is similar to that of
disseminated histoplasmosis reported in patients with
AIDS living in endemic areas. Reactivation
disseminated histoplasmosis should be considered in any
AIDS patient with a low CD4 lymphocyte count, a febrile illness, and a history of travel or residence in an endemic area.