Chest X-ray of a patient with acute pulmonary<unk>  Clinically, a wide spectrum of disease manifestations occurs, making diagnosis somewhat difficult. More severe forms include the chronic pulmonary form, often occurring in the presence of underlying pulmonary disease, and a disseminated form, which is characterized by the progressive spread of infection to extrapulmonary sites. Oral manifestations have been reported as the main complaint of the disseminated forms, leading the patient to seek treatment, whereas pulmonary symptoms in disseminated disease may be mild or even misinterpreted as flu.<unk>  can be diagnosed by samples containing the fungus taken from sputum (via bronchoalveolar lavage), blood, or infected organs. It can also be diagnosed by detection of antigens in blood or urine samples by ELISA or polymerase chain reaction. Antigens can cross-react with antigens of African<unk>  (caused by Histoplasma duboisii), blastomycosis, coccidioidomycosis, paracoccidioidomycosis, and talaromycosis infection.<unk>  can also be diagnosed by a test for antibodies against Histoplasma in the blood. Histoplasma skin tests indicate whether persons have been exposed, but do not indicate whether they have the disease. Formal<unk>  diagnoses are often confirmed only by culturing the fungus directly. Sabouraud agar is one agar growth medium on which the fungus can be cultured. Cutaneous manifestations of disseminated disease are diverse and often present as a nondescript rash with systemic complaints. Diagnosis is best established by urine antigen testing, as blood cultures may take up to 6 weeks for diagnostic growth to occur and serum antigen testing often comes back with a false negative before 4 weeks of disseminated infection. Types<unk>  may be divided into these types: :* Primary pulmonary<unk>  :* Progressive disseminated<unk>  :* Primary cutaneous<unk>  :* African<unk>  Image:Histoplasma capsulatum var. duboisii. PHIL 4221 lores.jpg Image:Tuberculate macroconida of the Jamaican isolate of Histoplasma capsulatum PHIL 4023 lores.jpg
Histoplasmosis
Tuberculosis
Toxoplasmosis
Talaromycosis
African histoplasmosis
Emmonsiosis
Lobomycosis
Zygomycosis