Histoplasmosis is a disease caused by breathing in infected airborne spores of the fungus Histoplasma capsulatum. These spores are commonly found in soil that has been disturbed, such as during plowing fields, sweeping chicken coops, or digging holes. Once inhaled, the spores can lead to a lung infection. In some cases, the infection can later spread to the eye through the bloodstream, resulting in a serious eye disease known as presumed ocular histoplasmosis syndrome (POHS). POHS is a leading cause of vision loss in individuals between the ages of 20 and 40.
The symptoms of histoplasmosis infection are often mild and can be easily mistaken for a common cold or flu. In fact, many individuals may not even experience any clear symptoms at all. The body’s immune system is typically able to fight off the infection within a few days without the need for treatment. However, even after the infection has resolved, tiny scars called histo spots may remain at the infection sites. Although these histo spots do not generally affect vision, they can potentially cause complications many years later. In some cases, abnormal blood vessels may grow beneath the retina, leading to symptoms similar to macular degeneration.
Some common symptoms of histoplasmosis include:
If you experience any of these symptoms, it is important to seek an evaluation from an ophthalmologist, who specializes in eye health and diseases.
Individuals who have lived in states within the Ohio and Mississippi River Valley are at a higher risk of histoplasmosis infection. Although many people have been exposed to the fungus, only a few go on to develop POHS. If you have previously had histoplasmosis, it is important to watch for any vision changes that could indicate the development of POHS. Even if you are unaware of having had histoplasmosis, it is recommended to have your eyes examined for histo spots if you have lived in areas with high rates of the infection.
To confirm a histoplasmosis diagnosis and evaluate for POHS, an ophthalmologist will conduct a thorough examination of your eyes. This examination will involve looking for histo spots and checking for swelling of the retina, which may indicate the growth of abnormal blood vessels. Additionally, an Amsler grid may be used to detect any wavy, blurry, or dark areas in your vision.
Special photographs of the eye may be taken using techniques such as optical coherence tomography (OCT), OCT angiography, or fluorescein angiography. These imaging methods provide detailed pictures of the retina and its thickness, helping the ophthalmologist identify any abnormalities in blood vessels and swelling.
Treatment for histoplasmosis aims to prevent further vision loss and manage the growth of abnormal blood vessels. Two common treatment options include anti-VEGF (vascular endothelial growth factor) injections and laser treatment.
Anti-VEGF drugs are used to block the growth of blood vessels that are not normal, reducing leakage and slowing down vision loss. These drugs are injected into the eye during an outpatient procedure. Multiple injections may be necessary over several months for optimal results.
Laser treatment involves using a focused beam of light to create small burns in the retina, destroying the abnormal blood vessels. While this treatment can stabilize vision within a few weeks, it may result in a permanent blind spot in the field of vision.
In some cases, steroid injections may be administered to reduce swelling caused by histoplasmosis.
It is crucial for individuals with histoplasmosis to maintain regular checkups with their ophthalmologist. Since histoplasmosis poses a lifelong threat to vision, early detection of any problems is essential for timely intervention and management.
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