Acute histoplasmosis: a modern appraisal.

Acute histoplasmosis is an infrequently recognized pulmonary disease endemic in Puerto Rico. Two cases of acute histoplasmosis which followed an exposure to bat guano in a tunnel are presented. Negative cultures of bronchial washings and negative transbronchial biopsies illustrate the usual difficulty in establishing a definitive diagnosis. Serial serum complement fixation titers suggested a recent infection. The illness was quickly and effectively controlled with oral ketoconazole. When symptoms of acute histoplasmosis persist beyond two weeks treatment with ketoconazole for at least two months should be considered.