avatarJevin Lortie

Summary

A 31-year-old individual with a history of Histoplasmosis, a common lung disease in the U.S. that often goes undetected, is at increased risk for severe COVID-19 due to scarring in the lungs, which can impede the ability to clear irritants and lead to more severe pneumonia.

Abstract

The author, who works in a body imaging lab, discovered an unusual bright spot during a routine scan, leading to a diagnosis of Histoplasmosis, a fungal lung infection. Despite appearing healthy, the resulting calcium deposits in the lungs from the body's defense mechanism against the fungus have left the author with pulmonary fibrosis, making it harder for the lungs to function optimally. This condition increases the risk of severe COVID-19 complications, as the lungs may struggle to clear fluid from a COVID-19 infection, potentially leading to severe pneumonia. The author emphasizes the importance of wearing masks and adhering to CDC guidelines, especially for individuals with underlying conditions that may not be immediately visible, as anyone could be at higher risk for COVID-19.

Opinions

  • The author believes that wearing masks is crucial, as people with underlying conditions, like their own Histoplasmosis, may look healthy but are at increased risk for COVID-19 complications.
  • The author suggests that many people may unknowingly have Histoplasmosis, as it often presents with mild symptoms similar to the flu and may only be discovered incidentally or during autopsies.
  • The author highlights the importance of being aware of and protecting oneself against COVID-19, especially for those with conditions that might not be externally apparent but can exacerb

The Weird Reason I’m at Risk for COVID-19

I look perfectly healthy, but anyone can have an underlying condition

The initial image that indicated something was in my lung. Photo by author.

I’m 31 years old, and I’m at risk for COVID-19.

A few years ago, I discovered I have an unusual lung disease. Actually, it’s pretty common in most of the U.S. It’s unusual because many people have it and don’t know about it.

I look perfectly healthy. Anyone around you might have an underlying condition. Please wear a mask.

I happened to find out I have this disease because I work in a body imaging lab. On a routine scan of myself, I noticed a strange bright spot. I was concerned, so I went to the doctor, where they gave me a chest X-ray and CT scan. I was worried it was cancer.

It wasn’t cancer, thankfully.

The doctor told me I have Histoplasmosis.

I have WHAT?

It turns out, most of the time, it’s not that big of a deal. Most of the time, though, we’re not in a global pandemic of a respiratory virus.

I’m 31 years old, and I’m at risk for COVID-19. I look perfectly healthy. Anyone around you might have an underlying condition. Please wear a mask.

Histoplasmosis is caused by a fungus called Histoplasma. It lives in animal droppings, especially from birds and bats. It’s often found in caves, dirt, and can be made airborne in construction or digging projects. When we breathe it in, it can cause a lung infection. Our bodies fight the fungal infection by surrounding it with calcium deposits in the lungs.

Follow-up X-ray on my chest showed a 4cm diameter mass in my lung. Photo by author.

While I can live my life normally, the calcium scarring caused by Histoplasmosis slightly impedes my airways. It’s not enough to make it hard to breathe, but it is harder for my lungs to clear out irritants when they need to.

This manifests as being prone to pneumonia. It’s not uncommon for me to get pneumonia or bronchitis once a year during the cold Wisconsin winters.

Since my lungs are prone to pneumonia, they might have a harder time clearing the fluid caused by a COVID-19 infection. Additionally, a pneumonia infection caused by COVID-19 might be more severe given my Histoplasmosis scarring.

COVID-19 causes inflammation in the lungs, leading to fluid accumulation which can impair breathing. If fluid is not able to get out of the lungs it can cause a secondary infection–COVID-19 pneumonia. The World Health Organization states that the most common diagnosis for severe COVID-19 cases is by also having severe pneumonia.

The current known risk factors for COVID-19, as listed by the CDC are:

  • Chronic kidney disease
  • COPD (chronic obstructive pulmonary disease)
  • Immunocompromised individuals
  • Obesity
  • Heart conditions
  • Sickle cell disease
  • Type 2 diabetes

However, the CDC lists conditions which might put people at increased risk as well:

Although Histoplasmosis isn’t specifically listed, it is a form of pulmonary fibrosis. The calcium scarring is fibrotic tissue that does not function as effectively as healthy lung tissue.

Anyone with any of the conditions on either of these lists should be extra-careful about their exposure to COVID-19. Everyone should practice social distancing, use a mask, and stay up to date with CDC guidelines.

CT scans of the large calcium deposit in my left lung. The right lung has some small calcifications but is relatively normal. Photo by author.

The CDC estimates that 60 to 90 percent of people that live in places where Histoplasma lives have been exposed to it, judging by antibody tests. Where I live in the Midwest, only about 6 people in 100,000 see a doctor for Histoplasmosis. My doctor told me that most people don’t know they have the disease, and it’s often found in autopsies without the person having a record of it.

The Histoplasma fungus infects the lungs and initially causes symptoms that one might mistake for the cold or flu: cough, fever, and aches. Some people can have more severe symptoms, particularly those that are immunologically compromised. Most people fight it off on their own, and simply assume they had the flu.

Our body seals off the fungus and kills it by building calcium walls around it, like a knot on a tree. This is what I was seeing in my image–the leftover calcium scarring from the war my body waged on this fungus. The many clusters of calcium look kind of like bunches of grapes. The largest one, that I was able to see on my rough X-ray in lab, is about 4cm in diameter. That’s roughly the size of a golf ball in my lungs!

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