A 58-Year-Old Renal Transplant Recipient With Fever and Progressive Dyspnea
Bibliographic record
Abstract
(See page 1738 for the Photo Quiz.) Diagnosis: Acute disseminated histoplasmosis. Routine inspection of Wright-Giemsa–stained peripheral blood smear showed multiple intracellular, encapsulated yeast cells measuring 2–5 µm located within peripheral neutrophils compatible with Histoplasma capsulatum (Figure 1). Liposomal amphotericin B therapy (5 mg/kg of body weight) was initiated, but the patient's condition deteriorated rapidly and he died of multiorgan failure within 24 hours after treatment initiation. Bronchoalveolar lavage and blood (mycoF/Lytic) cultures became positive after 19 days and the Sabouraud dextrose agar slant tubes incubated at 30°C grew a white mold (Figure 2). Microscopic examination of the mold using Cotton Blue staining revealed distinctively spiked macroconidia and microconidia (Figure 3). Serum and urinary antigen (Mira Vista, Indianapolis, Indiana) detection for histoplasmosis were highly positive. DNA sequencing analysis confirmed identification of H. capsulatum. ... Histoplasma capsulatum is a dimorphic fungus with a worldwide distribution. It is predominantly prevalent in North America, especially near the Ohio, Mississippi, and Saint Lawrence River valleys. The mycelial form of the fungus thrives best in moist and rich soils contaminated by bird droppings and can be grown at room temperature in a laboratory setting. However, diagnostic cultures can take as long as 6 weeks to grow. Our patient had a history of exposure to chicken coops. In addition, he had recently performed major house renovations. As such, the patient may have developed a primary infection from recent mold exposure during renovations or reactivated a latent infection acquired through remote exposure (chicken coops, or other environmental exposure in the Saint Lawrence River valley where he lived).
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.002 | 0.000 |
| Scholarly communication | 0.001 | 0.002 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.002 | 0.003 |
| Insufficient payload (model declined to judge) | 0.007 | 0.002 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".