Which fungus is listed as a cause of chronic diarrhea?

• A. Candida
• B. Aspergillus
• C. Cryptococcus
• D. Histoplasma

Answer: (D)

Chronic diarrhea from a fungal infection typically points to the ability of the organism to involve the gastrointestinal tract in a disseminated process. Histoplasma capsulatum can disseminate and involve the GI tract, especially the ileocecal region, leading to chronic diarrhea along with abdominal pain and weight loss. This pattern is more characteristic than with the other fungi listed, which are less commonly associated with chronic intestinal involvement: Candida tends to cause mucosal or systemic infections without a classic chronic diarrheal presentation; Aspergillus mainly affects the lungs and other organs in invasive disease but GI symptoms like chronic diarrhea are not typical; Cryptococcus most often presents with meningitis or disseminated disease, not chronic enteric diarrhea. Thus, Histoplasma best explains chronic diarrhea in this context.