The Researchers’ - Volume IV, Issue I, March-2018 ISSN : 2455-1503 International Journal of Research UGC Journal No. - 64379

1. Contested Space of Diaspora: A Case Study of Gujarati and Bohra Diasporas of Kozhikode City Muhammed Fakrudheen Ali.V.I, Research Scholar, University of Kerala

Calicut is one of the most prominent port city, since 20 th century in the south-west coast of India. Along with natives a few diaspora communities too played a major role in shaping the socio-cultural and political life of the city. There were basically four immigrant Hindu communities in the city, namely, the Gujaraties, the Konkini Brhmins, the Tamil Brahmins, and the Marvadees. Among them, the Gujaratis and Kongini Brahmins are the merchant communities whereas the Tamil Brahmins are associated with temple complexes.The Marvadees had their settlement only after with the establishment of Mavoor Gwaliyore Reyons factory 1n 1960s. So, among the Hindu diaspora, only the first two are coming under the study as per the specificities pertaining to the selected groups occupational and chronological boundaries.The majority of the city’s Muslim population is fundamentally the local converts to Islam, known as the Mappila Muslims. There are also a few immigrant Muslim communities as well. They are the Bohras, the Dhaknis, the Memons, the Batkals, the Barahmis and the Marikars. They were the trading communities. Baramis became very much a local community by the time as children of west Asian fathers and local mothers and Marikars were seafarers. This study, hence centred on the socio-cultural life of the two prominent Diaspora communities belong two religions, the Hindu Gujaraties and the Muslim Bohras.

Gujaratis Gujaratis consisted of one of the most prominent business communities in the world. Like other major cities in India, they are a numerically week, but an economically powerful community in Calicut as well. Though their prominence has been weakened during the course of time they wielded so much influence in the economic life of the city in the prescribed period. There is even a street named after them, the Guajarati Street, in the heart of the cities commercial metropolis.

History Gujaratis had a very long relationship with the city as traders. Along with their Muslim counterparts the Gujarati Hindus carried out the regions intra and international trade. It is said that Portuguese reached in

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the city in 1498 with the help of a Gujarati trader. Whatever may be the case the Gujarati settlement established here before 180 years. The integration of India under the British fuelled the process.

The early immigrants were from the Jamnagar region of Gujarat . They specialised in pulse trade. Though Kerala was almost self-sufficient in food grain production during the time, it needed cereals. Rice was also in demand when crop damages took place during heavy monsoon. They bought these commodities here and procured Malabar spices which were in great demand around the world. Trade was often done in the barter system. When the British currency system gained ground a shift had taken place to it. In addition to trade, they also imported precious metals like gold, stones and chemicals to the city. Gold was collected from then Bombay. In the local market, it was the Konginees who did gold business in hands with the local goldsmiths.

Social Life Gujarati settlers are from four castes, namely the Lohanas, Bhatyas, and Brahmins. The fourth one was the Jains. All of them belonged to the Vaisnava sect. Among them, Brahmins were small in numbers and worked mainly as priests to cater the spiritual and religious needs of the settlers. Since the Gujaratis are a very religious community the priests were very high in demand. Some of them also did trade and helped the traders as office staff.

By the prescribed time there had been two temples built, namely the Balakrishna temple and saint Jay ram temple. They were small temples modelled after the nagara style. Both were re built in 1960s, the spiritual life of the community was centred around these temples. Women from the community used recite bhajans daily in the morning.

Deepavali and Navarathri were the main festivals they celebrated. Deepavali was an occasion to repay the credits as well it also marked an occasion for the communities outreach. They used to send homemade sweets to neighbhours and business partners during the time. In fact Deepavali festival was very instrumental in introducing many new sweets in the city.

Navarthri was more an exclusive festival. There were extensive rituals associated with it in the temples. Children’s beginning of learning was most important among them. Though Navratri was also celebrated by the local Hindus, it was mainly confined to the temples then and was not a prominent a festival.

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During the prescribed time, men are formally educated whereas women’s education was least a concern. Boys used to enter into Ganapat School, Malabar Christian college school and the model school. In most cases, school education was confined to formal level as all had family business to look after. So, after matriculation, no interest was shown in higher studies. Women education was ignored due to the community’s traditional outlook. The Gujarati reform movement was not that effective to touch the convictions of their distant brethren.

But, changes started slowly. The leadership of two Gujaratis in the national movement had an impact. Inspired by Gandhiji and Patel some Gujaratis forged hand with the national movement, Shamji Sunder das and Lakshmi Moonji was two of them. The latter even took part in the Dandi march and later on elected to Calicut Municipal Corporation. According to Vijaysi Pathanji, aged 77, who is the senior most member of the community now, Gujaratis in the city had no political affiliations [i] . As a business community, they always stood with those who in power. Though Gandhiji was well admired and local leaders like Shamji was respected, the community was not ready to support the national movement. All political affiliations were personal.

This proximity to power helped the community many ways. Government always took a lenient approach to them. When the community applied to get sanction to run a school, it was allowed soon after filing the application in 1947. The school named as Gujarathi School was very instrumental in giving education to the children in the beach area. Apart from Guajarati, Muslims and local Hindu families found the school as a great help to educate their children. It was to run the school the first organisation of the community formed in 1953, namely the Guajarati Vidyalaya Association. Subsequently, the Guajarati Samaj was also formed in the same year. The Samaj had the responsibility to look after the temples and to take care of the aged members of the community.

Dhawoodi Bohras The Dawoodi Bohras were the sole Shiite group among the immigrant Muslim communities of Calicut. They have been living here for the last two centuries. We do not have ample evidence pertaining to the cause of the migration, but available documents shed light to their three hundred years old contacts with the city. [ii] It is believed that the business potential of Kallai [iii] might be the reason to form a settlement here. The assumption is backed by the prominence achieved by the Bohras in the timber trade in Calicut in the beginning of the twentieth century.

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The word Bohra derived from the Gujarati root vohoro or vyavahar meaning ‘to trade’. The term was used to denote Hindu, Muslim and Jain traders. However, it is the Muslim who generally called as Bohras. They are a sub-sect of the Ismailia Shiah Islam; the belief system has its origin in Yemen. [iv] In Yemen, they evolved from the Fatimid Caliphate and they were persecuted due to their difference from mainstream Sunni Islam .

Contours in the Islamic Space of Calicut Among the Muslims in the city the Boras were the first to accept the English language with an open heart, which imparted them an extra mileage in the socio-economic life. Though they always keep good relation with the local Muslims they maintain the cultural roots of the community intact. It may be due to the insistence that they never took part in age-old revelry existed between the Shiites of the adherent Kondotty region with the Ponnani Sunni group. This policy can be seen as psychological measure to protect the community from local influence. When they opened the window to the West they closed it for the fellow religionists of the neighbourhood. It is a difficult strategy to comprehend. The Gujaratis did the same in the case of Hindu reform movements during the time. Amado. M. Padilla had observed the decline in cultural awareness from the first generation of the immigrants to the fourth generation. [v] The Gujaratis, Konginis and Bohra Muslims of Calicut offer a strange contradiction to the theory. Though many generations have been passed, they never allowed their cultural seclusion to be broken to the locals. At the same time they selectively permit the western cultural elements to enter, as evident in the New Year celebration and all. The approach takes the researcher to a grey area where identity politics assumes a strange costume. As pointed out by Frederic Jameson deterritorialisation always keep some channels closed while others to let in [vi] by closing the cultural window to the local Muslims the Bohra Muslim psyche seems to have represented the difference, providing it a safe hole to vent. It is relevant in the context of well to do minority duels in the ocean of an arrogant and sectarian co-religionists. As in the case of any representation of differences the element of protest is also embedded in it. The collective memory of Shia prosecution and the alienation of the sect in the Sunni dominated Islamic space must have been the constitutive element here. As pointed out by John Lie, [vii] it is no longer assumed that immigrants make a sharp break from their homelands. Rather pre- emigration networks, culture and capital remain silent. The sojourn follows multifarious trajectories. But, the Gujaratis were not that open two western culture like the Boras. They were eager to get modern education with a psychological filter to safeguard themselves from the alien cultural influences. It may be due to the dominant position they enjoyed in the elite Hindu fold unlike Boras, the prosecuted, in the global Islamic space. In the Islamic space of the Calicut city the Bohra community marks an invisible presence. They stand in the periphery of

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the grand-narrative of cultural Islam in the city. Their involvement in the Islamic space of Calicut clearly illustrates the fact. They never came in the centre of any religious debate in the city. Instead their contributions mainly lie in the educational sector. They were instrumental in the establishment of Farook College and the foundation of J.D.T. orphanage . The Gujaratis also have the story to tell. They catalysed the modernisation process in the city by establishing schools and kept themselves away from the troubles which the native reformists faced.

Conclusion More than the co-religionists the Gujaratis of Kozhikode are closer to the Bhora Muslims of the city. So be the case of the Bohras. Historical and cultural affinities can be seen as the cementing factor in these ties. Both are trading communities coming from the same region. Though they are in competition with each other in national and international trade, the Diaspora status in an alien city might have brought the cultural affinities in the surface above the religious boundaries and professional revelries. Moreover the Shia identity of the Bohras might have occasioned the social coming together as the sect represents both a counter social and cultural reading and practise of the grant Islamic narrative van guarded by the Sunni tradition. Modern institutions like the Gujarati School became another meeting space of the post- independent generations of both communities to practise a salad bowl model of multiculturalism.

[i] Interview with Vijaysi Pathansi, Valiyangadi, 16 June 2016

[ii] P.P. Muhammed Koya Parappil, Kozhikkotte Muslinglude Charitram , , Focus publication, Calicut, 1994, pp.205-206.

[iii] During the period the banks of the river Kallai was one of the largest centres of wood industries in the world.

[iv] Farhad Daftary, The Ismaili-Their History and Doctrine , OUP, London, 2004, pp300-316.

[v] [v] Amado .M. Padilla and William Perez, Acculturation, social identity and social cognition-a new perspective , SUP, 2003, pp.35-55.

[vi] Federic Jameson, “On Cultural Studies”, Social Text , Vol.34, no.1, 1993 pp. 34-58.

[vii] Jon Lie, From International Migration to Transnational Diaspora , contemporary sociology, Vol.24,no.4,1995, pp.303-306.

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Case Study Meaning In Gujarati

સરળ ઉદાહરણો અને વ્યાખ્યાઓ સાથે case study નો વાસ્તવિક અર્થ જાણો., definitions of case study.

1 . સમયગાળા દરમિયાન ચોક્કસ વ્યક્તિ, જૂથ અથવા પરિસ્થિતિના વિકાસ પર સંશોધનની પ્રક્રિયા અથવા રેકોર્ડ.

1 . a process or record of research into the development of a particular person, group, or situation over a period of time.

2 . થીસીસ અથવા સિદ્ધાંતને સમજાવવા માટે વપરાયેલ અથવા વિશ્લેષણ કરેલ કંઈકનું ચોક્કસ ઉદાહરણ.

2 . a particular instance of something used or analysed in order to illustrate a thesis or principle.

Examples of Case Study :

1 . ઉદાહરણ તરીકે, અમારા કેસ સ્ટડીમાં 48 વર્ષનો માણસ

1 . For example, the 48 year old man in our case study

2 . તમે જાણો છો કે તમારે કેસ સ્ટડીની શા માટે જરૂર છે.

2 . You know why you need a case study .

3 . $2 મિલિયન સાથે કેવી રીતે નિવૃત્ત થવું [કેસ સ્ટડી]

3 . How to Retire with $2 Million [ Case Study ]

4 . 8000 બ્લોગ ટિપ્પણીઓ કેવી રીતે મેળવવી: એક કેસ સ્ટડી

4 . How to Get 8000 Blog Comments: A Case Study

5 . (એક દુરુપયોગ કરાયેલ વિજાતીય માણસનો કેસ સ્ટડી.

5 . (A case study of an abused heterosexual man.

6 . 01:19 - પરિણામ સાથે તમારો કેસ સ્ટડી શરૂ કરો

6 . 01:19 – Start your case study with the result

7 . નવો કેસ સ્ટડી: ઇસ્ટર્ન બેંક અને સારા માટે અમારી સાથે જોડાઓ

7 . New Case Study : Eastern Bank and Join Us For Good

8 . ખરેખર, સમલૈંગિક લગ્ન માટેની ઝુંબેશ અનુરૂપતામાં કેસ સ્ટડી પ્રદાન કરે છે, આધુનિક યુગમાં કેવી રીતે નરમ સરમુખત્યારશાહી અને પીઅર દબાણ લાગુ કરવામાં આવે છે તે અંગેની તીક્ષ્ણ આંતરદૃષ્ટિ અને કોઈપણ દૃષ્ટિકોણને અંતે દૂર કરવા માટે. ભેદભાવપૂર્ણ, "ફોબિક". ,

8 . indeed, the gay-marriage campaign provides a case study in conformism, a searing insight into how soft authoritarianism and peer pressure are applied in the modern age to sideline and eventually do away with any view considered overly judgmental, outdated, discriminatory,“phobic”,

9 . કેસ સ્ટડી હોમ્સ વાસ્તવમાં એક સ્કેચબુક છે.

9 . Case Study Homes is actually a sketchbook.

10 . કેસ સ્ટડીના સારાંશ પણ આવકાર્ય છે.

10 . case study abstracts will also be welcomed.

11 . અન્ય કેસ સ્ટડી, પારડીસ, મૂલ્યવાન અસર.

11 . The other case study , Pardis, valued impact.

12 . કેસ સ્ટડી: આહ, સાયબરસેક્સની કાલાતીત કલા.

12 . Case Study : Ah, the timeless art of cybersex.

13 . આજે માટે અમારો કેસ સ્ટડી Tazemasa.com સાથે છે!

13 . Our case study for today is with Tazemasa.com!

14 . ifpug ઇન્સ્ટન્ટ કેસ સ્ટડી રિવોર્ડ પ્રોગ્રામ શરૂ કરે છે.

14 . ifpug is launching a snap case study award program.

15 . કેસ સ્ટડી #15: તમારા મુલાકાતીઓને ઓછા વિકલ્પો ઓફર કરો

15 . Case Study #15: Offer fewer options to your visitors

16 . ગ્રીસમાં પેલોપોનીઝ મુખ્ય કેસ સ્ટડી બનાવે છે.

16 . The Peloponnese in Greece forms the main case study .

17 . કેસ સ્ટડી: એનને જે ગમે છે તે કરવા માટે તેણીની નોકરી કેવી રીતે છોડી દીધી

17 . Case Study : How Ann quit her job to do what she loves

18 . (ફિગ. કેસ સ્ટડી: લિન્ડા સ્પેનરને નવું એપાર્ટમેન્ટ જોઈએ છે.)

18 . (Fig. Case study : Linda Spanner wants a new apartment.)

19 . કેસ સ્ટડી: SEO વિના ગૂગલ પર કેવી રીતે પ્રભુત્વ મેળવવું (43 દિવસમાં)

19 . Case Study : How to Dominate Google Without SEO (in 43 Days)

20 . અને મેં થોડા ટૂંકા અઠવાડિયામાં "SEO કેસ સ્ટડી" માટે #5 હિટ કર્યું.

20 . And I hit the #5 for “SEO case study ” in a few short weeks.

21 . અમારી ટીમ કેસ-સ્ટડી પર કામ કરી રહી છે.

21 . Our team is working on a case-study.

22 . આ એક કેસ-સ્ટડી છે.

22 . This is a case-study.

23 . તેણીએ કેસ-સ્ટડીનું વિશ્લેષણ કર્યું.

23 . She analyzed the case-study.

24 . આ ક્લાસિક કેસ-સ્ટડી છે.

24 . This is a classic case-study.

25 . કેસ-સ્ટડી રસપ્રદ છે.

25 . The case-study is interesting.

26 . આ કેસ-સ્ટડી વ્યાપકપણે ટાંકવામાં આવે છે.

26 . This case-study is widely cited.

27 . આપણે કેસ-સ્ટડીની સમીક્ષા કરવાની જરૂર છે.

27 . We need to review the case-study.

28 . આ કેસ-સ્ટડી સારી રીતે માનવામાં આવે છે.

28 . This case-study is well-regarded.

29 . આ કેસ-સ્ટડીમાંથી આપણે શીખી શકીએ છીએ.

29 . We can learn from this case-study.

30 . હું આ કેસ-સ્ટડીથી આકર્ષિત છું.

30 . I'm fascinated by this case-study.

31 . તેમણે આ કેસ-સ્ટડી પર પુસ્તક લખ્યું.

31 . He wrote a book on this case-study.

32 . હું કેસ-સ્ટડી વાંચવાની ભલામણ કરું છું.

32 . I recommend reading the case-study.

33 . આ કેસ-સ્ટડી સારી રીતે દસ્તાવેજીકૃત છે.

33 . This case-study is well-documented.

34 . કેસ-સ્ટડી મુખ્ય આંતરદૃષ્ટિ દર્શાવે છે.

34 . The case-study reveals key insights.

35 . તેણે કેસ-સ્ટડી માટે ડેટા એકત્ર કર્યો.

35 . He collected data for the case-study.

36 . તેમણે કેસ-સ્ટડીના તારણો રજૂ કર્યા.

36 . He presented the case-study findings.

37 . આ કેસ-સ્ટડી વ્યાપકપણે માન્ય છે.

37 . This case-study is widely recognized.

38 . આ કેસ-સ્ટડી અત્યંત પ્રભાવશાળી છે.

38 . This case-study is highly influential.

39 . કેસ-સ્ટડી અમારા તારણો માન્ય કરે છે.

39 . The case-study validates our findings.

40 . આ કેસ-સ્ટડી વ્યાપકપણે સ્વીકારવામાં આવે છે.

40 . This case-study is widely acknowledged.

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Case Study meaning in Gujarati - Learn actual meaning of Case Study with simple examples & definitions. Also you will learn Antonyms , synonyms & best example sentences. This dictionary also provide you 10 languages so you can find meaning of Case Study in Hindi, Tamil , Telugu , Bengali , Kannada , Marathi , Malayalam , Gujarati , Punjabi , Urdu.

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  • What Is a Case Study? | Definition, Examples & Methods

What Is a Case Study? | Definition, Examples & Methods

Published on May 8, 2019 by Shona McCombes . Revised on November 20, 2023.

A case study is a detailed study of a specific subject, such as a person, group, place, event, organization, or phenomenon. Case studies are commonly used in social, educational, clinical, and business research.

A case study research design usually involves qualitative methods , but quantitative methods are sometimes also used. Case studies are good for describing , comparing, evaluating and understanding different aspects of a research problem .

Table of contents

When to do a case study, step 1: select a case, step 2: build a theoretical framework, step 3: collect your data, step 4: describe and analyze the case, other interesting articles.

A case study is an appropriate research design when you want to gain concrete, contextual, in-depth knowledge about a specific real-world subject. It allows you to explore the key characteristics, meanings, and implications of the case.

Case studies are often a good choice in a thesis or dissertation . They keep your project focused and manageable when you don’t have the time or resources to do large-scale research.

You might use just one complex case study where you explore a single subject in depth, or conduct multiple case studies to compare and illuminate different aspects of your research problem.

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Once you have developed your problem statement and research questions , you should be ready to choose the specific case that you want to focus on. A good case study should have the potential to:

  • Provide new or unexpected insights into the subject
  • Challenge or complicate existing assumptions and theories
  • Propose practical courses of action to resolve a problem
  • Open up new directions for future research

TipIf your research is more practical in nature and aims to simultaneously investigate an issue as you solve it, consider conducting action research instead.

Unlike quantitative or experimental research , a strong case study does not require a random or representative sample. In fact, case studies often deliberately focus on unusual, neglected, or outlying cases which may shed new light on the research problem.

Example of an outlying case studyIn the 1960s the town of Roseto, Pennsylvania was discovered to have extremely low rates of heart disease compared to the US average. It became an important case study for understanding previously neglected causes of heart disease.

However, you can also choose a more common or representative case to exemplify a particular category, experience or phenomenon.

Example of a representative case studyIn the 1920s, two sociologists used Muncie, Indiana as a case study of a typical American city that supposedly exemplified the changing culture of the US at the time.

While case studies focus more on concrete details than general theories, they should usually have some connection with theory in the field. This way the case study is not just an isolated description, but is integrated into existing knowledge about the topic. It might aim to:

  • Exemplify a theory by showing how it explains the case under investigation
  • Expand on a theory by uncovering new concepts and ideas that need to be incorporated
  • Challenge a theory by exploring an outlier case that doesn’t fit with established assumptions

To ensure that your analysis of the case has a solid academic grounding, you should conduct a literature review of sources related to the topic and develop a theoretical framework . This means identifying key concepts and theories to guide your analysis and interpretation.

There are many different research methods you can use to collect data on your subject. Case studies tend to focus on qualitative data using methods such as interviews , observations , and analysis of primary and secondary sources (e.g., newspaper articles, photographs, official records). Sometimes a case study will also collect quantitative data.

Example of a mixed methods case studyFor a case study of a wind farm development in a rural area, you could collect quantitative data on employment rates and business revenue, collect qualitative data on local people’s perceptions and experiences, and analyze local and national media coverage of the development.

The aim is to gain as thorough an understanding as possible of the case and its context.

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In writing up the case study, you need to bring together all the relevant aspects to give as complete a picture as possible of the subject.

How you report your findings depends on the type of research you are doing. Some case studies are structured like a standard scientific paper or thesis , with separate sections or chapters for the methods , results and discussion .

Others are written in a more narrative style, aiming to explore the case from various angles and analyze its meanings and implications (for example, by using textual analysis or discourse analysis ).

In all cases, though, make sure to give contextual details about the case, connect it back to the literature and theory, and discuss how it fits into wider patterns or debates.

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Case study meaning in gujarati, definition of case study.

  • a careful study of some social unit (as a corporation or division within a corporation) that attempts to determine what factors led to its success or failure
  • a detailed analysis of a person or group from a social or psychological or medical point of view

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case study - Meaning in Gujarati. case study definition, pronuniation, antonyms, synonyms and example sentences in Gujarati. translation in Gujarati for case study with similar and opposite words. case study ka gujarati mein matalab, arth aur prayog

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Case study: 33-year-old female presents with chronic sob and cough.

Sandeep Sharma ; Muhammad F. Hashmi ; Deepa Rawat .

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Last Update: February 20, 2023 .

  • Case Presentation

History of Present Illness:  A 33-year-old white female presents after admission to the general medical/surgical hospital ward with a chief complaint of shortness of breath on exertion. She reports that she was seen for similar symptoms previously at her primary care physician’s office six months ago. At that time, she was diagnosed with acute bronchitis and treated with bronchodilators, empiric antibiotics, and a short course oral steroid taper. This management did not improve her symptoms, and she has gradually worsened over six months. She reports a 20-pound (9 kg) intentional weight loss over the past year. She denies camping, spelunking, or hunting activities. She denies any sick contacts. A brief review of systems is negative for fever, night sweats, palpitations, chest pain, nausea, vomiting, diarrhea, constipation, abdominal pain, neural sensation changes, muscular changes, and increased bruising or bleeding. She admits a cough, shortness of breath, and shortness of breath on exertion.

Social History: Her tobacco use is 33 pack-years; however, she quit smoking shortly prior to the onset of symptoms, six months ago. She denies alcohol and illicit drug use. She is in a married, monogamous relationship and has three children aged 15 months to 5 years. She is employed in a cookie bakery. She has two pet doves. She traveled to Mexico for a one-week vacation one year ago.

Allergies:  No known medicine, food, or environmental allergies.

Past Medical History: Hypertension

Past Surgical History: Cholecystectomy

Medications: Lisinopril 10 mg by mouth every day

Physical Exam:

Vitals: Temperature, 97.8 F; heart rate 88; respiratory rate, 22; blood pressure 130/86; body mass index, 28

General: She is well appearing but anxious, a pleasant female lying on a hospital stretcher. She is conversing freely, with respiratory distress causing her to stop mid-sentence.

Respiratory: She has diffuse rales and mild wheezing; tachypneic.

Cardiovascular: She has a regular rate and rhythm with no murmurs, rubs, or gallops.

Gastrointestinal: Bowel sounds X4. No bruits or pulsatile mass.

  • Initial Evaluation

Laboratory Studies:  Initial work-up from the emergency department revealed pancytopenia with a platelet count of 74,000 per mm3; hemoglobin, 8.3 g per and mild transaminase elevation, AST 90 and ALT 112. Blood cultures were drawn and currently negative for bacterial growth or Gram staining.

Chest X-ray

Impression:  Mild interstitial pneumonitis

  • Differential Diagnosis
  • Aspiration pneumonitis and pneumonia
  • Bacterial pneumonia
  • Immunodeficiency state and Pneumocystis jiroveci pneumonia
  • Carcinoid lung tumors
  • Tuberculosis
  • Viral pneumonia
  • Chlamydial pneumonia
  • Coccidioidomycosis and valley fever
  • Recurrent Legionella pneumonia
  • Mediastinal cysts
  • Mediastinal lymphoma
  • Recurrent mycoplasma infection
  • Pancoast syndrome
  • Pneumococcal infection
  • Sarcoidosis
  • Small cell lung cancer
  • Aspergillosis
  • Blastomycosis
  • Histoplasmosis
  • Actinomycosis
  • Confirmatory Evaluation

CT of the chest was performed to further the pulmonary diagnosis; it showed a diffuse centrilobular micronodular pattern without focal consolidation.

On finding pulmonary consolidation on the CT of the chest, a pulmonary consultation was obtained. Further history was taken, which revealed that she has two pet doves. As this was her third day of broad-spectrum antibiotics for a bacterial infection and she was not getting better, it was decided to perform diagnostic bronchoscopy of the lungs with bronchoalveolar lavage to look for any atypical or rare infections and to rule out malignancy (Image 1).

Bronchoalveolar lavage returned with a fluid that was cloudy and muddy in appearance. There was no bleeding. Cytology showed Histoplasma capsulatum .

Based on the bronchoscopic findings, a diagnosis of acute pulmonary histoplasmosis in an immunocompetent patient was made.

Pulmonary histoplasmosis in asymptomatic patients is self-resolving and requires no treatment. However, once symptoms develop, such as in our above patient, a decision to treat needs to be made. In mild, tolerable cases, no treatment other than close monitoring is necessary. However, once symptoms progress to moderate or severe, or if they are prolonged for greater than four weeks, treatment with itraconazole is indicated. The anticipated duration is 6 to 12 weeks total. The response should be monitored with a chest x-ray. Furthermore, observation for recurrence is necessary for several years following the diagnosis. If the illness is determined to be severe or does not respond to itraconazole, amphotericin B should be initiated for a minimum of 2 weeks, but up to 1 year. Cotreatment with methylprednisolone is indicated to improve pulmonary compliance and reduce inflammation, thus improving work of respiration. [1] [2] [3]

Histoplasmosis, also known as Darling disease, Ohio valley disease, reticuloendotheliosis, caver's disease, and spelunker's lung, is a disease caused by the dimorphic fungi  Histoplasma capsulatum native to the Ohio, Missouri, and Mississippi River valleys of the United States. The two phases of Histoplasma are the mycelial phase and the yeast phase.

Etiology/Pathophysiology 

Histoplasmosis is caused by inhaling the microconidia of  Histoplasma  spp. fungus into the lungs. The mycelial phase is present at ambient temperature in the environment, and upon exposure to 37 C, such as in a host’s lungs, it changes into budding yeast cells. This transition is an important determinant in the establishment of infection. Inhalation from soil is a major route of transmission leading to infection. Human-to-human transmission has not been reported. Infected individuals may harbor many yeast-forming colonies chronically, which remain viable for years after initial inoculation. The finding that individuals who have moved or traveled from endemic to non-endemic areas may exhibit a reactivated infection after many months to years supports this long-term viability. However, the precise mechanism of reactivation in chronic carriers remains unknown.

Infection ranges from an asymptomatic illness to a life-threatening disease, depending on the host’s immunological status, fungal inoculum size, and other factors. Histoplasma  spp. have grown particularly well in organic matter enriched with bird or bat excrement, leading to the association that spelunking in bat-feces-rich caves increases the risk of infection. Likewise, ownership of pet birds increases the rate of inoculation. In our case, the patient did travel outside of Nebraska within the last year and owned two birds; these are her primary increased risk factors. [4]

Non-immunocompromised patients present with a self-limited respiratory infection. However, the infection in immunocompromised hosts disseminated histoplasmosis progresses very aggressively. Within a few days, histoplasmosis can reach a fatality rate of 100% if not treated aggressively and appropriately. Pulmonary histoplasmosis may progress to a systemic infection. Like its pulmonary counterpart, the disseminated infection is related to exposure to soil containing infectious yeast. The disseminated disease progresses more slowly in immunocompetent hosts compared to immunocompromised hosts. However, if the infection is not treated, fatality rates are similar. The pathophysiology for disseminated disease is that once inhaled, Histoplasma yeast are ingested by macrophages. The macrophages travel into the lymphatic system where the disease, if not contained, spreads to different organs in a linear fashion following the lymphatic system and ultimately into the systemic circulation. Once this occurs, a full spectrum of disease is possible. Inside the macrophage, this fungus is contained in a phagosome. It requires thiamine for continued development and growth and will consume systemic thiamine. In immunocompetent hosts, strong cellular immunity, including macrophages, epithelial, and lymphocytes, surround the yeast buds to keep infection localized. Eventually, it will become calcified as granulomatous tissue. In immunocompromised hosts, the organisms disseminate to the reticuloendothelial system, leading to progressive disseminated histoplasmosis. [5] [6]

Symptoms of infection typically begin to show within three to17 days. Immunocompetent individuals often have clinically silent manifestations with no apparent ill effects. The acute phase of infection presents as nonspecific respiratory symptoms, including cough and flu. A chest x-ray is read as normal in 40% to 70% of cases. Chronic infection can resemble tuberculosis with granulomatous changes or cavitation. The disseminated illness can lead to hepatosplenomegaly, adrenal enlargement, and lymphadenopathy. The infected sites usually calcify as they heal. Histoplasmosis is one of the most common causes of mediastinitis. Presentation of the disease may vary as any other organ in the body may be affected by the disseminated infection. [7]

The clinical presentation of the disease has a wide-spectrum presentation which makes diagnosis difficult. The mild pulmonary illness may appear as a flu-like illness. The severe form includes chronic pulmonary manifestation, which may occur in the presence of underlying lung disease. The disseminated form is characterized by the spread of the organism to extrapulmonary sites with proportional findings on imaging or laboratory studies. The Gold standard for establishing the diagnosis of histoplasmosis is through culturing the organism. However, diagnosis can be established by histological analysis of samples containing the organism taken from infected organs. It can be diagnosed by antigen detection in blood or urine, PCR, or enzyme-linked immunosorbent assay. The diagnosis also can be made by testing for antibodies again the fungus. [8]

Pulmonary histoplasmosis in asymptomatic patients is self-resolving and requires no treatment. However, once symptoms develop, such as in our above patient, a decision to treat needs to be made. In mild, tolerable cases, no treatment other than close monitoring is necessary. However, once symptoms progress to moderate or severe or if they are prolonged for greater than four weeks, treatment with itraconazole is indicated. The anticipated duration is 6 to 12 weeks. The patient's response should be monitored with a chest x-ray. Furthermore, observation for recurrence is necessary for several years following the diagnosis. If the illness is determined to be severe or does not respond to itraconazole, amphotericin B should be initiated for a minimum of 2 weeks, but up to 1 year. Cotreatment with methylprednisolone is indicated to improve pulmonary compliance and reduce inflammation, thus improving the work of respiration.

The disseminated disease requires similar systemic antifungal therapy to pulmonary infection. Additionally, procedural intervention may be necessary, depending on the site of dissemination, to include thoracentesis, pericardiocentesis, or abdominocentesis. Ocular involvement requires steroid treatment additions and necessitates ophthalmology consultation. In pericarditis patients, antifungals are contraindicated because the subsequent inflammatory reaction from therapy would worsen pericarditis.

Patients may necessitate intensive care unit placement dependent on their respiratory status, as they may pose a risk for rapid decompensation. Should this occur, respiratory support is necessary, including non-invasive BiPAP or invasive mechanical intubation. Surgical interventions are rarely warranted; however, bronchoscopy is useful as both a diagnostic measure to collect sputum samples from the lung and therapeutic to clear excess secretions from the alveoli. Patients are at risk for developing a coexistent bacterial infection, and appropriate antibiotics should be considered after 2 to 4 months of known infection if symptoms are still present. [9]

Prognosis 

If not treated appropriately and in a timely fashion, the disease can be fatal, and complications will arise, such as recurrent pneumonia leading to respiratory failure, superior vena cava syndrome, fibrosing mediastinitis, pulmonary vessel obstruction leading to pulmonary hypertension and right-sided heart failure, and progressive fibrosis of lymph nodes. Acute pulmonary histoplasmosis usually has a good outcome on symptomatic therapy alone, with 90% of patients being asymptomatic. Disseminated histoplasmosis, if untreated, results in death within 2 to 24 months. Overall, there is a relapse rate of 50% in acute disseminated histoplasmosis. In chronic treatment, however, this relapse rate decreases to 10% to 20%. Death is imminent without treatment.

  • Pearls of Wisdom

While illnesses such as pneumonia are more prevalent, it is important to keep in mind that more rare diseases are always possible. Keeping in mind that every infiltrates on a chest X-ray or chest CT is not guaranteed to be simple pneumonia. Key information to remember is that if the patient is not improving under optimal therapy for a condition, the working diagnosis is either wrong or the treatment modality chosen by the physician is wrong and should be adjusted. When this occurs, it is essential to collect a more detailed history and refer the patient for appropriate consultation with a pulmonologist or infectious disease specialist. Doing so, in this case, yielded workup with bronchoalveolar lavage and microscopic evaluation. Microscopy is invaluable for definitively diagnosing a pulmonary consolidation as exemplified here where the results showed small, budding, intracellular yeast in tissue sized 2 to 5 microns that were readily apparent on hematoxylin and eosin staining and minimal, normal flora bacterial growth. 

  • Enhancing Healthcare Team Outcomes

This case demonstrates how all interprofessional healthcare team members need to be involved in arriving at a correct diagnosis. Clinicians, specialists, nurses, pharmacists, laboratory technicians all bear responsibility for carrying out the duties pertaining to their particular discipline and sharing any findings with all team members. An incorrect diagnosis will almost inevitably lead to incorrect treatment, so coordinated activity, open communication, and empowerment to voice concerns are all part of the dynamic that needs to drive such cases so patients will attain the best possible outcomes.

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Histoplasma Contributed by Sandeep Sharma, MD

Disclosure: Sandeep Sharma declares no relevant financial relationships with ineligible companies.

Disclosure: Muhammad Hashmi declares no relevant financial relationships with ineligible companies.

Disclosure: Deepa Rawat declares no relevant financial relationships with ineligible companies.

This book is distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0) ( http://creativecommons.org/licenses/by-nc-nd/4.0/ ), which permits others to distribute the work, provided that the article is not altered or used commercially. You are not required to obtain permission to distribute this article, provided that you credit the author and journal.

  • Cite this Page Sharma S, Hashmi MF, Rawat D. Case Study: 33-Year-Old Female Presents with Chronic SOB and Cough. [Updated 2023 Feb 20]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-.

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  11. Case Study: 33-Year-Old Female Presents with Chronic SOB and Cough

    Case Presentation. History of Present Illness: A 33-year-old white female presents after admission to the general medical/surgical hospital ward with a chief complaint of shortness of breath on exertion. She reports that she was seen for similar symptoms previously at her primary care physician's office six months ago.

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