infectious diseases
Histoplasmosis
Treatment of Histoplasmosis
No treatment needed for acute, self-limited infection For mild to moderate infection,itraconazole For severe infection,amphotericin B (See also Antifungal Medications .) Serum concentration ofitraconazoleand urine or blood levels ofHistoplasmaantigen should be monitored during therapy. may be less effective ( Treatment reference ). Acute primary histoplasmosis requires no antifungal therapy unless there is no spontaneous improvement after 1 month. If infection does not resolve, treatment is withitraconazole200 mg orally is given 3 times a day for 3 days, then 2 times a day for 6 to 12 weeks. Fluconazoleis less effective, and other azoles are not well-studied but have been used successfully. Severe pneumonia requires more aggressive therapy withamphotericin B. For chronic cavitary histoplasmosis,itraconazole200 mg orally is given 3 times a day for 3 days, then 2 times a day for 12 to 24 months. Other azoles oramphotericin Bis used if patients are seriously ill or do not respond to or tolerateitraconazole. For severe disseminated histoplasmosis, liposomalamphotericin B3 mg/kg IV once a day (preferred) oramphotericin B0.5 to 1.0 mg/kg IV once a day for 2 weeks or until the patient is clinically stable is the treatment of choice. Patients can then be switched toitraconazole200 mg orally 3 times a day for 3 days, then 2 times a day continued for 12 months after they become afebrile and require no ventilatory or blood pressure support. In patients with AIDS,itraconazoleis given indefinitely to prevent relapse or until CD4 cell counts are > 150/mcL. 1.Wheat LJ, Freifeld AG, Kleiman MB, et al: Clinical practice guidelines for the management of patients with histoplasmosis: 2007 Update by the Infectious Diseases Society of America.Clin Infect Dis45(7):807-825, 2007. doi: 10.1086/521259 