Disseminated histoplasmosis in infants.
BACKGROUND
Disseminated histoplasmosis usually occurs in immunocompromised patients who reside in Histoplasma capsulatum-endemic regions. It has also been described in immunocompetent infants after exposure to a large inoculum of the pathogen resulting in case fatality rates of 40 to 50%.


METHODS
From 1983 through 1996 all infants with documented disseminated histoplasmosis were treated with amphotericin B followed by daily ketoconazole for 3 months. Immunologic workups were performed at the time of diagnosis and at 4 to 6 weeks of therapy. Surviving patients were followed for at least 1 year. Time to resolution of signs and symptoms was recorded, as were complications.


RESULTS
We managed 40 patients with disseminated histoplasmosis. The age in months at diagnosis was 15.3+/-10.2 (mean +/- SD), and 24 were male. All patients were from endemic regions and they presented with fever, spleen and/or liver enlargement and hematologic abnormalities. Diagnosis was made by histology and culture of bone marrow, spleen, lymph node, bronchoalveolar or liver samples. Twenty patients presented with T cell deficiency that resolved at 4 to 6 weeks of therapy in all of the retested patients, and 10 of 12 tested patients had hyperglobulinemia that resolved. Thirty-five (88%) patients were cured by treatment; 4 died and 1 relapsed.


CONCLUSIONS
Disseminated histoplasmosis should be considered in infants from endemic areas who present with fever, hepatosplenomegaly and hematologic abnormalities. These patients develop transient hyperglobulinemia and T cell deficiency that resolve with treatment. Treatment with amphotericin B followed by an oral azole for 3 months is effective in most patients.
Odio
C M
CM
Division of Infectious Diseases, National Children's Hospital, School of Medicine, Universidad Autónoma de Centro América, San Jose, Costa Rica.
Navarrete
M
M
Carrillo
J M
JM
Mora
L
L
Carranza
A
A
D000666:Amphotericin B / Q000627:therapeutic use; D000935:Antifungal Agents / Q000627:therapeutic use; D003364:Costa Rica / Q000453:epidemiology; D019353:Endemic Diseases; D005260:Female; D006660:Histoplasmosis / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology; D006801:Humans; D007223:Infant; D007654:Ketoconazole / Q000627:therapeutic use; D008297:Male; D016019:Survival Analysis
D000935:Antifungal Agents; D000666:Amphotericin B; D007654:Ketoconazole