Overview of histoplasmosis.
Histoplasmosis is an endemic infection in most of the United States and can be found worldwide. The spectrum of this illness ranges from asymptomatic infection to severe disseminated disease. Life-threatening illness is usually associated with an immunocompromised state; however, 20 percent of severe illnesses result from a heavy inoculum in healthy persons. Culture remains the gold standard for diagnosis but requires a lengthy incubation period. Fungal staining produces quicker results than culture but is less sensitive. Testing for antigen and antibodies is rapid and sensitive when used for particular disease presentations. An advantage of antigen detection is its usefulness in monitoring disease therapy. Antifungal therapy is indicated in chronic or disseminated disease and severe, acute infection. Amphotericin B is the agent of choice in severe cases; however, patients must be monitored for nephrotoxicity and hypokalemia. Itraconazole is effective in moderate disease and is well tolerated, even with long-term use. Hepatotoxicity, the most severe adverse effect of itraconazole, is uncommon and usually transient.
Kurowski
Rene
R
Department of Family and Community Medicine, University of Louisville School of Medicine, Louisville, Kentucky 40202, USA. r.kurowski@louisville.edu
Ostapchuk
Michael
M
D000666:Amphotericin B / Q000009:adverse effects / Q000627:therapeutic use*; D000935:Antifungal Agents / Q000009:adverse effects / Q000627:therapeutic use*; D003937:Diagnosis, Differential; D015725:Fluconazole / Q000009:adverse effects / Q000627:therapeutic use; D006660:Histoplasmosis / Q000175:diagnosis* / Q000188:drug therapy*; D006801:Humans; D017964:Itraconazole / Q000009:adverse effects / Q000627:therapeutic use
D000935:Antifungal Agents; D017964:Itraconazole; D000666:Amphotericin B; D015725:Fluconazole