title: Cerebral histoplasmosis in the azole era: report of four cases and review.
abstract: We report four cases of cerebral histoplasmosis and discuss features of six additional cases reported in the medical literature in the past 10 years, when azoles have been available for therapy. Most patients with this disease are immunocompromised or have a history that suggests heavy exposure to Histoplasma capsulatum. Fever and other clinical findings of systemic toxicity caused by disseminated histoplasmosis may be absent; 5 of 10 patients did not manifest these findings. Although the mainstay of treatment for central nervous system histoplasmosis remains amphotericin B, 9 of the 10 patients received itraconazole or fluconazole either as initial therapy or after a course of treatment with amphotericin B.
authors.affiliation: Division of Infectious Diseases, Department of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA. saccentemichael@uams.edu
authors.forename: Michael
authors.initials: M
authors.lastname: Saccente
authors.forename: Richard W
authors.initials: RW
authors.lastname: McDonnell
authors.forename: Larry M
authors.initials: LM
authors.lastname: Baddour
authors.forename: M Jane
authors.initials: MJ
authors.lastname: Mathis
authors.forename: Robert W
authors.initials: RW
authors.lastname: Bradsher
mesh_terms: D000328:Adult; D000368:Aged; D000666:Amphotericin B / Q000627:therapeutic use*; D000935:Antifungal Agents / Q000627:therapeutic use*; D017809:Fatal Outcome; D005260:Female; D006660:Histoplasmosis / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged
chemical_list: D000935:Antifungal Agents; D000666:Amphotericin B