title: Recognition, diagnosis, and treatment of histoplasmosis complicating tumor necrosis factor blocker therapy.
abstract: Life-threatening histoplasmosis is one of the most common opportunistic infections in patients receiving tumor necrosis factor (TNF) blockers. Delays in considering the diagnosis may lead to increased morbidity and mortality. Most affected patients present with pneumonitis, usually accompanied by additional signs of progressive dissemination, or with signs of progressive dissemination alone. The diagnosis often can be promptly established using antigen detection or direct examination of bronchoalveolar lavage specimens. If histoplasmosis is diagnosed promptly, antifungal therapy is highly effective. After a favorable clinical response, the safety of both discontinuation of antifungal therapy and the resumption of TNF blocker remains undetermined. The management of the immune reconstitution inflammatory syndrome that may follow discontinuation of TNF blockers also requires investigation. Prescribers should become aware of the recognition, diagnosis, and treatment of histoplasmosis and educate recipients about decreasing their risk of exposure and both recognizing and reporting signs of early infection.
authors: Pulmonary-Critical Care and Infectious Diseases, Roudebush Veterans Affairs Medical Center, Indianapolis, Indiana 46202, USA. chage@iupui.edu
authors: Chadi A
authors: CA
authors: Hage
authors: Suzanne
authors: S
authors: Bowyer
authors: Stacey E
authors: SE
authors: Tarvin
authors: Debra
authors: D
authors: Helper
authors: Martin B
authors: MB
authors: Kleiman
authors: L Joseph
authors: LJ
authors: Wheat
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000911:Antibodies, Monoclonal / Q000008:administration & dosage*; D000935:Antifungal Agents / Q000627:therapeutic use; D005260:Female; D006658:Histoplasma / Q000302:isolation & purification / Q000472:pathogenicity; D006660:Histoplasmosis / Q000175:diagnosis* / Q000188:drug therapy* / Q000209:etiology / Q000517:prevention & control; D006801:Humans; D054019:Immune Reconstitution Inflammatory Syndrome / Q000150:complications; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*
chemical_list: D000911:Antibodies, Monoclonal; D000935:Antifungal Agents; D014409:Tumor Necrosis Factor-alpha