Comparison of Treated and Untreated Severe Histoplasmosis

Furcolow, Michael L.

doi:10.1001/jama.1963.03700100049008

Cited by 78 publications

(36 citation statements)

References 10 publications

(2 reference statements)

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“…Nontuberculous mycobacterial infections, especially Mycobacterium avium complex and Mycobacterium kansasii; other endemic fungal infections, including blastomycosis, sporotrichosis, and coccidioidomycosis; and sarcoidosis are also possible differential diagnoses. The natural history of untreated chronic pulmonary histoplasmosis is one of progressive pulmonary insufficiency leading to death (39,47,96). The patients do not appear to die of overwhelming infection but rather of the consequences of the infection in lungs that are already damaged.…”

Section: Pulmonary Histoplasmosismentioning

confidence: 99%

“…Treatment options have increased considerably since then (Table 4). A series of clinical trials that established the effectiveness of amphotericin B was performed in the 1950s and 1960s by the National Communicable Disease Center (forerunner of the Centers for Disease Control and Prevention) Cooperative Mycoses Study Group and the Veterans Administration-Armed Forces Cooperative Study on Histoplasmosis (39,96,110,123). In the same time period, investigators at the National Institutes of Health and the Missouri State Sanitorium reported on their experiences with treatment of disseminated histoplasmosis with amphotericin B (104,119).…”

Section: Treatment Treatment Optionsmentioning

confidence: 99%

“…Mortality in those who had disseminated disease and who were not treated was 83%, compared with 23% in amphotericin B-treated patients (39). Similarly, Reddy et al reported that 100% of untreated patients died, compared with 7% for those who were deemed to have received an adequate amount of amphotericin B (104).…”

Section: Treatment Treatment Optionsmentioning

confidence: 99%

“…Those studies also established an effective total dose of amphotericin B to be used for these forms of histoplasmosis. For the next 30 years, patients generally received a total dosage of 25 to 35 mg/kg amphotericin B over several months, often with resultant serious toxicity (39,96,104). By the time that the first Mycoses Study Group/Infectious Diseases Society of America (IDSA) guidelines for the management of histoplasmosis were published in 2000, treatment with amphotericin B for the entire course of therapy was unusual.…”

Section: Treatment Treatment Optionsmentioning

confidence: 99%

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Histoplasmosis: a Clinical and Laboratory Update

2007

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SUMMARY Infection with Histoplasma capsulatum occurs commonly in areas in the Midwestern United States and Central America, but symptomatic disease requiring medical care is manifest in very few patients. The extent of disease depends on the number of conidia inhaled and the function of the host's cellular immune system. Pulmonary infection is the primary manifestation of histoplasmosis, varying from mild pneumonitis to severe acute respiratory distress syndrome. In those with emphysema, a chronic progressive form of histoplasmosis can ensue. Dissemination of H. capsulatum within macrophages is common and becomes symptomatic primarily in patients with defects in cellular immunity. The spectrum of disseminated infection includes acute, severe, life-threatening sepsis and chronic, slowly progressive infection. Diagnostic accuracy has improved greatly with the use of an assay for Histoplasma antigen in the urine; serology remains useful for certain forms of histoplasmosis, and culture is the ultimate confirming diagnostic test. Classically, histoplasmosis has been treated with long courses of amphotericin B. Today, amphotericin B is rarely used except for severe infection and then only for a few weeks, followed by azole therapy. Itraconazole is the azole of choice following initial amphotericin B treatment and for primary treatment of mild to moderate histoplasmosis.

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Section: Pulmonary Histoplasmosismentioning

confidence: 99%

Section: Treatment Treatment Optionsmentioning

confidence: 99%

Section: Treatment Treatment Optionsmentioning

confidence: 99%

Section: Treatment Treatment Optionsmentioning

confidence: 99%

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Histoplasmosis: a Clinical and Laboratory Update

2007

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“…(14) The recommended dosage of IV amphotericin B for patients who require hospitalisation is 0.7-1.0 mg/kg/day, with the total dose to be administered over 2-4 months being 35mg/kg.…”

Section: Histoplasmosis Primarily Involves the Lungs And Isolatedmentioning

confidence: 99%

Laryngeal histoplasmosis: an occupational hazard

Hassan

Yunus³

2013

smedj

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Isolated laryngeal histoplasmosis is a very rare entity. It has variable clinical presentations that might mimic both benign and malignant lesions, and is usually associated with pulmonary and other disseminated forms of histoplasmosis. Herein, we report a case of primary laryngeal histoplasmosis without the involvement of other systems in a 70-year-old Chinese man, who previously worked as a miner. He presented with a history of hoarseness for two months, with no other associated symptoms. Direct laryngoscopy revealed irregularity of the posterior onethird of both vocal folds. Histopathological examination revealed the presence of Histoplasma capsulatum on periodic acid-Schiff and Grocott's methenamine silver staining. The lesion resolved after one month of oral itraconazole treatment. However, the patient had to complete six months of antifungal treatment to prevent recurrence.

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Histoplasma endocarditis. Case report and review of the literature

Hartley¹

1967

Archives of Internal Medicine

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Comparison of Treated and Untreated Severe Histoplasmosis

Cited by 78 publications

References 10 publications

Histoplasmosis: a Clinical and Laboratory Update

Histoplasmosis: a Clinical and Laboratory Update

Laryngeal histoplasmosis: an occupational hazard

Histoplasma endocarditis. Case report and review of the literature

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