Histoplasmosis (cont.)
How is histoplasmosis treated?
For asymptomatic people or people with acute localized infection who are
otherwise healthy, antifungal treatment is usually not recommended as these
people have or will resolve the infection in about three weeks. If symptoms
persist a month or more, itraconazole (Sporanox), ketoconazole (Nizoral) or
amphotericin B (Fungizone, Amphocin) may be effective. If CNS involvement occurs, or if the person is
compromised by other diseases or is immunocompromised and has severe
histoplasmosis (progressive disseminated histoplasmosis), either itraconazole or
amphotericin B is recommended. The lengths of time, dosing amounts, and dosing
routes are usually individualized for the patient; consultations with both
infectious disease and pulmonary specialists are recommended. Other new azole
compound drugs may be effective in some difficult or unresponsive cases; the
consultants could help select the appropriate new drug treatment.
Surgery has been used to treat some complications seen in some cases of
histoplasmosis. Examples of surgical procedures include pericardiocentesis or a
pericardial window procedure (both designed to remove fluid that compresses the
heart) in the few patients that develop pericarditis; resection of cavitary lung
lesions; excision of lymph nodes that compress pulmonary, vascular, or other
structures; and replacement of damaged heart valves or other structures.
What are the complications seen with histoplasmosis?
The majority (about 90%) of people that are infected with H. capsulatum recover
completely with no complications. A few cases may show small areas of lung
scarring on chest X-rays. With progressive severity of the disease (chronic to
disseminated), the complications become more numerous and disabling. Pleural
effusions and pericarditis can develop in about 5% of acute symptomatic
patients. Another 5% may develop rheumatologic problems like arthritis, erythema
nodosum, or erythema multiforme. About 90% of patients with chronic pulmonary
histoplasmosis develop cavitary lung lesions, and some may develop pulmonary
fibrosis and dyspnea (shortness of breath), and some may get adrenal gland
infections which may be rarely associated with Cushing's syndrome (elevated
cortisol levels, causing upper body obesity and a rounded face). Others may
develop ocular histoplasmosis syndrome in which H. capsulatum spreads from the
lungs to the retinal blood vessels (choroid) which become inflamed (uveitis) and
then develop fragile abnormal blood vessels. This area can form scar tissue and
thus replace the retina's macular tissue, which results in partial blindness.
Patients with acute progressive disseminated histoplasmosis may develop CNS
problems that result in encephalopathy or seizures; adrenal insufficiency; or
cardiac problems like valve failure, angina, and poor cardiac output. Acute
progressive disseminated histoplasmosis, if not treated quickly and
appropriately, can lead to death in a few weeks. Even with lifelong antifungal
treatment, about 10%-20% of cases will relapse.
Next: How is histoplasmosis prevented? »
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