Diseases histoplasmosis

The following are fungal diseases — histoplasmosis, coccidioidomycosis, blastomycosis, paracoccidioidomycosis, cryptococcosis, sporotrichosis, candidiasis, aspergillosis, and mucormycosis. 

Altered GI flora Bartonellosis Decreased gastric acidity Decreased gastric motility Diabetes mellitus GI surgery Hemolytic diseases Histoplasmosis Inflammatory bowel disease Lymphoproliferative diseases Malaria... 

Suggested Alternatives for Differential Diagnosis Influenza, infectious mononucleosis, hepatitis, leptospirosis, infective endocarditis, malaria, tuberculosis, typhoid fever, cryptococcosis, histoplasmosis, ankylosing spondylitis and undifferentiated spondyloarthropathy, collagen vascular disease, chronic fatigue syndrome, malignancy, and osteomyelitis. 

Suggested Alternatives for Differential Diagnosis Bartonellosis, brucellosis, other causes of encephalitis, coxsackieviruses, cryptococcosis, cysticercosis, cytomegalovirus, histoplasmosis, legionellosis, leptospirosis, listeria, lyme disease, malaria, rabies, tuberculosis, mumps, stroke, metabolic encephalopathy, Reye syndrome, Bartonella infection, Naegleria infection, Ebstein-Barr virus, prion disease, toxic ingestions, and AIDS. 

Lenhart, Steven W., Millie P. Schafer, Mitchell Singal, and Rana A. Hajjeh. Histoplasmosis Protecting Workers at Risk. Rev. ed. Centers for Disease Control and Prevention, December 2004. 

Acute (infantile) disseminated histoplasmosis is seen in infants and young children and (rarely) in adults with Hodgkin s disease or other lympho-... 

Acute pulmonary histoplasmosis Asymptomatic or mild disease... 

Disseminated histoplasmosis Acute (Infantile) Subacute Progressive histoplasmosis (immunocompetent patients and immunosuppressed patients without AIDS) 0.02-0.05 Disseminated histoplasmosis Untreated mortality 83% to 93% relapse 5% to 23% in non-AIDS patients therapy is recommended tor all patients Nonimmunosuppressedpatients Ketoconazole 400 mj day orally x 6-12 months or amphotericin B 35 mg/kg IV Immunosuppressed patients (non-AIDS) or endocarditis or CNS disease Amphotericin B >35 mg/kg x 3 months followed by fluconazole or itraconazole 200 mg orally twice daily x 12 months Life-threatening disease Amphotericin B 0.7-1 mg/kg/day IV for a total dosage of 35 mj kg over 2-4 months once the patient is afebrile, able to take oral medications, and no longer requires blood pressure or ventilatory support therapy can be changed to itraconazole 200 mg orally twice daily for 6-18 months Non-life-threatening disease Itraconazole 200-400 mg orally daily for 6-18 months fluconazole therapy 400-800 mg daily should be reserved for patients intolerant to itraconazole, and the development of resistance can lead to relapses... 

Data from Deepe CS. Histoplasma capsulatum. In Mandell CL, Bennett JE, Dolin % eds. Principles and Practice of Infectious Diseases, 6th ed. Philadelphia, PA Churchill Livingstone, 2005 3012-3026 Wheat J, Sarosi C, McKinsey D, et al. Practice guidelines for the management of patients with histoplasmosis. Oin Infect Dis 2000 30 688-695 Wheat U, Kauffman CA. Histoplasmosis. Infect Dis Oin North Am 2003 17(1) 1-19. 

Most adults with disseminated histoplasmosis demonstrate a mild, chronic form of the disease. Untreated patients are often ill for 10 to 20 years, with long asymptomatic periods interrupted by relapses characterized by weight loss, weakness, and fatigue. 

Patients with mild, self-limited disease, chronic disseminated disease, or chronic pulmonary histoplasmosis who have no underlying immunosuppression can usually be treated with either oral ketoconazole or IV amphotericin B. 

Histoplasmosis (capsules and injection) Treatment of histoplasmosis, including chronic cavitary pulmonary disease and disseminated, nonmeningeal histoplasmosis in nonimmunocompromised or immunocompromised patients. 

Blastomycosis/histoplasmosis- 200 mg once daily. If there is no obvious improvement or there is evidence of progressive fungal disease, increase the dose in 100 mg increments to a maximum of 400 mg/day. Give doses above 200 mg/day in 2 divided doses. 

Primary esophageal histoplasmosis must be considered in patients who have a history of gastroesophageal reflux disease and are immunosuppressed by long-term glucocorticoids (SEDA-22,450 333). Oropharyngeal candidiasis is a well-described adverse effect of inhaled glucocorticoids. However, few cases of esophageal candidiasis have been reported (SEDA-22,179). 

As a percentage of AIDS patients presenting with histoplasmosis as the initial manifestation of their disease,... 

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