Histoplasma capsulatum infection

Cardiovascular system Acute congestive heart failure and fatal asystole have been attributed to itraconazole [16 ]. A 22-year-old-man with asymptomatic HTV infection treated with zidovudine, lamivudine and lopinavir/ritonavir was treated with itraconazole (200 mg three hmes daily for 2 days followed by 200 mg twice daily) after initial improvement from Histoplasma capsulatum infection requiring ICU treatment. 

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. 

Amphotericin B is used to treat systemic disseminated fungal infections caused by Candida spp., Cryptococcus neoformans, and the invasive dimorphic fungi Aspergillus spp., Histoplasma capsulatum, Coccidioides immi-tis, Blastomyces dermatitidis, and Sporothrix schenckii). Intravenous amphotericin B remains the treatment of choice for serious invasive fungal infections unresponsive to other agents. 

Pneumocystis carini pneumonia (PCP), the most common of the opportunistic infections, occurs in more than 80% of AIDS patients (13). Toxoplasmosis, a protozoan infection of the central nervous system, is activated in AIDS patients when the CD4+ count drops and severe impairment of cell-mediated immunity occurs. Typically, patients have a mass lesion(s) in the brain. These mass lesions usually respond well to therapy and can disappear completely. Fungal infections, such as Cyptococcalmeningitis, are extremely common in AIDS patients, and Histoplasma capsulatum appears when cell-mediated immunity has been destroyed by the HIV virus, leading to widespread infection of the lungs, liver, spleen, lymph nodes, and bone marrow. AIDS patients are particularly susceptible to bacteremia caused by nontyphoidal strains of Salmonella. Bacteremia may be cleared by using antibiotic therapy. 

For systemic treatment of fungal infections in dogs and cats, ketoconazole and fluconazole are available as tablets and oral suspensions, itraconazole as capsules, while miconazole and fluconazole are available as parenteral solutions. Even though ketoconazole is often effective, itraconazole may be the preferred azole for the treatment of systemic disease caused by dimorphic fungi (Blastomyces dermatitidis, Histoplasma capsulatum, Sporothrix schenckii). The activity of fluconazole against dimorphic fungi is limited to coccidioidal disease (Coccidioides immitis), but this azole penetrates the blood-brain barrier. 

Histoplasmosis is caused by Histoplasma capsulatum and is endemic in parts of the central United States along the Ohio and Mississippi River valleys. Although most patients experience asymptomatic infection, some may experience chronic, disseminated disease. 

A l t - to 20-day test system was reported for evaluating the in vivo antifungal activity of compounds against experimental infections of ocardia asteroides, Histoplasma capsulatum, and Paracoccidioide s brasITTensis.Efficacy was based on extension of the mean survival time of untreated as compared with treated mice the 50 effective dose (ED50) was determined for sulfonamides, amphotericin B, and saramycetin. 

Fluconazole is fungistatic at therapeutic concentrations and has good activity against Candida albicans infections. However, some non-albican Candida species (e.g. C. glabrata, C. parapsilosis, C. krusei and C. tropicalis] are less sensitive to fluconazole. Fluconazole is active against Trichophyton spp. Cryptococcus neoformans, Histoplasma capsulatum, Microsporum spp. and Epidermophyton spp. Fluconazole, however, has no useful activity against moulds such as Aspergillus spp. 

Zhou P, Sieve MC, Bennett J, Kwon-Chung KJ, Tewari RP, GazzineUi RT, et al. IL-12 prevents mortality in mice infected with Histoplasma capsulatum through... 

Penicillium marneffei can cause a disseminated infection in immunocompromised patients.Morphologically the organisms must be differentiated from H. capsulatum, C. neoformans, and C. albicans. The monoclonal antibody EBA-1 against the galactomannan of Aspergillus species cross-reacts with and detects P. marneffei in tissue sections. ° ° Immunohisto-chemistry has also been used to detect Blastomyces, Coccidioides, and Histoplasma. However, the antibodies have significant cross-reactivity with several other fungi. 

The polyenic antibiotic dermostatin which possesses in vitro activity against dermatophytes and Candida has been re-examined with a view towards its Jja vitro and vivo activity against Cryptococcus, Blastomyces and Histoplasma in a variety of test systems. Dermostatin was less active in vivo than amphotericin B against . albicans and H. capsulatum while the activities of the 2 antibiotics were comparable against C. neoformans and Blastomyces dermatitldis infections in mice. ... 

---