Pulmonary Histoplasmosis
Quick Facts on Histoplasma capsulatum:
• Dimorphic fungi, in yeast phase within the body
• Most common endemic fungal disease
• Most common in North America: Central and Midwest US, Ohio and Mississippi river valleys
• Lives in soil, especially contaminated with bird or bat droppings
Making the Diagnosis of Histoplasmosis:
• Histology / cytology, Sputum / BAL cx, Serum and Urine, Antigen testing, Serology, PCR
Treatment:
• Depends on severity and chronicity of disease
• Resistant to echinocandins (e.g. micafungin)!!
• Mild to moderate disease:
- Treat with azole
- Itraconazole first line
- Duration depends on acute or chronic disease
• Severe disease
- Liposomal amphotericin
- Followed by extended azole therapy
- Add corticosteroids for respiratory failure (guidelines / data vary!)
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