Abstract
Histoplasmosis is the most common endemic mycosis in the North America, Central America,
and many countries of South America and also occurs in China, India, Southeast Asia,
Africa, Australia, and Europe. Clinical syndromes are not specific and histoplasmosis
often is overlooked in the evaluation of patients with community-acquired pneumonia,
chronic cavitary pneumonia resembling tuberculosis or anaerobic infection, granulomatous
inflammatory diseases such as sarcoidosis or Crohn disease, and malignancy. The diagnosis
depends on understanding the geographic distribution, common clinical presentations,
and tests used for diagnosis of histoplasmosis. While histoplasmosis resolves without
treatment in most patients, treatment is indicated in all immunocompromised patients
and those with progressive disseminated disease or chronic pulmonary disease. Treatment
is appropriate in most patients with acute pulmonary disease but rarely in those with
other pulmonary or mediastinal manifestations. The preferred agents include liposomal
amphotericin B for more severe cases and itraconazole for milder cases and “step-down”
therapy following response to amphotericin B.
Keywords
histoplasmosis - pneumonia - disseminated - epidemiology - diagnosis - antigen - antibody
- treatment
