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Disseminated histoplasmosis in infants
C M Odio1, M Navarrete, J M Carrillo
1Division of Infectious Diseases, National Children's Hospital, School of Medicine, Universidad Autónoma de Centro América, San Jose, Costa Rica.
The Pediatric Infectious Disease Journal
|December 23, 1999
Summary
Disseminated histoplasmosis in infants can be fatal but is treatable. Prompt diagnosis and treatment with amphotericin B followed by an oral azole for 3 months are effective, leading to recovery in most cases.
Area of Science:
- Pediatric Infectious Diseases
- Mycology
- Immunology
Background:
- Disseminated histoplasmosis typically affects immunocompromised individuals in endemic areas.
- Infants, even if immunocompetent, are at risk following significant exposure, with high fatality rates (40-50%).
Purpose of the Study:
- To evaluate the treatment outcomes and clinical course of disseminated histoplasmosis in infants.
- To identify key clinical presentations and associated immunological changes in affected infants.
Main Methods:
- A cohort of 40 infants diagnosed with disseminated histoplasmosis between 1983 and 1996.
- Treatment involved amphotericin B followed by 3 months of daily ketoconazole.
- Immunologic workups and clinical follow-up for at least 1 year were conducted.
Main Results:
- Fever, hepatosplenomegaly, and hematologic abnormalities were common presenting signs.
- Transient T cell deficiency and hyperglobulinemia were observed, resolving with treatment.
- An 88% cure rate was achieved, with 4 deaths and 1 relapse.
Conclusions:
- Disseminated histoplasmosis in infants from endemic regions requires consideration in cases of fever, hepatosplenomegaly, and hematologic abnormalities.
- Transient immunological deficits are characteristic and resolve with therapy.
- Combination therapy with amphotericin B and an oral azole is highly effective.
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