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Disseminated histoplasmosis in patients infected with human immunodeficiency virus
1Department of Medicine, University of Arizona College of Medicine, Phoenix.
Abstract:
Progressive disseminated histoplasmosis (PDH) is a common opportunistic infection complicating the course of infection with human immunodeficiency virus (HIV). PDH has been noted in areas nonendemic for histoplasmosis and occurs more frequently in areas heavily endemic for the fungus. PDH is frequently the AIDS-defining illness and presents as a febrile and wasting disease. The respiratory component may be overshadowed by the severity of the systemic illness. Chest roentgenograms show diffuse reticulonodular infiltrates. Frequently, the initial chest roentgenogram may show no abnormalities. Timely diagnosis requires a high index of diagnostic suspicion. Blood cultures, with use of the lysis-centrifugation system, are highly useful, as is the examination of the bone marrow, the peripheral blood smear, and the respiratory secretions. An experimental serological test that detects histoplasma polysaccharide antigen appears to be the simplest diagnostic test. Amphotericin B is the drug of choice for initial therapy, followed by further administration of amphotericin B for suppression. Early results with itraconazole are encouraging for long-term suppression.
Insights
Progressive disseminated histoplasmosis (PDH) is a significant opportunistic infection in HIV patients. Early diagnosis and treatment with Amphotericin B, followed by suppressive therapy, are crucial for managing this severe fungal disease.
Area of Science:
- Infectious Diseases
- Mycology
- Immunocompromised Hosts
Background:
- Progressive disseminated histoplasmosis (PDH) is a common opportunistic infection in human immunodeficiency virus (HIV) patients.
- PDH occurs in both endemic and nonendemic areas, often presenting as an AIDS-defining illness with systemic symptoms and potential respiratory involvement.
Purpose of the Study:
- To highlight the diagnostic challenges and therapeutic strategies for progressive disseminated histoplasmosis in HIV-infected individuals.
Main Methods:
- Review of clinical presentation, diagnostic modalities, and treatment outcomes for PDH in HIV.
- Emphasis on diagnostic suspicion, blood cultures (lysis-centrifugation), bone marrow examination, respiratory secretions analysis.
- Mention of an experimental histoplasma polysaccharide antigen serological test.
Main Results:
- Chest roentgenograms may show diffuse infiltrates or be normal initially.
- Timely diagnosis relies on a high index of suspicion and appropriate laboratory tests.
- Amphotericin B is the primary treatment, with itraconazole showing promise for long-term suppression.
Conclusions:
- PDH requires prompt diagnosis and aggressive management in HIV patients.
- Diagnostic tools include cultures, smears, and antigen detection.
- Amphotericin B followed by suppressive therapy is the recommended treatment approach.