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Recognition, diagnosis, and treatment of histoplasmosis complicating tumor necrosis factor blocker therapy

Chadi A Hage1, Suzanne Bowyer, Stacey E Tarvin

  • 1Pulmonary-Critical Care and Infectious Diseases, Roudebush Veterans Affairs Medical Center, Indianapolis, Indiana 46202, USA. chage@iupui.edu

Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America
|December 3, 2009
PubMed

Insights

Life-threatening histoplasmosis is a common opportunistic infection in patients on tumor necrosis factor (TNF) blockers. Prompt diagnosis via antigen detection or lavage examination and early antifungal treatment are crucial for better outcomes.

Area of Science:

  • Infectious Diseases
  • Immunology
  • Pulmonology

Background:

  • Opportunistic infections, particularly histoplasmosis, pose significant risks for patients undergoing tumor necrosis factor (TNF) blocker therapy.
  • Delayed diagnosis of histoplasmosis in this population is associated with increased morbidity and mortality.
  • Patients often present with pneumonitis or disseminated disease.

Purpose of the Study:

  • To highlight the importance of early recognition, diagnosis, and management of histoplasmosis in TNF blocker recipients.
  • To emphasize prompt diagnostic methods and effective antifungal therapy.
  • To identify areas requiring further research, including antifungal therapy cessation and TNF blocker resumption.

Main Methods:

  • Review of clinical presentations of histoplasmosis in TNF blocker users.
  • Discussion of diagnostic approaches, including antigen detection and bronchoalveolar lavage (BAL) examination.
  • Analysis of treatment efficacy and management challenges.

Main Results:

  • Histoplasmosis is a frequent and serious opportunistic infection in patients on TNF blockers.
  • Antigen detection and BAL examination allow for prompt diagnosis.
  • Antifungal therapy is highly effective when initiated early.

Conclusions:

  • Early diagnosis and treatment of histoplasmosis are critical for improving outcomes in TNF blocker recipients.
  • Further research is needed to determine the safety of discontinuing antifungal therapy and resuming TNF blockers.
  • Management of immune reconstitution inflammatory syndrome (IRIS) post-TNF blocker discontinuation requires investigation.

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