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Management of Histoplasmosis by Infectious Disease Physicians
Patrick B Mazi1, Sandra R Arnold2, John W Baddley3
1Division of Infectious Diseases, Washington University in St Louis, St Louis, Missouri, USA.
Background:
The Infectious Diseases Society of America (IDSA) guidelines for the management of histoplasmosis were last revised 15 years ago. Since those guidelines were compiled, new antifungal treatment options have been developed. Furthermore, the ongoing development of immunomodulatory therapies has increased the population at increased risk to develop histoplasmosis.
Methods:
An electronic survey about the management practices of histoplasmosis was distributed to the adult infectious disease (ID) physician members of the IDSA's Emerging Infections Network.
Results:
The survey response rate was 37% (551/1477). Only 46% (253/551) of respondents reported seeing patients with histoplasmosis. Regions considered endemic had 82% (158/193) of physicians report seeing patients with histoplasmosis compared to 27% (95/358) of physicians in regions not classically considered endemic (P < 0.001). Most ID physicians follow IDSA treatment guidelines recommending itraconazole for acute pulmonary (189/253 [75%]), mild-moderate disseminated (189/253 [75%]), and as step-down therapy for severe disseminated histoplasmosis with (232/253 [92%]) and without (145/253 [57%]) central nervous system involvement. There were no consensus recommendations observed for survey questions regarding immunocompromised patients.
Conclusions:
Though there are increased reports of histoplasmosis diagnoses outside regions classically considered endemic, a majority of ID physicians reported not seeing patients with histoplasmosis. Most respondents reported adherence to IDSA guidelines recommending itraconazole in each clinical situation. New histoplasmosis guidelines need to reflect the growing need for updated general guidance, particularly for immunocompromised populations.
Insights
Most infectious disease physicians follow current guidelines for histoplasmosis management, but updated recommendations are needed, especially for immunocompromised patients. New antifungal options and rising risk populations necessitate guideline revisions.
Area of Science:
- Infectious Diseases
- Mycology
- Clinical Medicine
Background:
- The Infectious Diseases Society of America (IDSA) last updated histoplasmosis management guidelines 15 years ago.
- New antifungal treatments and increased use of immunomodulatory therapies have emerged since the last guidelines.
- These changes have expanded the population at risk for developing histoplasmosis.
Purpose of the Study:
- To assess current histoplasmosis management practices among infectious disease (ID) physicians.
- To identify adherence to existing IDSA guidelines.
- To determine the need for updated histoplasmosis management guidelines, particularly for at-risk populations.
Main Methods:
- An electronic survey was distributed to adult ID physician members of the IDSA's Emerging Infections Network.
- The survey focused on the management practices of histoplasmosis.
- Response rate was 37% (551/1477).
Main Results:
- Only 46% of respondents reported managing histoplasmosis patients.
- Physicians in endemic regions were more likely to see histoplasmosis cases (82% vs. 27%).
- Most physicians adhere to IDSA guidelines, recommending itraconazole for various histoplasmosis presentations, but consensus was lacking for immunocompromised patients.
Conclusions:
- Despite increased diagnoses outside endemic areas, many ID physicians rarely encounter histoplasmosis.
- Current adherence to IDSA guidelines for itraconazole use is high.
- Updated guidelines are crucial, with a specific focus on the growing population of immunocompromised patients at risk for histoplasmosis.
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