Histoplasmosis

(CID 2007;45:807)

• Epidemiology: endemic to central & SE U.S., but sporadic cases throughout U.S.
• Clinical manifestations:
  • Acute:
    • PNA ± hilar LAN, often subacute, but high inoculum can cause acute severe PNA
  • Chronic lung disease:
    • cough + B sx ± cavitary lesions (Ddx TB, blasto)
  • Disseminated (seen in immunosupp.):
    • fever,
    • fatigue,
    • wt loss,
    • mucocutaneous lesions,
    • ΔMS, arthritis, pericarditis,
    • interstitial infiltrates HSN, LAN, cytopenias
• Treatment:
  • mild to mod: itraconazole
  • disseminated/severe: ampho → itraconazole