Histoplasmosis (cont.)

For asymptomatic people or people with acute localized infection who are otherwise healthy, antifungal treatment is usually not recommended as these people have or will resolve the infection in about three weeks. If symptoms persist a month or more, itraconazole (Sporanox), ketoconazole (Nizoral) or amphotericin B (Fungizone, Amphocin) may be effective. If CNS involvement occurs, or if the person is compromised by other diseases or is immunocompromised and has severe histoplasmosis (progressive disseminated histoplasmosis), either itraconazole or amphotericin B is recommended. The lengths of time, dosing amounts, and dosing routes are usually individualized for the patient; consultations with both infectious disease and pulmonary specialists are recommended. Other new azole compound drugs may be effective in some difficult or unresponsive cases; the consultants could help select the appropriate new drug treatment.

Surgery has been used to treat some complications seen in some cases of histoplasmosis. Examples of surgical procedures include pericardiocentesis or a pericardial window procedure (both designed to remove fluid that compresses the heart) in the few patients that develop pericarditis; resection of cavitary lung lesions; excision of lymph nodes that compress pulmonary, vascular, or other structures; and replacement of damaged heart valves or other structures.

The majority (about 90%) of people that are infected with H. capsulatum recover completely with no complications. A few cases may show small areas of lung scarring on chest X-rays. With progressive severity of the disease (chronic to disseminated), the complications become more numerous and disabling. Pleural effusions and pericarditis can develop in about 5% of acute symptomatic patients. Another 5% may develop rheumatologic problems like arthritis, erythema nodosum, or erythema multiforme. About 90% of patients with chronic pulmonary histoplasmosis develop cavitary lung lesions, and some may develop pulmonary fibrosis and dyspnea (shortness of breath), and some may get adrenal gland infections which may be rarely associated with Cushing's syndrome (elevated cortisol levels, causing upper body obesity and a rounded face). Others may develop ocular histoplasmosis syndrome in which H. capsulatum spreads from the lungs to the retinal blood vessels (choroid) which become inflamed (uveitis) and then develop fragile abnormal blood vessels. This area can form scar tissue and thus replace the retina's macular tissue, which results in partial blindness. Patients with acute progressive disseminated histoplasmosis may develop CNS problems that result in encephalopathy or seizures; adrenal insufficiency; or cardiac problems like valve failure, angina, and poor cardiac output. Acute progressive disseminated histoplasmosis, if not treated quickly and appropriately, can lead to death in a few weeks. Even with lifelong antifungal treatment, about 10%-20% of cases will relapse.

Source: MedicineNet.com
http://www.medicinenet.com/histoplasmosis/article.htm