Management of histoplasmosis

Histoplasmosis is a systemic fungal infection that infects millions of people living in areas where the infection is endemic. However, most people with histoplasmosis have a self-limited illness that does not require treatment with an antifungal agent. Patients who do require treatment are those who are immunosuppressed, those who are exposed to a large fungal inoculum that overwhelms their immune system, and those who have symptomatic disseminated infection, chronic pulmonary infection, or focal organ involvement. The treatment of choice for severe histoplasmosis is amphotericin B, while itraconazole is given for mild to moderate histoplasmosis. Most patients who require initial treatment with amphotericin B respond quickly and can then be switched to itraconazole to finish the course of therapy.