Materiały źródłowe

• #1 Histoplasmosis: An Overview Treatment of Histoplasmosis | IntechOpen

  https://www.intechopen.com/online-first/86238

  In 2000, the Infectious Diseases Society of America (IDSA) published a clinical practice guideline on managing patients with histoplasmosis and, in 2020, the first global guideline for diagnosing and managing disseminated histoplasmosis in people living with HIV (PLHIV). The optimal treatment depends on the patients clinical syndrome: acute mild/moderate, acute moderately/severe, chronic cavitary pulmonary, mediastinal lesions, or broncholithiasis. Asymptomatic patients or patients with mild cases of histoplasmosis with symptoms lasting less than four weeks do not usually require antifungal treatment. When necessary, itraconazole is the treatment of choice in mild to moderate acute forms of the disease, often for six weeks. For severe histoplasmosis, amphotericin B is recommended as initial therapy, followed by itraconazole as consolidation therapy. Long-term treatment for at least 12 months is recommended in patients with chronic cavitary histoplasmosis.

• #2 Pulmonary Histoplasmosis: A Clinical Update

  https://www.mdpi.com/2309-608X/9/2/236

  Histoplasmosis is a dimorphic fungus that grows as a mold in the environment and as a yeast in human tissues. […] While most immunocompetent patients with mild acute or subacute pulmonary histoplasmosis should receive therapy, all immunocompromised patients and those with chronic pulmonary disease or progressive disseminated disease should also receive therapy. […] Liposomal amphotericin B is the agent of choice for severe or disseminated disease, and itraconazole is recommended in milder cases or as “step-down” therapy after initial improvement with amphotericin B. […] In mild-to-moderate cases, treatment is usually unnecessary, though Itraconazole (200 mg 3 times daily for 3 days and then 200 mg once or twice daily for 6–12 weeks) should be given to patients with symptoms lasting over 1 month.

• #3 Histoplasmosis – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/histoplasmosis/diagnosis-treatment/drc-20373499

  Treatment usually isn’t necessary if you have a mild case of histoplasmosis. But if your symptoms are severe or if you have the chronic or disseminated form of the disease, you’ll likely need treatment with one or more antifungal drugs. If you have a severe form of the disease, you might need to continue to take medications for three months to a year. […] Will I need treatment and, if so, which do you recommend? […] What side effects can I expect from treatment?

• #4 Histoplasmosis Treatment & Management: Approach Considerations, Medical Care, Surgical Care

  https://emedicine.medscape.com/article/299054-treatment

  Most infections in individuals who are immunocompetent are self-limiting and do not require therapy. In cases of prolonged infection, cases of systemic infection, or those involving individuals who are immunocompromised, medical treatment is recommended. […] In patients with prolonged symptoms (4 wk) or those with overwhelming pulmonary involvement, initiate medical therapy with itraconazole for 6-12 weeks. Response to therapy should be monitored via chest imaging. Patients should be monitored for several years after treatment for possible relapse. […] Patients with severe infection should be treated with amphotericin B for 1-2 weeks; once the patient is stable, amphotericin B may be changed to itraconazole and should be continued for 1 year. […] This often is fatal if not treated; the mortality rate may be as high as 50% without treatment, compared with a mortality rate of 28% with treatment.

• #5 Histoplasmosis Treatment & Management: Approach Considerations, Medical Care, Surgical Care

  https://emedicine.medscape.com/article/299054-treatment

  Most infections in individuals who are immunocompetent are self-limiting and do not require therapy. In cases of prolonged infection, cases of systemic infection, or those involving individuals who are immunocompromised, medical treatment is recommended. […] In patients with prolonged symptoms (4 wk) or those with overwhelming pulmonary involvement, initiate medical therapy with itraconazole for 6-12 weeks. Response to therapy should be monitored via chest imaging. Patients should be monitored for several years after treatment for possible relapse. […] Patients with severe infection should be treated with amphotericin B for 1-2 weeks; once the patient is stable, amphotericin B may be changed to itraconazole and should be continued for 1 year. […] This often is fatal if not treated; the mortality rate may be as high as 50% without treatment, compared with a mortality rate of 28% with treatment.

• #6 IDSA 2025 Guideline Update on the Treatment of Asymptomatic Histoplasma Pulmonary Nodules (Histoplasmomas) and Mild or Moderate Acute Pulmonary Histoplasmosis in Adults, Children, and Pregnant People

  https://www.idsociety.org/practice-guideline/histoplasmosis-2025/

  In immunocompetent adults and children presenting with mild acute pulmonary histoplasmosis, the panel suggests against routinely providing antifungal treatment (conditional* recommendation, very low certainty of evidence). […] Treatment may be considered in immunocompetent patients with mild acute pulmonary histoplasmosis and prolonged duration of illness, progression of pulmonary infiltrates, or enlarging hilar or mediastinal adenopathy. […] In immunocompetent adults and children presenting with moderate acute pulmonary histoplasmosis, the panel suggests either antifungal treatment or no antifungal treatment, considering the severity and duration of signs/symptoms, as well as potential harms of antifungal treatment (conditional* recommendation, very low certainty of evidence). […] When treatment is indicated, itraconazole is preferred.

• #7 Histoplasmosis – acute (primary) pulmonary – UF Health

  https://ufhealth.org/conditions-and-treatments/histoplasmosis-acute-primary-pulmonary

  Most cases of histoplasmosis clear up without specific treatment. People are advised to rest and take medicine to control fever. […] Your health care provider may prescribe medicine if you are sick for more than 4 weeks, have a weakened immune system, or are having breathing problems.

• #8 IDSA 2025 Guideline Update on the Treatment of Asymptomatic Histoplasma Pulmonary Nodules (Histoplasmomas) and Mild or Moderate Acute Pulmonary Histoplasmosis in Adults, Children, and Pregnant People

  https://www.idsociety.org/practice-guideline/histoplasmosis-2025/

  In immunocompetent adults and children presenting with mild acute pulmonary histoplasmosis, the panel suggests against routinely providing antifungal treatment (conditional* recommendation, very low certainty of evidence). […] Treatment may be considered in immunocompetent patients with mild acute pulmonary histoplasmosis and prolonged duration of illness, progression of pulmonary infiltrates, or enlarging hilar or mediastinal adenopathy. […] In immunocompetent adults and children presenting with moderate acute pulmonary histoplasmosis, the panel suggests either antifungal treatment or no antifungal treatment, considering the severity and duration of signs/symptoms, as well as potential harms of antifungal treatment (conditional* recommendation, very low certainty of evidence). […] When treatment is indicated, itraconazole is preferred.

• #9 IDSA 2025 Guideline Update on the Treatment of Asymptomatic Histoplasma Pulmonary Nodules (Histoplasmomas) and Mild or Moderate Acute Pulmonary Histoplasmosis in Adults, Children, and Pregnant People

  https://www.idsociety.org/practice-guideline/histoplasmosis-2025/

  In immunocompetent adults and children presenting with mild acute pulmonary histoplasmosis, the panel suggests against routinely providing antifungal treatment (conditional* recommendation, very low certainty of evidence). […] Treatment may be considered in immunocompetent patients with mild acute pulmonary histoplasmosis and prolonged duration of illness, progression of pulmonary infiltrates, or enlarging hilar or mediastinal adenopathy. […] In immunocompetent adults and children presenting with moderate acute pulmonary histoplasmosis, the panel suggests either antifungal treatment or no antifungal treatment, considering the severity and duration of signs/symptoms, as well as potential harms of antifungal treatment (conditional* recommendation, very low certainty of evidence). […] When treatment is indicated, itraconazole is preferred.

• #10 Pulmonary Histoplasmosis: A Clinical Update

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9964986/

  Histoplasmosis is a dimorphic fungus that grows as a mold in the environment and as a yeast in human tissues. […] While most immunocompetent patients with mild acute or subacute pulmonary histoplasmosis should receive therapy, all immunocompromised patients and those with chronic pulmonary disease or progressive disseminated disease should also receive therapy. […] Liposomal amphotericin B is the agent of choice for severe or disseminated disease, and itraconazole is recommended in milder cases or as step-down therapy after initial improvement with amphotericin B. […] In mild-to-moderate cases, treatment is usually unnecessary, though Itraconazole (200 mg 3 times daily for 3 days and then 200 mg once or twice daily for 6-12 weeks) should be given to patients with symptoms lasting over 1 month.

• #11 Histoplasmosis Treatment & Management: Approach Considerations, Medical Care, Surgical Care

  https://emedicine.medscape.com/article/299054-treatment

  Most infections in individuals who are immunocompetent are self-limiting and do not require therapy. In cases of prolonged infection, cases of systemic infection, or those involving individuals who are immunocompromised, medical treatment is recommended. […] In patients with prolonged symptoms (4 wk) or those with overwhelming pulmonary involvement, initiate medical therapy with itraconazole for 6-12 weeks. Response to therapy should be monitored via chest imaging. Patients should be monitored for several years after treatment for possible relapse. […] Patients with severe infection should be treated with amphotericin B for 1-2 weeks; once the patient is stable, amphotericin B may be changed to itraconazole and should be continued for 1 year. […] This often is fatal if not treated; the mortality rate may be as high as 50% without treatment, compared with a mortality rate of 28% with treatment.

• #12 Pulmonary Histoplasmosis: A Clinical Update

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9964986/

  Histoplasmosis is a dimorphic fungus that grows as a mold in the environment and as a yeast in human tissues. […] While most immunocompetent patients with mild acute or subacute pulmonary histoplasmosis should receive therapy, all immunocompromised patients and those with chronic pulmonary disease or progressive disseminated disease should also receive therapy. […] Liposomal amphotericin B is the agent of choice for severe or disseminated disease, and itraconazole is recommended in milder cases or as step-down therapy after initial improvement with amphotericin B. […] In mild-to-moderate cases, treatment is usually unnecessary, though Itraconazole (200 mg 3 times daily for 3 days and then 200 mg once or twice daily for 6-12 weeks) should be given to patients with symptoms lasting over 1 month.

• #13 Histoplasmosis: An Overview Treatment of Histoplasmosis | IntechOpen

  https://www.intechopen.com/online-first/86238

  In 2000, the Infectious Diseases Society of America (IDSA) published a clinical practice guideline on managing patients with histoplasmosis and, in 2020, the first global guideline for diagnosing and managing disseminated histoplasmosis in people living with HIV (PLHIV). The optimal treatment depends on the patients clinical syndrome: acute mild/moderate, acute moderately/severe, chronic cavitary pulmonary, mediastinal lesions, or broncholithiasis. Asymptomatic patients or patients with mild cases of histoplasmosis with symptoms lasting less than four weeks do not usually require antifungal treatment. When necessary, itraconazole is the treatment of choice in mild to moderate acute forms of the disease, often for six weeks. For severe histoplasmosis, amphotericin B is recommended as initial therapy, followed by itraconazole as consolidation therapy. Long-term treatment for at least 12 months is recommended in patients with chronic cavitary histoplasmosis.

• #14 Histoplasmosis Treatment & Management: Approach Considerations, Medical Care, Surgical Care

  https://emedicine.medscape.com/article/299054-treatment

  Most infections in individuals who are immunocompetent are self-limiting and do not require therapy. In cases of prolonged infection, cases of systemic infection, or those involving individuals who are immunocompromised, medical treatment is recommended. […] In patients with prolonged symptoms (4 wk) or those with overwhelming pulmonary involvement, initiate medical therapy with itraconazole for 6-12 weeks. Response to therapy should be monitored via chest imaging. Patients should be monitored for several years after treatment for possible relapse. […] Patients with severe infection should be treated with amphotericin B for 1-2 weeks; once the patient is stable, amphotericin B may be changed to itraconazole and should be continued for 1 year. […] This often is fatal if not treated; the mortality rate may be as high as 50% without treatment, compared with a mortality rate of 28% with treatment.

• #15 Pulmonary Histoplasmosis: A Clinical Update

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9964986/

  In patients with moderately severe to severe acute pulmonary histoplasmosis, Lipid Amphotericin B (3.0-5.0 mg/kg daily intravenously for 12 weeks) followed by itraconazole (200 mg 3 times daily for 3 days and then 200 mg twice daily, for a total of 12 weeks) is recommended. […] All patients with chronic cavitary pulmonary histoplasmosis should receive therapy, as therapy is associated with decreased mortality, and regression of the pulmonary infiltrates in two-thirds of cases. […] The current guidelines recommend itraconazole (200 mg 3 times daily for 3 days and then once or twice daily for at least 1 year), but some experts recommend 18-24 months in view of the risk for relapse, which occurs in 10% to 20% of the cases. […] Patients with severe disease should receive intravenous Liposomal Amphotericin B until they are stabilized (usually 1 to 2 weeks), followed by itraconazole monotherapy.

• #16 Histoplasmosis Treatment & Management: Approach Considerations, Medical Care, Surgical Care

  https://emedicine.medscape.com/article/299054-treatment

  Patients with cavitary lesions must be treated, in most patients itraconazole is sufficient and should be given for one year. Relapse may occur in up to 15% of patients. […] In patients with mild-to-moderate disease, itraconazole should be administered for at least 1 year, clinical findings have resolved, and Histoplasma antigen, if initially positive, has reverted to negative or is below 2 ng/mL. […] Initiate medical therapy for all patients with progressive disseminated histoplasmosis and meningitis. […] Antifungal therapy does not play a role. Bronchoscopic or surgical removal may be required. […] Treatment for mediastinal granuloma is not recommended in asymptomatic patients; for symptomatic patients, itraconazole may be used for 6-12 weeks, although clinical trials to support this are lacking.

• #17 Pulmonary Histoplasmosis: A Clinical Update

  https://www.mdpi.com/2309-608X/9/2/236

  In patients with moderately severe to severe acute pulmonary histoplasmosis, Lipid Amphotericin B (3.0–5.0 mg/kg daily intravenously for 1–2 weeks) followed by itraconazole (200 mg 3 times daily for 3 days and then 200 mg twice daily, for a total of 12 weeks) is recommended. […] All patients with chronic cavitary pulmonary histoplasmosis should receive therapy, as therapy is associated with decreased mortality, and regression of the pulmonary infiltrates in two-thirds of cases. […] The current guidelines recommend itraconazole (200 mg 3 times daily for 3 days and then once or twice daily for at least 1 year), but some experts recommend 18–24 months in view of the risk for relapse, which occurs in 10% to 20% of the cases. […] Patients with severe disease should receive intravenous Liposomal Amphotericin B until they are stabilized (usually 1 to 2 weeks), followed by itraconazole monotherapy. […] In patients with mild-to-moderate disease, therapy may be with itraconazole monotherapy and should be continued for at least 1 year as well and until all clinical findings have resolved and Histoplasma antigen, if initially positive, has reverted to negative or is below 2 ng/mL.

• #18 Histoplasmosis Treatment & Management: Approach Considerations, Medical Care, Surgical Care

  https://emedicine.medscape.com/article/299054-treatment

  Patients with cavitary lesions must be treated, in most patients itraconazole is sufficient and should be given for one year. Relapse may occur in up to 15% of patients. […] In patients with mild-to-moderate disease, itraconazole should be administered for at least 1 year, clinical findings have resolved, and Histoplasma antigen, if initially positive, has reverted to negative or is below 2 ng/mL. […] Initiate medical therapy for all patients with progressive disseminated histoplasmosis and meningitis. […] Antifungal therapy does not play a role. Bronchoscopic or surgical removal may be required. […] Treatment for mediastinal granuloma is not recommended in asymptomatic patients; for symptomatic patients, itraconazole may be used for 6-12 weeks, although clinical trials to support this are lacking.

• #19 Pulmonary Histoplasmosis: A Clinical Update

  https://www.mdpi.com/2309-608X/9/2/236

  In patients with moderately severe to severe acute pulmonary histoplasmosis, Lipid Amphotericin B (3.0–5.0 mg/kg daily intravenously for 1–2 weeks) followed by itraconazole (200 mg 3 times daily for 3 days and then 200 mg twice daily, for a total of 12 weeks) is recommended. […] All patients with chronic cavitary pulmonary histoplasmosis should receive therapy, as therapy is associated with decreased mortality, and regression of the pulmonary infiltrates in two-thirds of cases. […] The current guidelines recommend itraconazole (200 mg 3 times daily for 3 days and then once or twice daily for at least 1 year), but some experts recommend 18–24 months in view of the risk for relapse, which occurs in 10% to 20% of the cases. […] Patients with severe disease should receive intravenous Liposomal Amphotericin B until they are stabilized (usually 1 to 2 weeks), followed by itraconazole monotherapy. […] In patients with mild-to-moderate disease, therapy may be with itraconazole monotherapy and should be continued for at least 1 year as well and until all clinical findings have resolved and Histoplasma antigen, if initially positive, has reverted to negative or is below 2 ng/mL.

• #20 Histoplasmosis: An Overview Treatment of Histoplasmosis | IntechOpen

  https://www.intechopen.com/online-first/86238

  All patients with chronic pulmonary histoplasmosis should be treated due to most patients` progressive loss of pulmonary function. Oral itraconazole is given as a loading dose (200 mg orally three times daily for the first three days) followed by a maintenance dose (200 mg orally once or twice daily) for at least one year until 24 months because of the substantial risk of relapse (after treatment stopped up to 10 to 20% of patients with chronic pulmonary histoplasmosis could relapse within two years of stopping therapy). […] In patients with severe dyspnea, hypoxemia, and/or development of acute respiratory distress syndrome, the addition of methylprednisolone (0.5 to 1.0 mg/kg/d intravenously) for one to two weeks has been used in some patients with clinical benefit. […] The IDSA recommended treatment is: a one-to-two-week induction therapy, with liposomal amphotericin B, 3 mg/kg/day for severe disease or itraconazole, a 3-day loading dose of 3x200mg, and then long-term maintenance itraconazole therapy, 200 mg daily, for a minimum period of 12 months.

• #21 Veterinary Diagnostics: Treatment of Histoplasmosis in Dogs and Cats

  https://miravistavets.com/fungal-diseases/histoplasma/review-treatment-of-histoplasmosis/

  In cats receiving capsules, 5 mg/kg twice daily or 10 mg/kg once daily is appropriate, while a lower starting dose with the solution (7.5 mg/kg/day) should be considered. […] At least 6 months of itraconazole is recommended in humans and dogs and cats. […] Many cases require a year or more of treatment, especially those with bone/joint, ocular, or central nervous system involvement or widespread disseminated disease. […] Treat for at least 6 months and until the (1) clinical findings have resolved, (2) radiographic findings have resolved or improved significantly and are thought to represent residual scarring, and (3) the antigen is negative.

• #22 Histoplasmosis Treatment & Management: Approach Considerations, Medical Care, Surgical Care

  https://emedicine.medscape.com/article/299054-treatment

  Most infections in individuals who are immunocompetent are self-limiting and do not require therapy. In cases of prolonged infection, cases of systemic infection, or those involving individuals who are immunocompromised, medical treatment is recommended. […] In patients with prolonged symptoms (4 wk) or those with overwhelming pulmonary involvement, initiate medical therapy with itraconazole for 6-12 weeks. Response to therapy should be monitored via chest imaging. Patients should be monitored for several years after treatment for possible relapse. […] Patients with severe infection should be treated with amphotericin B for 1-2 weeks; once the patient is stable, amphotericin B may be changed to itraconazole and should be continued for 1 year. […] This often is fatal if not treated; the mortality rate may be as high as 50% without treatment, compared with a mortality rate of 28% with treatment.

• #23 Histoplasmosis: Adult and Adolescent OIs | NIH

  https://clinicalinfo.hiv.gov/en/guidelines/hiv-clinical-guidelines-adult-and-adolescent-opportunistic-infections/histoplasmosis

  If used, primary prophylaxis should be discontinued in people on ART once CD4 counts are 150 cells/mm3 for 6 months and HIV-1 viral loads are undetectable. […] Preferred Therapy: Liposomal amphotericin B 3 mg/kg IV daily. […] Step-down therapy to oral itraconazole, 200 mg three times a day for 3 days followed by 200 mg two times a day, should be given for 12 months. […] In patients with mild-to-moderate disseminated histoplasmosis, oral itraconazole, 200 mg three times daily for 3 days followed by 200 mg twice daily for 12 months, is an appropriate initial therapy. […] In patients with confirmed meningitis, liposomal amphotericin B should be administered as initial therapy at a dose of 5 mg/kg IV daily for 4 to 6 weeks depending on the resolution of symptoms and improvement of abnormal CSF findings.

• #24 Histoplasmosis — EACS Guidelines

  https://eacs.sanfordguide.com/eacs-part1/eacs-section4/ois/histoplasmosis

  Fluconazole should not be used for treatment of histoplasmosis. Little clinical evidence is available for the use of voriconazole, posaconazole and isavuconazole. Measurement of plasma concentration of itraconazole is advised to guide optimal treatment, and itraconazole oral suspension should be preferred due to better bioavailability. Serum itraconazole trough concentration should be at least 1 mcg/mL if measured by high-performance liquid chromatography (HPLC). If levels cannot be measured, consider alternative drugs. Severe disseminated histoplasmosis Induction therapy: liposomal amphotericin B 3 mg/kg/day iv For 2 weeks or until clinical improvement Consolidation therapy: itraconazole 200 mg tid po for 3 days, then 200 mg bid po For at least 12 months Moderate disseminated histoplasmosis itraconazole 200 mg tid po for 3 days, then 200mg bid po For at least 12 months Histoplasma meningitis Induction therapy: liposomal amphotericin B 5 mg/kg qd iv For 4-6 weeks Consolidation therapy: itraconazole 200 mg bid-tid po For at least 12 months and until resolution of abnormal CSF findings […] Consider long-term suppressive therapy in severe cases of meningitis and in cases of relapse despite adequate treatment.

• #25 Histoplasmosis: Adult and Adolescent OIs | NIH

  https://clinicalinfo.hiv.gov/en/guidelines/hiv-clinical-guidelines-adult-and-adolescent-opportunistic-infections/histoplasmosis

  If used, primary prophylaxis should be discontinued in people on ART once CD4 counts are 150 cells/mm3 for 6 months and HIV-1 viral loads are undetectable. […] Preferred Therapy: Liposomal amphotericin B 3 mg/kg IV daily. […] Step-down therapy to oral itraconazole, 200 mg three times a day for 3 days followed by 200 mg two times a day, should be given for 12 months. […] In patients with mild-to-moderate disseminated histoplasmosis, oral itraconazole, 200 mg three times daily for 3 days followed by 200 mg twice daily for 12 months, is an appropriate initial therapy. […] In patients with confirmed meningitis, liposomal amphotericin B should be administered as initial therapy at a dose of 5 mg/kg IV daily for 4 to 6 weeks depending on the resolution of symptoms and improvement of abnormal CSF findings.

• #26 Histoplasmosis — EACS Guidelines

  https://eacs.sanfordguide.com/eacs-part1/eacs-section4/ois/histoplasmosis

  Fluconazole should not be used for treatment of histoplasmosis. Little clinical evidence is available for the use of voriconazole, posaconazole and isavuconazole. Measurement of plasma concentration of itraconazole is advised to guide optimal treatment, and itraconazole oral suspension should be preferred due to better bioavailability. Serum itraconazole trough concentration should be at least 1 mcg/mL if measured by high-performance liquid chromatography (HPLC). If levels cannot be measured, consider alternative drugs. Severe disseminated histoplasmosis Induction therapy: liposomal amphotericin B 3 mg/kg/day iv For 2 weeks or until clinical improvement Consolidation therapy: itraconazole 200 mg tid po for 3 days, then 200 mg bid po For at least 12 months Moderate disseminated histoplasmosis itraconazole 200 mg tid po for 3 days, then 200mg bid po For at least 12 months Histoplasma meningitis Induction therapy: liposomal amphotericin B 5 mg/kg qd iv For 4-6 weeks Consolidation therapy: itraconazole 200 mg bid-tid po For at least 12 months and until resolution of abnormal CSF findings […] Consider long-term suppressive therapy in severe cases of meningitis and in cases of relapse despite adequate treatment.

• #27 How to handle progressive disseminated histoplasmosis

  https://www.patientcareonline.com/view/how-handle-progressive-disseminated-histoplasmosis

  Progressive disseminated histoplasmosis (PDH) is most likely to occur in patients with AIDS. […] Liposomal amphotericin B or amphotericin B lipid complex is recommended for the initial treatment of moderately severe to severe PDH. […] Itraconazole may be appropriate for those with mild to moderate PDH and is recommended for maintenance therapy. […] Two phases of treatment are required for AIDS patients with PDH. An induction phase, usually lasting 12 weeks, reverses symptoms and end-organ damage. This is followed by a maintenance phase to prevent recurrence. […] In a study by Johnson and associates, liposomal amphotericin B had an 88% success rate compared with 64% for amphotericin B deoxycholate in the induction phase of treatment of moderate to severe histoplasmosis in AIDS patients.

• #28 Histoplasmosis: Adult and Adolescent OIs | NIH

  https://clinicalinfo.hiv.gov/en/guidelines/hiv-clinical-guidelines-adult-and-adolescent-opportunistic-infections/histoplasmosis

  If used, primary prophylaxis should be discontinued in people on ART once CD4 counts are 150 cells/mm3 for 6 months and HIV-1 viral loads are undetectable. […] Preferred Therapy: Liposomal amphotericin B 3 mg/kg IV daily. […] Step-down therapy to oral itraconazole, 200 mg three times a day for 3 days followed by 200 mg two times a day, should be given for 12 months. […] In patients with mild-to-moderate disseminated histoplasmosis, oral itraconazole, 200 mg three times daily for 3 days followed by 200 mg twice daily for 12 months, is an appropriate initial therapy. […] In patients with confirmed meningitis, liposomal amphotericin B should be administered as initial therapy at a dose of 5 mg/kg IV daily for 4 to 6 weeks depending on the resolution of symptoms and improvement of abnormal CSF findings.

• #29 Pulmonary Histoplasmosis: A Clinical Update

  https://www.mdpi.com/2309-608X/9/2/236

  In patients with moderately severe to severe acute pulmonary histoplasmosis, Lipid Amphotericin B (3.0–5.0 mg/kg daily intravenously for 1–2 weeks) followed by itraconazole (200 mg 3 times daily for 3 days and then 200 mg twice daily, for a total of 12 weeks) is recommended. […] All patients with chronic cavitary pulmonary histoplasmosis should receive therapy, as therapy is associated with decreased mortality, and regression of the pulmonary infiltrates in two-thirds of cases. […] The current guidelines recommend itraconazole (200 mg 3 times daily for 3 days and then once or twice daily for at least 1 year), but some experts recommend 18–24 months in view of the risk for relapse, which occurs in 10% to 20% of the cases. […] Patients with severe disease should receive intravenous Liposomal Amphotericin B until they are stabilized (usually 1 to 2 weeks), followed by itraconazole monotherapy. […] In patients with mild-to-moderate disease, therapy may be with itraconazole monotherapy and should be continued for at least 1 year as well and until all clinical findings have resolved and Histoplasma antigen, if initially positive, has reverted to negative or is below 2 ng/mL.

• #30 Histoplasmosis: Adult and Adolescent OIs | NIH

  https://clinicalinfo.hiv.gov/en/guidelines/hiv-clinical-guidelines-adult-and-adolescent-opportunistic-infections/histoplasmosis

  If used, primary prophylaxis should be discontinued in people on ART once CD4 counts are 150 cells/mm3 for 6 months and HIV-1 viral loads are undetectable. […] Preferred Therapy: Liposomal amphotericin B 3 mg/kg IV daily. […] Step-down therapy to oral itraconazole, 200 mg three times a day for 3 days followed by 200 mg two times a day, should be given for 12 months. […] In patients with mild-to-moderate disseminated histoplasmosis, oral itraconazole, 200 mg three times daily for 3 days followed by 200 mg twice daily for 12 months, is an appropriate initial therapy. […] In patients with confirmed meningitis, liposomal amphotericin B should be administered as initial therapy at a dose of 5 mg/kg IV daily for 4 to 6 weeks depending on the resolution of symptoms and improvement of abnormal CSF findings.

• #31 Update on Therapy for Histoplasmosis

  https://www.patientcareonline.com/view/update-therapy-histoplasmosis

  CNS histoplasmosis can present as meningitis as well as parenchymal lesions. Response to therapy is often not as good as is seen in other forms of the disease, and the relapse rate tends to be higher. Liposomal AmB at a dosage of 5 mg/kg/d is recommended for CNS histoplasmosis because higher levels of drug in the brain are thought to be achieved with this formulation than with other formulations of AmB.16 A 4- to 6-week course of liposomal AmB is preferred, followed by itraconazole given 2 or 3 times daily for at least a year. Itraconazole levels and Histoplasma antigen levels should be monitored. Abnormal findings from cerebrospinal fluid analysis or on radiographic imaging or abnormal antigen levels should be resolved before discontinuation of therapy. […] Histoplasmosis is a disease with many manifestations. Multiple antifungal agents are available, but AmB and itraconazole are the mainstays of therapy.

• #32 Histoplasmosis: Pediatric OIs | NIH

  https://clinicalinfo.hiv.gov/en/guidelines/hiv-clinical-guidelines-pediatric-opportunistic-infections/histoplasmosis

  The preferred treatment for severe or moderately severe progressive disseminated histoplasmosis is initial (induction) therapy with amphotericin B for 2 weeks (and favorable clinical response), followed by consolidation therapy with itraconazole for at least 12 months (AI*). […] Itraconazole monotherapy for 12 months is recommended for HIV-infected children with mild to moderate progressive disseminated histoplasmosis (AII*). […] Liposomal amphotericin B for 4 to 6 weeks is the preferred initial treatment in the presence of focal brain lesions (BIII*). Thereafter, children should receive itraconazole consolidation therapy for at least 12 months and until cerebrospinal fluid abnormalities, including histoplasma antigen, have resolved (AII*). […] In the event of immune reconstitution inflammatory syndrome, antiretroviral therapy should be continued along with antifungal therapy (AIII).

• #33 Update on Therapy for Histoplasmosis

  https://www.patientcareonline.com/view/update-therapy-histoplasmosis

  Prolonged suppression (secondary prophylaxis) with once-daily itraconazole is recommended for patients who experience relapse or are in irreversible immunosuppression. Itraconazole can be discontinued in patients with HIV/AIDS after 1 year if blood cultures are negative for Histoplasma, serum and urine Histoplasma antigen levels are less than 2 ng/mL (4 U/mL), and the CD4+ cell count is greater than 150/L while they are receiving highly active antiretroviral therapy.15 […] Prophylaxis for disseminated histoplasmosis with once-daily itraconazole is recommended for HIV-infected patients with CD4+ cell counts of less than 150/L who are living in areas in which H capsulatum is highly endemic (more than 10 cases per 100 patient-years).1 […] Liposomal AmB is the drug of choice in patients with HIV/AIDS. Its use has been associated with higher response rates and lower mortality compared with use of AmB deoxycholate in this patient population.2 Although previous guidelines recommended treating with liposomal AmB for the entire course, the current recommendation is to switch to oral itraconazole after an initial 1 to 2 weeks of treatment.1

• #34 Update on Therapy for Histoplasmosis

  https://www.patientcareonline.com/view/update-therapy-histoplasmosis

  Prolonged suppression (secondary prophylaxis) with once-daily itraconazole is recommended for patients who experience relapse or are in irreversible immunosuppression. Itraconazole can be discontinued in patients with HIV/AIDS after 1 year if blood cultures are negative for Histoplasma, serum and urine Histoplasma antigen levels are less than 2 ng/mL (4 U/mL), and the CD4+ cell count is greater than 150/L while they are receiving highly active antiretroviral therapy.15 […] Prophylaxis for disseminated histoplasmosis with once-daily itraconazole is recommended for HIV-infected patients with CD4+ cell counts of less than 150/L who are living in areas in which H capsulatum is highly endemic (more than 10 cases per 100 patient-years).1 […] Liposomal AmB is the drug of choice in patients with HIV/AIDS. Its use has been associated with higher response rates and lower mortality compared with use of AmB deoxycholate in this patient population.2 Although previous guidelines recommended treating with liposomal AmB for the entire course, the current recommendation is to switch to oral itraconazole after an initial 1 to 2 weeks of treatment.1

• #35 Histoplasmosis: Adult and Adolescent OIs | NIH

  https://clinicalinfo.hiv.gov/en/guidelines/hiv-clinical-guidelines-adult-and-adolescent-opportunistic-infections/histoplasmosis

  Long-term suppressive therapy with oral itraconazole (200 mg daily) should be administered to people with severe disseminated infection or CNS infection for 12 months after completing induction therapy or after reinduction therapy to those whose disease relapsed despite initial receipt of an appropriate therapy. […] Fluconazole is less effective than itraconazole for the treatment of histoplasmosis but has been shown to be moderately effective at a dose of 800 mg daily. […] All triazole antifungals have the potential for complex, and possibly bidirectional, interactions with certain antiretroviral agents and other anti-infective agents.

• #36 Histoplasmosis: Pediatric OIs | NIH

  https://clinicalinfo.hiv.gov/en/guidelines/hiv-clinical-guidelines-pediatric-opportunistic-infections/histoplasmosis

  Longer-term suppressive therapy (secondary prophylaxis) with itraconazole may be required in HIV-infected children who are severely immunosuppressed (meaning CD4 percentage 15% at any age or CD4 count 150 cells/mm3 in children aged 6 years) and patients who experience relapse despite receipt of appropriate therapy (AIII).

• #37 Update on Therapy for Histoplasmosis

  https://www.patientcareonline.com/view/update-therapy-histoplasmosis

  Prolonged suppression (secondary prophylaxis) with once-daily itraconazole is recommended for patients who experience relapse or are in irreversible immunosuppression. Itraconazole can be discontinued in patients with HIV/AIDS after 1 year if blood cultures are negative for Histoplasma, serum and urine Histoplasma antigen levels are less than 2 ng/mL (4 U/mL), and the CD4+ cell count is greater than 150/L while they are receiving highly active antiretroviral therapy.15 […] Prophylaxis for disseminated histoplasmosis with once-daily itraconazole is recommended for HIV-infected patients with CD4+ cell counts of less than 150/L who are living in areas in which H capsulatum is highly endemic (more than 10 cases per 100 patient-years).1 […] Liposomal AmB is the drug of choice in patients with HIV/AIDS. Its use has been associated with higher response rates and lower mortality compared with use of AmB deoxycholate in this patient population.2 Although previous guidelines recommended treating with liposomal AmB for the entire course, the current recommendation is to switch to oral itraconazole after an initial 1 to 2 weeks of treatment.1

• #38 Histoplasmosis: Adult and Adolescent OIs | NIH

  https://clinicalinfo.hiv.gov/en/guidelines/hiv-clinical-guidelines-adult-and-adolescent-opportunistic-infections/histoplasmosis

  If used, primary prophylaxis should be discontinued in people on ART once CD4 counts are 150 cells/mm3 for 6 months and HIV-1 viral loads are undetectable. […] Preferred Therapy: Liposomal amphotericin B 3 mg/kg IV daily. […] Step-down therapy to oral itraconazole, 200 mg three times a day for 3 days followed by 200 mg two times a day, should be given for 12 months. […] In patients with mild-to-moderate disseminated histoplasmosis, oral itraconazole, 200 mg three times daily for 3 days followed by 200 mg twice daily for 12 months, is an appropriate initial therapy. […] In patients with confirmed meningitis, liposomal amphotericin B should be administered as initial therapy at a dose of 5 mg/kg IV daily for 4 to 6 weeks depending on the resolution of symptoms and improvement of abnormal CSF findings.

• #39 Histoplasmosis: Adult and Adolescent OIs | NIH

  https://clinicalinfo.hiv.gov/en/guidelines/hiv-clinical-guidelines-adult-and-adolescent-opportunistic-infections/histoplasmosis

  Histoplasmosis is a fungal infection caused by the dimorphic fungus Histoplasma capsulatum (H. capsulatum). […] Data from a prospective, randomized, controlled trial indicate that itraconazole can reduce the incidence of histoplasmosis, although not mortality, in people who have advanced HIV (CD4 counts 150 cells/mm3) and live in areas where histoplasmosis is highly endemic. […] The Panel on Guidelines for the Prevention and Treatment of Opportunistic Infections in Adults and Adolescents With HIV (the Panel) continues to recommend itraconazole at a dose of 200 mg daily as primary prophylaxis to people with CD4 counts 150 cells/mm3 who are at high risk because of occupational histoplasmosis exposure or who live in a community with a hyperendemic rate of histoplasmosis (10 cases/100 person-years).

• #40 Update on Therapy for Histoplasmosis

  https://www.patientcareonline.com/view/update-therapy-histoplasmosis

  Prolonged suppression (secondary prophylaxis) with once-daily itraconazole is recommended for patients who experience relapse or are in irreversible immunosuppression. Itraconazole can be discontinued in patients with HIV/AIDS after 1 year if blood cultures are negative for Histoplasma, serum and urine Histoplasma antigen levels are less than 2 ng/mL (4 U/mL), and the CD4+ cell count is greater than 150/L while they are receiving highly active antiretroviral therapy.15 […] Prophylaxis for disseminated histoplasmosis with once-daily itraconazole is recommended for HIV-infected patients with CD4+ cell counts of less than 150/L who are living in areas in which H capsulatum is highly endemic (more than 10 cases per 100 patient-years).1 […] Liposomal AmB is the drug of choice in patients with HIV/AIDS. Its use has been associated with higher response rates and lower mortality compared with use of AmB deoxycholate in this patient population.2 Although previous guidelines recommended treating with liposomal AmB for the entire course, the current recommendation is to switch to oral itraconazole after an initial 1 to 2 weeks of treatment.1

• #41 Histoplasmosis: Adult and Adolescent OIs | NIH

  https://clinicalinfo.hiv.gov/en/guidelines/hiv-clinical-guidelines-adult-and-adolescent-opportunistic-infections/histoplasmosis

  If used, primary prophylaxis should be discontinued in people on ART once CD4 counts are 150 cells/mm3 for 6 months and HIV-1 viral loads are undetectable. […] Preferred Therapy: Liposomal amphotericin B 3 mg/kg IV daily. […] Step-down therapy to oral itraconazole, 200 mg three times a day for 3 days followed by 200 mg two times a day, should be given for 12 months. […] In patients with mild-to-moderate disseminated histoplasmosis, oral itraconazole, 200 mg three times daily for 3 days followed by 200 mg twice daily for 12 months, is an appropriate initial therapy. […] In patients with confirmed meningitis, liposomal amphotericin B should be administered as initial therapy at a dose of 5 mg/kg IV daily for 4 to 6 weeks depending on the resolution of symptoms and improvement of abnormal CSF findings.

• #42 Histoplasmosis Medication: Antifungals, Nonsteroidal Anti-inflammatory Drugs, Corticosteroids

  https://emedicine.medscape.com/article/299054-medication

  The goals of pharmacotherapy are to reduce morbidity and to prevent complications. Amphotericin B is indicated for pregnant women with histoplasmosis who require treatment. […] The current Infectious Diseases Society of America guidelines recommend itraconazole for mild-to-moderate infection and amphotericin B for severe infection. Itraconazole levels should be monitored starting two weeks after the start of treatment. levels greater than 10 mcg/mL should raise concern about toxicity. In addition, hepatic enzymes should be monitored as hepatotoxicity can occur. The treatment success rate with itraconazole is 80-100%. […] Fluconazole is recommended as a second-line agent. Treatment success is approximately 63% with fluconazole; relapse rates may also be higher. Resistance to fluconazole may be seen in AIDS patients with histoplasmosis.

• #43 Update on Therapy for Histoplasmosis

  https://www.patientcareonline.com/view/update-therapy-histoplasmosis

  Serum itraconazole levels should be assessed after 2 weeks of therapy. Drug levels should also be assessed after dose adjustments and the addition of new medications that may interact with itraconazole as well as in the setting of treatment failure. Random concentrations should be at least 1.0 g/mL.1 Levels greater than 10 g/mL should raise concern about toxicity, and the dose should be lowered. […] Fluconazole is not preferred for treatment of histoplasmosis; it is less active in vitro and has been associated with higher relapse rates and the development of resistance.3,4 Its use as a second-line agent is indicated in cases in which itraconazole is not tolerated. […] Newer antifungal agents include posaconazole, voriconazole, and echinocandins. Posaconazole appears to be active against H capsulatum in vitro,5 and it shows promise in the setting of salvage therapy in experimental models.6 Voriconazole also has been used successfully in some case studies.7 Echinocandins have little activity in vitro and in murine models and should not be used for the treatment of histoplasmosis.8

• #44 Histoplasmosis Medication: Antifungals, Nonsteroidal Anti-inflammatory Drugs, Corticosteroids

  https://emedicine.medscape.com/article/299054-medication

  The goals of pharmacotherapy are to reduce morbidity and to prevent complications. Amphotericin B is indicated for pregnant women with histoplasmosis who require treatment. […] The current Infectious Diseases Society of America guidelines recommend itraconazole for mild-to-moderate infection and amphotericin B for severe infection. Itraconazole levels should be monitored starting two weeks after the start of treatment. levels greater than 10 mcg/mL should raise concern about toxicity. In addition, hepatic enzymes should be monitored as hepatotoxicity can occur. The treatment success rate with itraconazole is 80-100%. […] Fluconazole is recommended as a second-line agent. Treatment success is approximately 63% with fluconazole; relapse rates may also be higher. Resistance to fluconazole may be seen in AIDS patients with histoplasmosis.

• #45 Histoplasmosis Treatment & Management: Approach Considerations, Medical Care, Surgical Care

  https://emedicine.medscape.com/article/299054-treatment

  Most infections in individuals who are immunocompetent are self-limiting and do not require therapy. In cases of prolonged infection, cases of systemic infection, or those involving individuals who are immunocompromised, medical treatment is recommended. […] In patients with prolonged symptoms (4 wk) or those with overwhelming pulmonary involvement, initiate medical therapy with itraconazole for 6-12 weeks. Response to therapy should be monitored via chest imaging. Patients should be monitored for several years after treatment for possible relapse. […] Patients with severe infection should be treated with amphotericin B for 1-2 weeks; once the patient is stable, amphotericin B may be changed to itraconazole and should be continued for 1 year. […] This often is fatal if not treated; the mortality rate may be as high as 50% without treatment, compared with a mortality rate of 28% with treatment.

• #46 Update on Therapy for Histoplasmosis

  https://www.patientcareonline.com/view/update-therapy-histoplasmosis

  For acute, severe pulmonary disease, treatment should begin immediately. A lipid formulation of AmB is preferred and should be given for the initial 1 to 2 weeks of treatment, followed by itraconazole to complete a 3-month course of therapy. If patients have acute respiratory distress symptoms, methylprednisolone is indicated as well for the first 1 to 2 weeks of therapy.1 […] Treatment is indicated for chronic cavitary disease. It usually is effective, although relapse occurs in up to 15% of patients.10 Generally, itraconazole should be used for at least 1 year. Some experts recommend 18 to 24 months of treatment.1 Response to therapy can be monitored by chest imaging. Patients should be followed up for several years after treatment because of the risk of relapse. […] In patients who have mild to moderate illness, itraconazole can be used as first-line therapy. It should be continued for at least 1 year, with monitoring of drug levels during therapy. In addition, response should be assessed with serum and urine antigen monitoring. Antigen levels should be assessed at 2 weeks and 1 month before treatment and then every 3 months during therapy and for 6 months after treatment is discontinued.1

• #47 Histoplasmosis Medication: Antifungals, Nonsteroidal Anti-inflammatory Drugs, Corticosteroids

  https://emedicine.medscape.com/article/299054-medication

  The goals of pharmacotherapy are to reduce morbidity and to prevent complications. Amphotericin B is indicated for pregnant women with histoplasmosis who require treatment. […] The current Infectious Diseases Society of America guidelines recommend itraconazole for mild-to-moderate infection and amphotericin B for severe infection. Itraconazole levels should be monitored starting two weeks after the start of treatment. levels greater than 10 mcg/mL should raise concern about toxicity. In addition, hepatic enzymes should be monitored as hepatotoxicity can occur. The treatment success rate with itraconazole is 80-100%. […] Fluconazole is recommended as a second-line agent. Treatment success is approximately 63% with fluconazole; relapse rates may also be higher. Resistance to fluconazole may be seen in AIDS patients with histoplasmosis.

• #48 Histoplasmosis – Infectious Diseases – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/infectious-diseases/fungi/histoplasmosis

  Treatment of Histoplasmosis […] No treatment needed for acute, self-limited infection […] For mild to moderate infection, itraconazole […] For severe infection, amphotericin B […] Serum concentration of itraconazole and urine or blood levels of Histoplasma antigen should be monitored during therapy. […] Fluconazole and voriconazole may be less effective […] Posaconazole and isavuconazonium are active against H. capsulatum and may be effective in the treatment of patients with histoplasmosis. Further data and experience are required to determine which medication is the best in each clinical situation. […] Acute primary histoplasmosis requires no antifungal therapy unless there is no spontaneous improvement after 1 month. If infection does not resolve, treatment is with itraconazole 200 mg orally is given 3 times a day for 3 days, then 2 times a day for 6 to 12 weeks. […] Severe pneumonia requires more aggressive therapy with amphotericin B.

• #49 Update on Therapy for Histoplasmosis

  https://www.patientcareonline.com/view/update-therapy-histoplasmosis

  Serum itraconazole levels should be assessed after 2 weeks of therapy. Drug levels should also be assessed after dose adjustments and the addition of new medications that may interact with itraconazole as well as in the setting of treatment failure. Random concentrations should be at least 1.0 g/mL.1 Levels greater than 10 g/mL should raise concern about toxicity, and the dose should be lowered. […] Fluconazole is not preferred for treatment of histoplasmosis; it is less active in vitro and has been associated with higher relapse rates and the development of resistance.3,4 Its use as a second-line agent is indicated in cases in which itraconazole is not tolerated. […] Newer antifungal agents include posaconazole, voriconazole, and echinocandins. Posaconazole appears to be active against H capsulatum in vitro,5 and it shows promise in the setting of salvage therapy in experimental models.6 Voriconazole also has been used successfully in some case studies.7 Echinocandins have little activity in vitro and in murine models and should not be used for the treatment of histoplasmosis.8

• #50 Update on Therapy for Histoplasmosis

  https://www.patientcareonline.com/view/update-therapy-histoplasmosis

  Histoplasmosis is caused by the dimorphic fungus Histoplasma capsulatum, which is endemic to the Ohio and Mississippi river valleys. It is associated with a variety of manifestations, and its severity ranges from asymptomatic infection to severe disseminated illness. Treatment is often based on the severity and site of the disease. Updated guidelines for the treatment of histoplasmosis have been published by the Infectious Diseases Society of America.1 […] In the treatment of histoplasmosis, the first-line agents are amphotericin B (AmB) and itraconazole (Table A,B). AmB is commonly used for severe disease, at least during initial treatment. Lipid formulations are preferred. These include liposomal AmB and AmB lipid complex. The deoxycholate formulation can be used if the risk of nephrotoxicity is low. For CNS disease and disseminated disease in patients with HIV/AIDS, liposomal AmB is preferred.1,2 Treatment can be switched to oral itraconazole once clinical response is seen. This usually occurs within 1 to 2 weeks.

• #51 Histoplasmosis Medication: Antifungals, Nonsteroidal Anti-inflammatory Drugs, Corticosteroids

  https://emedicine.medscape.com/article/299054-medication

  Amphotericin B is the drug of choice for treating overwhelming acute pulmonary histoplasmosis, chronic pulmonary histoplasmosis, and all forms of progressive disseminated pulmonary histoplasmosis. If using amphotericin B for maintenance therapy for acute progressive disseminated histoplasmosis, continue weekly intravenous treatment in an outpatient setting. […] The current Infectious Disease Society of America (IDSA) and American Thoracic Society (ATS) guidelines recommend the addition of intravenous methylprednisolone for severe acute pulmonary histoplasmosis. […] Treatment is recommended for at least 1 year; immunosuppressed patients may need a longer duration of treatment. Patients with relapse of infection (10-15% of patients) after completion of therapy may require lifelong therapy. […] Use steroids to decrease the severe hypersensitivity inflammatory response to histoplasmal antigens. Carefully monitor patients with systemic infections or sepsis and those who are immunosuppressed. Assess for signs of superinfection and worsening sepsis.

• #52 Histoplasmosis: An Overview Treatment of Histoplasmosis | IntechOpen

  https://www.intechopen.com/online-first/86238

  All patients with chronic pulmonary histoplasmosis should be treated due to most patients` progressive loss of pulmonary function. Oral itraconazole is given as a loading dose (200 mg orally three times daily for the first three days) followed by a maintenance dose (200 mg orally once or twice daily) for at least one year until 24 months because of the substantial risk of relapse (after treatment stopped up to 10 to 20% of patients with chronic pulmonary histoplasmosis could relapse within two years of stopping therapy). […] In patients with severe dyspnea, hypoxemia, and/or development of acute respiratory distress syndrome, the addition of methylprednisolone (0.5 to 1.0 mg/kg/d intravenously) for one to two weeks has been used in some patients with clinical benefit. […] The IDSA recommended treatment is: a one-to-two-week induction therapy, with liposomal amphotericin B, 3 mg/kg/day for severe disease or itraconazole, a 3-day loading dose of 3x200mg, and then long-term maintenance itraconazole therapy, 200 mg daily, for a minimum period of 12 months.

• #53 Histoplasmosis Treatment & Management: Approach Considerations, Medical Care, Surgical Care

  https://emedicine.medscape.com/article/299054-treatment

  Antifungal therapy is not effective for fibrosing mediastinitis; corticosteroids and nonsteroidal anti-inflammatory drugs (NSAIDs) also are ineffective. Surgery is not recommended. […] Use surgical procedures for diagnostic purposes when other modalities are unrevealing. Intervention is also required when medical therapy is insufficient to alleviate the effects of progressive fibrosis, calcification, and scarring. […] In rare cases of overwhelming infection, extensive pulmonary involvement may cause severe hypoxemia and acute respiratory distress syndrome. In these instances, initiate antifungal therapy and arrange inpatient supportive respiratory care. […] Most thin-walled cavities resolve spontaneously. […] Chronic infection has a long protracted course over months to years, with long asymptomatic periods. Inpatient care is required when transformation to subacute or acute infection occurs.

• #54 Histoplasmosis Treatment & Management: Approach Considerations, Medical Care, Surgical Care

  https://emedicine.medscape.com/article/299054-treatment

  Patients with cavitary lesions must be treated, in most patients itraconazole is sufficient and should be given for one year. Relapse may occur in up to 15% of patients. […] In patients with mild-to-moderate disease, itraconazole should be administered for at least 1 year, clinical findings have resolved, and Histoplasma antigen, if initially positive, has reverted to negative or is below 2 ng/mL. […] Initiate medical therapy for all patients with progressive disseminated histoplasmosis and meningitis. […] Antifungal therapy does not play a role. Bronchoscopic or surgical removal may be required. […] Treatment for mediastinal granuloma is not recommended in asymptomatic patients; for symptomatic patients, itraconazole may be used for 6-12 weeks, although clinical trials to support this are lacking.

• #55 Clinical Overview of Histoplasmosis | Histoplasmosis | CDC

  https://www.cdc.gov/histoplasmosis/hcp/clinical-overview/index.html

  Mild to moderate cases of acute pulmonary histoplasmosis will often resolve without treatment. Treatment is indicated for moderate to severe acute pulmonary, chronic pulmonary, disseminated, and central nervous system (CNS) histoplasmosis. […] Antifungal agents proven effective are amphotericin B (including liposomal and lipid formulations) and itraconazole (for mild-to-moderate infections and step-down therapy). Therapeutic drug monitoring should be considered for certain antifungals like itraconazole when treating histoplasmosis. […] Treatment options include intravitreal anti-vascular endothelial growth factor (anti-VEGF) injections or photodynamic therapy (PDT). Scientists do not believe that people with POHS have active fungi in their eyes. As a result, unlike other fungal infections, antifungal medications are not typically recommended as treatment for POHS. […] However, disseminated histoplasmosis infections involving the eye requires antifungal treatment. These infections are distinct from POHS and have rarely been reported.

• #56 Presumed Ocular Histoplasmosis (POHS): Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/5635-histoplasmosis

  Not everyone needs treatment. If Histoplasma capsulatum is not affecting your vision, you may only need monitoring. […] Your care will likely not include antifungal medications. Even though a fungus causes ocular histoplasmosis, its not the same as having a fungal infection. […] Instead, your care may include therapies to stop choroidal neovascularization, such as: […] Antivascular endothelial growth factor (anti-VEGF) therapy: You receive injections of anti-VEGF in the affected eye. This substance blocks abnormal blood vessel development, which can relieve symptoms. It may take several injections before you notice results. […] Photodynamic therapy: You receive an injection of a light-sensitive drug (verteporfin) into your arm. It accumulates in the abnormal blood vessels in the eye. Low-power laser beams activate the drug to destroy the abnormal blood vessels.

• #57

  https://www.aao.org/eye-health/diseases/what-is-histoplasmosis

  A certain chemical can cause blood vessels that are not normal to grow under the retina. This chemical is called vascular endothelial growth factor, or VEGF. One method for treating histoplasmosis is to block VEGF. […] Several anti-VEGF drugs can block the trouble-causing VEGF. Blocking VEGF reduces the growth of blood vessels and slows their leakage. This helps to slow vision loss and in some cases improves vision. […] Your ophthalmologist injects the anti-VEGF drug into your eye in an outpatient procedure. Before the procedure, your ophthalmologist will clean your eye to prevent infection. They will numb your eye with anesthetic eye drops. You may receive multiple anti-VEGF injections over the course of many months. Repeat anti-VEGF treatments are often needed for continued benefit. […] Laser treatment for histoplasmosis is usually done as an outpatient procedure. You will have this treatment either in the doctors office or at the hospital.

• #58 Histoplasmosis: Symptoms & Treatment | West Boca Eye Center

  https://www.westbocaeyecenter.com/post/histoplasmosis-symptoms-treatment

  How Is Histoplasmosis Treated? […] Anti-VEGF treatment. A certain chemical can cause blood vessels that are not normal to grow under the retina. This chemical is called vascular endothelial growth factor, or VEGF. One method for treating histoplasmosis is to target VEGF. Several anti-VEGF drugs can block the trouble causing VEGF. Blocking VEGF reduces the growth of blood vessels and slows their leakage. This helps to slow vision loss and in some cases improves vision. Your ophthalmologist injects the anti-VEGF drug into your eye in an outpatient procedure. Before the procedure, your ophthalmologist will clean your eye to prevent infection. They will numb your eye with anesthetic eye drops. You may receive multiple anti-VEGF injections over the course of many months. Repeat anti VEGF treatments are often needed for continued benefit.

• #59

  https://www.aao.org/eye-health/diseases/what-is-histoplasmosis

  The laser beam in this procedure is a high-energy, focused beam of light. It produces a small burn when it hits the area of the retina where you need treatment. The burn destroys the blood vessels that are not normal. This prevents further leakage, bleeding and growth. […] After laser treatment, your vision may be more blurry than before treatment. But this will often stabilize within a few weeks. A scar forms where the laser burned your retina. The scar makes a permanent blind spot that might be noticeable in your field of vision. […] Laser treatment does not cure histoplasmosis. It reduces the chance of blood vessels spreading and causing more harm to your vision. If these blood vessels do return, you may need more laser surgery. […] Your ophthalmologist may treat you with steroid injections. These shots in the eye reduce swelling due to histoplasmosis. […] Histoplasmosis remains a threat to your vision for your lifetime. It is important to have regular checkups with your ophthalmologist to detect any problems as early as possible.

• #60 Histoplasmosis: Symptoms & Treatment | West Boca Eye Center

  https://www.westbocaeyecenter.com/post/histoplasmosis-symptoms-treatment

  Laser treatment for histoplasmosis is usually done as an outpatient procedure. You will have this treatment either in the doctor’s office or at the hospital. The laser beam in this procedure is a high energy, focused beam of light. It produces a small burn when it hits the area of the retina where you need treatment. The burn destroys the blood vessels that are not normal. This prevents further leakage, bleeding and growth. After laser treatment, your vision may be more blurry than before treatment. But this will often stabilize within a few weeks. A scar forms where the laser burned your retina. The scar makes a permanent blind spot that might be noticeable in your field of vision. Laser treatment does not cure histoplasmosis. It reduces the chance of blood vessels spreading and causing more harm to your vision. If these blood vessels do return, you may need more laser surgery.

• #61

  https://www.aao.org/eye-health/diseases/what-is-histoplasmosis

  The laser beam in this procedure is a high-energy, focused beam of light. It produces a small burn when it hits the area of the retina where you need treatment. The burn destroys the blood vessels that are not normal. This prevents further leakage, bleeding and growth. […] After laser treatment, your vision may be more blurry than before treatment. But this will often stabilize within a few weeks. A scar forms where the laser burned your retina. The scar makes a permanent blind spot that might be noticeable in your field of vision. […] Laser treatment does not cure histoplasmosis. It reduces the chance of blood vessels spreading and causing more harm to your vision. If these blood vessels do return, you may need more laser surgery. […] Your ophthalmologist may treat you with steroid injections. These shots in the eye reduce swelling due to histoplasmosis. […] Histoplasmosis remains a threat to your vision for your lifetime. It is important to have regular checkups with your ophthalmologist to detect any problems as early as possible.

• #62 Histoplasmosis: Symptoms & Treatment | West Boca Eye Center

  https://www.westbocaeyecenter.com/post/histoplasmosis-symptoms-treatment

  Your ophthalmologist may treat you with steroid injections. These shots in the eye reduce swelling due to histoplasmosis. Histoplasmosis remains a threat to your vision for your lifetime. It is important to have regular checkups with your ophthalmologist to detect any problems as early as possible. […] Treatment can include anti-VEGF drugs, laser treatment, and steroids.

• #63 IDSA 2025 Guideline Update on the Treatment of Asymptomatic Histoplasma Pulmonary Nodules (Histoplasmomas) and Mild or Moderate Acute Pulmonary Histoplasmosis in Adults, Children, and Pregnant People

  https://www.idsociety.org/practice-guideline/histoplasmosis-2025/

  In patients with asymptomatic, previously untreated Histoplasma pulmonary nodules (histoplasmomas), for which patients should antifungal treatment be initiated? […] In adults and children with asymptomatic non-calcified pulmonary nodules related to histoplasmosis with no evidence of other active sites, or asymptomatic patients with known untreated prior infection, the panel suggests against routinely providing treatment for histoplasmosis to prevent reactivation (conditional* recommendation, very low certainty of evidence). […] Treatment of pregnant individuals should only be considered after carefully weighing the potential benefits vs. harms of treatment, ideally in consultation with a maternal fetal medicine specialist and an infectious diseases specialist, as these cases are rare, complex, and highly variable. If treatment is necessary, azoles should be avoided in the first trimester when possible and liposomal amphotericin B used instead.

• #64 IDSA 2025 Guideline Update on the Treatment of Asymptomatic Histoplasma Pulmonary Nodules (Histoplasmomas) and Mild or Moderate Acute Pulmonary Histoplasmosis in Adults, Children, and Pregnant People

  https://www.idsociety.org/practice-guideline/histoplasmosis-2025/

  In patients with asymptomatic, previously untreated Histoplasma pulmonary nodules (histoplasmomas), for which patients should antifungal treatment be initiated? […] In adults and children with asymptomatic non-calcified pulmonary nodules related to histoplasmosis with no evidence of other active sites, or asymptomatic patients with known untreated prior infection, the panel suggests against routinely providing treatment for histoplasmosis to prevent reactivation (conditional* recommendation, very low certainty of evidence). […] Treatment of pregnant individuals should only be considered after carefully weighing the potential benefits vs. harms of treatment, ideally in consultation with a maternal fetal medicine specialist and an infectious diseases specialist, as these cases are rare, complex, and highly variable. If treatment is necessary, azoles should be avoided in the first trimester when possible and liposomal amphotericin B used instead.

• #65 IDSA 2025 Guideline Update on the Treatment of Asymptomatic Histoplasma Pulmonary Nodules (Histoplasmomas) and Mild or Moderate Acute Pulmonary Histoplasmosis in Adults, Children, and Pregnant People

  https://www.idsociety.org/practice-guideline/histoplasmosis-2025/

  In immunocompromised adults and children presenting with mild or moderate acute pulmonary histoplasmosis who are at moderate to high risk of progression to disseminated disease, the panel suggests antifungal treatment (conditional* recommendation, very low certainty of evidence). […] When treatment is indicated, itraconazole is preferred. […] Treatment of pregnant individuals should only be considered after carefully weighing the potential benefits vs. harms of treatment, ideally in consultation with a maternal fetal medicine specialist and an infectious diseases specialist, as these cases are rare, complex, and highly variable. If treatment is necessary, azoles should be avoided in the first trimester when possible and liposomal amphotericin B used instead.

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