HistoryThis section has been translated automatically.
DefinitionThis section has been translated automatically.
Intracellular systemic mycosis with infestation of the immune system and internal organs by the dimorphic fungus Histoplasma capsulatum.
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PathogenThis section has been translated automatically.
Histoplasma capsulatum(dimorphic fungus living as a saprophyte in soil, dust, bird and bat droppings).
ClassificationThis section has been translated automatically.
- Benign or asymptomatic form
- Acute pulmonary histoplasmosis
- Disseminated form
- Chronic pulmonary histoplasmosis.
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Most infections are subclinical or inapparent. When a lung infection manifests itself, it appears as a tuberculosis-like disease, which can heal spontaneously.
Inhalation of a large amount of pathogens can lead to the development of acute pneumonia.
In individual cases, especially in immunocompromised persons, a haematogenic spread can occur with infestation of the lymph nodes, spleen, liver and bone marrow.
Primary infections of the skin (and/or mucous membranes) can lead to chronic ulcers at the inoculation site.
Skin alterations are also observed in hematogenic sowing: disintegrated granulomas in the area of mouth, nose and larynx with later mutilation.
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Internal therapyThis section has been translated automatically.
- In immunocompetence: In non-meningeal, non-life-threatening, disseminated forms, antifungal therapy with azole derivatives. Itraconazole (e.g. Sempera Kps.) 200-400 mg/day for 6-9 months has proven to be the preparation with the fewest side effects and good efficacy.
- For immunosuppression or life-threatening forms: Amphotericin B once/day 0.3-0.8 mg/kg bw i.v. for 6 weeks. Gradual introduction with 0.25 mg/kg bw/day, with good tolerability increase to the above-mentioned dose as a continuous infusion over 4-6 hours. Side effects such as paresis, arachnoiditis or radiculitis can be reduced by pre-injection of glucocorticoids. Subsequent maintenance therapy with itraconazole 200 mg/day p.o. Maintenance therapy is absolutely necessary in immunocompromised patients because of the high relapse rate. Therapy duration depends on the clinic.
LiteratureThis section has been translated automatically.
- Buck BE et al (2001) Transmission of histoplasmosis by organ transplantation. N Engl J Med 344: 310
- Darling STA (1906) A protozoon general infection producing pseudotubercels in the lungs and focal necroses in the liver, spleen and lymph nodes. JAMA 46: 1283-1285
- Jackson A et al (1994) Oral azole drugs as systemic antifungal therapy. N Engl J Med 330: 263-272
- Johnson PC et al (2002) Safety and efficacy of liposomal amphotericin B compared with conventional amphotericin B for induction therapy of histoplasmosis in patients with AIDS. Ann Internal Med 137: 105-109
- Karimi K et al (2002) Differences in histoplasmosis in patients with acquired immunodeficiency syndrome in the United States and Brazil. J Infect Dis 186: 1655-1660
- Lee JH et al (2002) Life-threatening histoplasmosis complicating immunotherapy with tumor necrosis factor alpha antagonists infliximab and etanercept. Arthritis Rheum 46: 2565-2570
- LeMonte AM (2000) Amphotericin B combined with itraconazole or fluconazole for treatment of histoplasmosis. J Infect Dis 182: 545-550
- Norris S et al (1994) Prevention of relapse of histoplasmosis with fluconazole in patients with the acquired immunodeficiency syndrome. At J Med 96: 504-508
- Stevens DA (1994) Management of systemic fungal disease in patients with AIDS. J Am Acad Dermatol 31: 64-67
- Wheat J et al (1993) Prevention of relapse of histoplasmosis with itraconazole in patients with the acquired immunodeficiency syndrome. The national institute of allergy and infectious disease clinical trials and mycosis study group collaborators. Ann Inter Med 118: 610-616
- Vathesatogkit P et al (2003) A 27-year-old HIV-infected woman with severe sepsis and pulmonary infiltrates. Disseminated histoplasmosis with severe sepsis and acute respiratory failure. Chest 123: 272-273, 274-276
- Wood KL et al (2003) Histoplasmosis after treatment with anti-tumor necrosis factor-alpha therapy. At J Respir Crit Care Med 167: 1279-1282
Incoming links (12)Amphotericin b; Cytomycosis, reticuloendothelial; Darling's disease; Granuloma, pseudotuberculoids; Histoplasm capsulatum; Histoplasmosis, african; Histoplasmosis, epidemic; Lung diseases, skin changes; Mycoses; Nokardiosis; ... Show all
Outgoing links (6)Cutaneous tuberculosis (overview); Dimorphic mushrooms; Glucocorticosteroids; Histoplasmosis, african; Hiv infection; Itraconazole;
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