Diagnosis and treatment of histoplasmosis in HIV-infected patients
- John W Baddley, MD, MSPH
John W Baddley, MD, MSPH
- Professor of Medicine
- Birmingham VA Medical Center
- University of Alabama at Birmingham
Histoplasmosis is an important infectious disease among patients with AIDS and continues to cause severe morbidity and mortality in endemic areas, particularly in resource-limited settings [1,2].
The diagnosis and treatment of histoplasmosis will be discussed here. The epidemiology and clinical manifestations of infection are discussed elsewhere. (See "Epidemiology and clinical manifestations of histoplasmosis in HIV-infected patients".)
There are multiple diagnostic tests for disseminated H. capsulatum infection, including culture, serology, antigen testing, and direct microscopy; the diagnostic yield will depend on the stage of disease. Since most AIDS patients have disseminated disease, the most sensitive and specific test is detection of histoplasma antigen .
When resources are limited, the simplest and least expensive test (although not definitive) is direct microscopy of budding yeast within tissues or body fluids. The combination of culture with direct microscopy increases the diagnostic yield.
Timely diagnosis requires a high index of clinical suspicion. The advantages and disadvantages of these methods for diagnosis of histoplasmosis in the HIV-infected patient are discussed below. Additional information on diagnostic testing for histoplasmosis can also be found elsewhere. (See "Diagnosis and treatment of disseminated histoplasmosis in HIV-uninfected patients".)
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- Antigen detection
- Direct microscopy
- Skin testing
- DIFFERENTIAL DIAGNOSIS
- Antifungal agents
- - Amphotericin B
- - Itraconazole
- - Fluconazole
- - Other agents
- Moderately severe to severe disease
- Mild to moderate disease
- DRUG INTERACTIONS
- DURATION OF THERAPY
- MONITORING OF PATIENTS
- IMMUNE RECONSTITUTION
- MORBIDITY AND MORTALITY
- Prognostic factors
- SUPPRESSIVE THERAPY
- SOCIETY GUIDELINE LINKS
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS