Sandbox carlos

Preferred regimen: Lipid formulation of 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.
Preferred regimen (2): The deoxycholate formulation of amphotericin B (0.7–1.0 mg/kg daily intravenously) is an alternative to a lipid formulation in patients who are at a low risk for nephrotoxicity (A-III)
Preferred regimen (3): Methylprednisolone (0.5–1.0 mg/kg daily intravenously) during the first 1–2 weeks of antifungal therapy is recommended for patients who develop respiratory complications, including hypoxemia or significant respiratory distress (B-III).
Note (1): In severe cases, cases accompanied by respiratory insufficiency, or hypoxemia, anecdotal reports [49] suggest that corticosteroid therapy may hasten recovery
Note (2): The pulmonary infiltrates should be resolved on the chest radiograph before antifungal therapy is stopped.

Treatment is usually unnecessary
Patients who continue to have symptoms for >1 month: Itraconazole (200 mg 3 times daily for 3 days and then 200 mg once or twice daily for 6–12 weeks)
Note (1): Antifungal treatment is unnecessary in patients with mild symptoms caused by acute pulmonary histoplasmosis

Preferred regimen: Itraconazole (200 mg 3 times daily for 3 days and then once or twice daily for at least 1 year) is recommended
Note (1): Blood levels of itraconazole should be obtained after the patient has been receiving this agent for at least 2 weeks to ensure adequate drug exposure
Note (2): Patients with underlying emphysema often develop progressive pulmonary disease, which is characterized by cavities with surrounding inflammation, after infection with Hysotplasma capsulatum

3.3 Patients with evidence of hemodynamic compromise or unremitting symptoms after several days of therapy with nonsteroidal anti-inflammatory therapy:

Prednisone (0.5–1.0 mg/kg daily [maximum, 80 mg daily] in tapering doses over 1–2 weeks)

Itraconazole (200 mg 3 times daily for 3 days and then once or twice daily for 6–12 weeks)
Note: Pericardial fluid removal is indicated for patients with hemodynamic compromise
Note: Pericarditis occurs as a complication of inflammation in adjacent mediastinal lymph nodes in patients with acute pulmonary histoplasmosis.

Preferred regimen: Prednisone (0.5–1.0 mg/kg daily [maximum, 80 mg daily] in tapering doses over 1–2 weeks)

5.1 Treatment is usually unnecessary
5.2 Patients who have symptoms that warrant treatment with corticosteroids and in those who continue to have symptoms for >1 month (B-III)
Itraconazole (200 mg 3 times daily for 3 days and then 200 mg once or twice daily for 6–12 weeks)
5.3 Severe cases with obstruction or compression of contiguous structures
Preferred regimen: Prednisone (0.5–1.0 mg/kg daily [maximum, 80 mg daily] in tapering doses over 1–2 weeks)
Note: Antifungal treatment is unnecessary in most patients with symptoms due to mediastinal lymphadenitis
Note (2): Itraconazole is recommended for 6–12 weeks to reduce the risk of progressive disseminated disease caused by corticosteroid-induced immunosuppression in patients who are given corticosteroids and in patients whose symptoms last longer than 1 month.

6.1 Treatment is usually unnecessary
6.2 Symptomatic cases
Preferred regimen: Itraconazole (200 mg 3 times daily for 3 days and then once or twice daily for 6–12 weeks)
Note: Itraconazole is appropriate for symptomatic cases, but there are no controlled trials to prove its efficacy.
Note (2): There is no evidence that mediastinal granuloma evolves into mediastinal fibrosis. Thus, treatment with either surgery or itraconazole should not be used to

prevent the development of mediastinal fibrosis

7.1 Antifungal treatment is not recommended
7.2 If clinical findings cannot differentiate mediastinal fibrosis from mediastinal granuloma
Preferred regimen: Itraconazole (200 mg once or twice daily for 12 weeks)
Note: The placement of intravascular stents is recommended for selected patients with pulmonary vessel obstruction
Note (2): Mediastinal fibrosis is characterized by invasive fibrosis that encases mediastinal or hilar nodes and that is defined by occlusion of central vessels and airways

Antifungal treatment is not recommended
Note: Lung parenchymal sites of infection may contract and then persist indefinitely as lung nodules or histoplasmomas....

Preferred regimen: Liposomal amphotericin B (3.0 mg/kg daily) is recommended for 1–2 weeks, followed by oral itraconazole (200 mg 3 times daily for 3 days and then 200 mg twice daily for a total of at least 12 months)
Note: Substitution of another lipid formulation at a dosage of 5.0 mg/kg daily may be preferred in some patients because of cost or tolerability
Note (2): The deoxycholate formulation of amphotericin B (0.7–1.0 mg/kg daily) is an alternative to a lipid formulation in patients who are at a low risk for nephrotoxicity
10.2 Immunosupressed patients (Immunosupression cannot be reversed)
Lifelong suppressive therapy with itraconazole (200 mg daily)
10.3 Mild to moderate disease
Itraconazole (200 mg 3 times daily for 3 days and then twice daily for at least 12 months)

need more things**

Preferred regimen: Itraconazole (200 mg daily) in patients with HIV infection with CD4 cell counts <150 cells/mm3 in specific areas of endemicity where the incidence of histoplasmosis is >10 cases per 100 patient-years

::::* Note: Prophylaxis with itraconazole (200 mg daily) may be appropriate in specific circumstances in other immunosuppressed patients

Treatment for CNS Histoplasmosis

Histoplasmosis in Children?

  Acute Pulmonary Histoplasmosis

  Progressive Disseminated Histoplasmosis

Progressive Disseminated Histoplasmosis???

References

↑ Galgiani JN, Ampel NM, Blair JE, Catanzaro A, Johnson RH, Stevens DA; et al. (2005). "Coccidioidomycosis". Clin Infect Dis. 41 (9): 1217–23. doi:10.1086/496991. PMID 16206093.