A case of disseminated histoplasmosis successfully treated with the investigational drug posaconazole

Clark, Benjamin M.; Foster, Rachel; Tunbridge, A.; Green, S.

doi:10.1016/j.jinf.2005.01.001

Cited by 39 publications

(14 citation statements)

References 18 publications

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“…One of these seven patients, who had meningitis, was also later reported as having been successfully treated with posaconazole (103). One other patient who had disseminated histoplasmosis was also successfully treated with posaconazole (13). The echinocandins do not have in vitro activity against H. capsulatum and are ineffective in animal models of infection (73); they should not be used for treating histoplasmosis.…”

Section: Treatment Treatment Optionsmentioning

confidence: 99%

Histoplasmosis: a Clinical and Laboratory Update

2007

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SUMMARY Infection with Histoplasma capsulatum occurs commonly in areas in the Midwestern United States and Central America, but symptomatic disease requiring medical care is manifest in very few patients. The extent of disease depends on the number of conidia inhaled and the function of the host's cellular immune system. Pulmonary infection is the primary manifestation of histoplasmosis, varying from mild pneumonitis to severe acute respiratory distress syndrome. In those with emphysema, a chronic progressive form of histoplasmosis can ensue. Dissemination of H. capsulatum within macrophages is common and becomes symptomatic primarily in patients with defects in cellular immunity. The spectrum of disseminated infection includes acute, severe, life-threatening sepsis and chronic, slowly progressive infection. Diagnostic accuracy has improved greatly with the use of an assay for Histoplasma antigen in the urine; serology remains useful for certain forms of histoplasmosis, and culture is the ultimate confirming diagnostic test. Classically, histoplasmosis has been treated with long courses of amphotericin B. Today, amphotericin B is rarely used except for severe infection and then only for a few weeks, followed by azole therapy. Itraconazole is the azole of choice following initial amphotericin B treatment and for primary treatment of mild to moderate histoplasmosis.

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Section: Treatment Treatment Optionsmentioning

confidence: 99%

Histoplasmosis: a Clinical and Laboratory Update

2007

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“…Posaconazole was prescribed when the infection became refractory to itraconazole therapy. The patient improved dramatically within 1 month and was maintained on posaconazole for 6 months thereafter, without relapse following drug cessation [42].…”

Section: Clinical Data: Posaconazole and Voriconazole Use For Endemicmentioning

confidence: 96%

The Role of Second-Generation Antifungal Triazoles for Treatment of the Endemic Mycoses

Freifeld

Bariola

Andes

2010

Curr Infect Dis Rep

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Endemic fungi are geographically restricted to certain areas of the United States where they are typically found in soil. They often cause asymptomatic or self-limited flu-like infections in humans. Occasionally, they cause serious human disease including acute or chronic pneumonias, or bone, skin, or central nervous system disease. Amphotericin B and first-generation triazoles are standard therapy for serious endemic fungal infections. Adverse effects, drug intolerance, and rare refractory infections may limit their use; therefore, experience is increasing using newer triazoles (voriconazole and posaconazole) to potentially circumvent these problems. This article reviews the basic scientific information and clinical experience using triazoles for treating endemic fungal infections.

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“…В некоторых исследованиях высказывается мне ние, что флюконазол и кетоконазол могут приме няться для лечения как активного, так и хроническо го легочного гистоплазмоза, однако они менее эффективны, чем итраконазол, и должны назначать ся только в особых ситуациях либо при плохой пере носимости последнего (класс рекомендаций DII). Вориконазол и позаконазол активны в отношении H. capsulatum и успешно применяются в качестве ре зервных препаратов [44][45][46][47][48]. Эхинокандины не эф фективны при лечении инфекции, вызванной Histo plasma [49].…”

Section: иммуноскомпрометированные больныеunclassified