A Case of Histoplasmosis with Central Nervous System Relapse after Itraconazole Therapy Needs Further Research

Abstract

Central nervous system (CNS) histoplasmosis occurs in 5-20% of all cases and is most commonly seen in immunosuppressed patients who have acquired immunodeficiency syndrome (AIDS) or have received organ transplant. The prevalence of histoplasmosis in patients greater than 65 years old between the years of 1999-2008 in the state of Texas was about 2-3 cases per 100,000 patients year. Since 1990 with the discovery of Triazoles, itraconazole (ICZ) has become the standard initial and suppressive therapy in patients with mild-moderate histoplasmosis without CNS involvement. However, poor penetration of ICZ into the brain, in vitro fluconazole resistance and lack of controlled-trials pose challenge in the treatment of cerebral histoplasmosis.

Clinical, radiological and laboratory characteristics of central nervous system histoplasmosis: A systematic review of a severe disease

“…We found 1159 studies and included 108 manuscripts published between 1962 and 2022, totaling 298 patients 7–10,12–115 . We excluded 38 articles that could not be retrieved.…”

Central Nervous System Histoplasmosis: An Updated Insight

“…There are not enough comparative trials of CNS histoplasmosis therapy, and considering the scarcity and variability of clinical cases, it can occasionally be difficult to establish definitive treatments [ 66 ]. Amphotericin B, fluconazole, and itraconazole are used alone or in a combined form.…”

“…Liposomal amphotericin B is preferred over standard amphotericin B formulation in view of its greater CNS penetration and lower toxicity. According to clinical practice, drug administration should be followed by clinical experience and descriptive studies [ 35 , 66 ]. To avoid relapses, clinical surveillance of patients should be monitored for at least 1 year after finishing treatment [ 26 ].…”