Chronic progressive CNS histoplasmosis presenting in childhood: Response to fluconazole therapy

Rivera, Ignacio V.; Curless, Richard G.; Indacochea, Fernando J.; Scott, Gwen

doi:10.1016/0887-8994(92)90040-6

Cited by 27 publications

(11 citation statements)

References 7 publications

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“…Favorable outcomes have been reported in 4 patients with Histoplasma meningitis who were treated with Flu [20][21][22]. Prior therapy with AmB had been unsuccessful for all 4, and therapy with Itra had also been unsuccessful for 1 patient [20].…”

Section: Discussionmentioning

confidence: 93%

Amphotericin B Combined with Itraconazole or Fluconazole for Treatment of Histoplasmosis

et al. 2000

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To investigate the efficacy of combined treatment with fluconazole (Flu) and amphotericin B (AmB) for Histoplasma capsulatum meningitis, MICs were determined for 10 clinical isolates, following National Committee for Clinical Laboratory Standards guidelines. Weak synergy was observed for 6 of the 10 isolates. For the in vivo models, mice either were sham treated or were given Flu (75 mg/kg/day), AmB (2 mg/kg every other day), itraconazole (Itra; 75 mg/kg/day), AmB+Flu, or AmB+Itra. Following infection with 5x105 yeasts, Flu antagonized AmB's reduction of fungal burden without reducing its effect on survival. When in vivo antagonism was reproduced following infection with 1x104 yeasts, a higher fungal burden was observed in the lungs. Itra had no effect on AmB's activity and was more effective than Flu for clearance of fungal burden. These findings caution against use of AmB+Flu for treatment of histoplasmosis, but studies of the effect of treatment on the fungal burden in the brain are needed to assess combination therapy for meningitis.

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Section: Discussionmentioning

confidence: 93%

Amphotericin B Combined with Itraconazole or Fluconazole for Treatment of Histoplasmosis

et al. 2000

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“…If the results remain nondiagnostic, more invasive methods may be justified. Cisternal or ventricular fluid analysis [12,20,21] or biopsy of brain lesions or involved meninges have been helpful in such cases [1]. For severely ill patients, biopsy may be preferred over additional CSF evaluation, to obtain definitive results more quickly, at which time a large volume of CSF should be obtained.…”

Section: Discussionmentioning

confidence: 99%

Diagnosis and Management of Central Nervous System Histoplasmosis

Wheat¹,

Musial²,

Jenny-Avital

2005

Clinical Infectious Diseases

175

144

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Two cases of Histoplasma meningitis are presented, illustrating the difficulty in diagnosis and treatment. The first case occurred in a patient with acquired immunodeficiency syndrome as a relapse of disseminated histoplasmosis and resolved after prolonged treatment and ongoing antiretroviral therapy. The second case occurred in a cardiac allograft recipient as meningitis and focal brain lesions that responded to liposomal amphotericin B, but the patient died shortly after therapy was completed. Unfortunately, there are no prospective studies addressing the diagnosis and management of patients with histoplasmosis of the central nervous system from which to provide evidence-based guidelines for care. In the absence of such data, an approach will be presented on the basis of our experience and opinions.

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“…Primary azole therapy of CNS histoplasmosis should be discouraged. Although success has been reported in a few cases, failures rates are high (71,106,116,130).…”

Section: Central Nervous System Histoplasmosismentioning

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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Chronic progressive CNS histoplasmosis presenting in childhood: Response to fluconazole therapy

Cited by 27 publications

References 7 publications

Amphotericin B Combined with Itraconazole or Fluconazole for Treatment of Histoplasmosis

Amphotericin B Combined with Itraconazole or Fluconazole for Treatment of Histoplasmosis

Diagnosis and Management of Central Nervous System Histoplasmosis

Histoplasmosis: a Clinical and Laboratory Update

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