Histoplasmosis is a fungal infection caused by the pathogen Histoplasma capsulatum. It can occur in both immunocompetent and immunocompromised individuals and is most commonly acquired through inhalation of environmental spores. Respiratory infection is the most common manifestation of histoplasmosis, but it can also lead to severe disseminated infection, especially in immunocompromised individuals.
The Infectious Diseases Society of America (IDSA) last updated its guidelines for the management of histoplasmosis in 2007. Since then, new antifungal treatment options have been developed, and the population at risk for histoplasmosis has increased due to the use of immunosuppressive therapies. Therefore, there is a need for updated guidelines that reflect these changes.
In a recent survey conducted among adult infectious disease (ID) physicians, it was found that only 46% of respondents reported seeing patients with histoplasmosis. The majority of respondents followed the IDSA guidelines for the treatment of histoplasmosis, which recommend the use of itraconazole in various clinical situations.
For the treatment of mild-to-moderate acute pulmonary histoplasmosis and mild-to-moderate disseminated histoplasmosis in the outpatient setting, itraconazole was the preferred choice of antifungal medication. In severe disseminated histoplasmosis with and without central nervous system (CNS) involvement, itraconazole was also recommended for step-down therapy after initial treatment with amphotericin B.
Other azoles such as voriconazole, posaconazole, and isavuconazole were less commonly recommended by respondents. There was no consensus on the use of antifungal therapy in immunocompromised patients, and further research is needed to guide the management of these individuals.
It is important to note that the current guidelines are based on limited data, and there is a need for additional research to inform the management of histoplasmosis, especially in immunocompromised populations. The guidelines should also consider the expanding geographic distribution of Histoplasma and promote a high level of clinical suspicion for histoplasmosis in patients with compatible clinical syndromes.
In conclusion, itraconazole is the preferred medication for the treatment of histoplasmosis according to the current IDSA guidelines. However, further research is needed to guide the management of histoplasmosis, particularly in immunocompromised patients. Healthcare providers should consider histoplasmosis as a potential diagnosis, even in areas not traditionally considered endemic.