Histoplasmosis

Question 1

Presentation

Answer 1

Asymptomatic and self-limited to disseminated

Cough and SOB

Fever, fatigue, weight loss, HSM

Question 2

Diagnosis

Answer 2

+ histoplasma antigen in blood/urine

Question 3

CD4 count

Answer 3

< 200

Question 4

Non-pharmacological treatment

Answer 4

Avoid exposure:
Creating dust when working with surface soil
Cleaning chicken coops
Disturbing areas contaminated with bird/bat poop
Cleaning, remodeling, demolishing buildings
Exploring caves

Question 5

Pharmacological

Answer 5

Start ART ASAP

Mild-moderate: Itraconazole 200 mg PO TID X 3 days, then 200 mg PO BID ≥ 12 months
Alternatives: posaconazole, voriconazole, fluconazole

Severe: Liposomal amphotericin 3 mg/kg IV daily x 2 weeks THEN itraconazole 200 mg PO TID x 3 days THEN itraconazole 200 mg PO BID x 12 months
Alternatives: Amphotericin 5 mg/kg IV daily x 2 weeks THEN posaconazole/voriconazole/fluconazole x 12 months

Question 6

Primary Prophylaxis

Answer 6

CD4 < 150 cells/mm3 + high risk
- Itraconazole 200 mg PO daily

D/C: CD4 ≥ 150 cells/mm3 x 6 months on ART

Question 7

Secondary Prophylaxis

Answer 7

Severe disseminated or CNS infection after completing 12 months
- Itraconazole 200 mg PO daily

D/C
* Azole therapy x 1 year
* - fungal cultures
* Unquantifiable histoplasma antigen
* Viral suppression on ART
* CD4 count ≥ 150 cells/mm3 x 6 months on ART

Question 8

Restart

Answer 8

CD4 count < 150 cells/mm^3