Histoplasmosis: An Overview Treatment of Histoplasmosis

In 2000, the Infectious Diseases Society of America (IDSA) published a clinical practice guideline on managing patients with histoplasmosis and, in 2020, the first global guideline for diagnosing and managing disseminated histoplasmosis in people living with HIV (PLHIV). The classification of pulmonary histoplasmosis is done after clinical presentation and imaging. The optimal treatment depends on the patient’s clinical syndrome: acute mild/moderate, acute moderately/severe, chronic cavitary pulmonary, mediastinal lesions, or broncholithiasis. Asymptomatic patients or patients with mild cases of histoplasmosis with symptoms lasting less than four weeks do not usually require antifungal treatment. When necessary, itraconazole is the treatment of choice in mild to moderate acute forms of the disease, often for six weeks. For severe histoplasmosis, amphotericin B is recommended as initial therapy, followed by itraconazole as consolidation therapy. Long-term treatment for at least 12 months is recommended in patients with chronic cavitary histoplasmosis.