Histoplasmosis in patients with the acquired immune deficiency syndrome.

Important note: Information in this article was accurate in 1987. The state of the art may have changed since the publication date.

Histoplasmosis in patients with the acquired immune deficiency syndrome.

Am J Med. 1986 Dec;81(6):974-8. Unique Identifier : AIDSLINE MED/87097312
Mandell W; Goldberg DM; Neu HC

Abstract: Five patients with disseminated histoplasmosis are reviewed. Four of five had the acquired immune deficiency syndrome (AIDS) and one was receiving steroid therapy. All were immigrants to the United States from Puerto Rico, the Dominican Republic, or South America, and none had a history of travel to regions of the United States where Histoplasma is endemic. Histoplasma complement fixation titers to mycelial antigen were not demonstrable in three of three patients in whom they were measured. Of the four patients with AIDS, Histoplasma capsulatum was isolated from bone marrow aspirates in two patients and from lymph node and liver biopsy specimens in one patient each. One of the bone marrow specimens showed organisms on Gomori-methenamine silver stain. In the other three cases, results of staining were falsely negative and diagnosis awaited culture results weeks later. Amphotericin B therapy resulted in rapid clinical improvement in the three patients that were treated. Intravenous therapy was followed by treatment with oral ketoconazole. Follow-up has not been long enough to determine the ultimate efficacy of ketoconazole. Disseminated histoplasmosis should be considered in all patients from the Caribbean or South America with AIDS or who are receiving immunosuppressive therapy.

Keywords: Acquired Immunodeficiency Syndrome/*COMPLICATIONS Adult Amphotericin B/THERAPEUTIC USE Case Report Drug Therapy, Combination Ethnic Groups Female Histoplasma/ISOLATION & PURIF Histoplasmosis/DRUG THERAPY/*ETIOLOGY/MICROBIOLOGY Human Ketoconazole/THERAPEUTIC USE Male Middle Age JOURNAL ARTICLE

870430
M8740209

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