Histoplasmosis
Prevention of Exposure
Although HIV-infected persons living in or visiting
histoplasmosis-endemic areas cannot completely avoid exposure to Histoplasma
capsulatum, they should avoid activities known to be associated with
increased risk (e.g., cleaning chicken coops, disturbing soil beneath
bird-roosting sites, and exploring caves).
Prevention of Disease
Routine skin testing with histoplasmin in histoplasmosis-endemic areas
is not predictive of disease and should not be performed.
Data from a prospective controlled trial indicate that itraconazole can reduce the frequency of histoplasmosis among patients who have advanced HIV infection and who live in areas in which H. capsulatum is endemic; thus, physicians may wish to consider chemoprophylaxis for adult and adolescent patients who live in an area endemic for H. capsulatum and who have a CD4+ T-lymphocyte count of <100 cells/µL. However, when deciding on such prophylaxis, physicians should consider the possibility of drug interactions, toxicity, development of resistance, and the cost of prophylaxis. The need for prophylaxis or suppressive therapy for other fungal infections (e.g., cryptococcosis and candidiasis) should be considered when making decisions about prophylaxis for histoplasmosis. Itraconazole has not been demonstrated conclusively to prevent candidiasis, although it has activity for chronic suppression of cryptococcosis.
Prevention of Recurrence
Patients who complete initial therapy should be administered lifelong
suppressive treatment with itraconazole.
Notes:
Pediatric Note
Because primary histoplasmosis can lead to disseminated infection
in children, it is reasonable to administer lifelong suppressive therapy
after an acute episode of the disease.
Note Regarding Pregnancy
Itraconazole is embryotoxic and teratogenic in animal systems. Therefore,
primary prophylaxis against histoplasmosis is not indicated during pregnancy
(DIII). However, because of the risk of the disease to maternal health,
prophylaxis against recurrent histoplasmosis is indicated.
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