DISSEMINATED HISTOPLASMOSIS IN CHILDREN - THE ROLE OF ITRACONAZOLE THERAPY

Objectives. To describe the clinical characteristics and laboratory di agnosis of seven children with disseminated histoplasmosis and evaluat e the effectiveness of itraconazole therapy in this severe form of the mycosis as well as to determine the long term results of such treatme nt. Methods. The diagnosis of histoplasmosis was based on the direct o bservation of Histoplasma capsulatum var. capsulatum and/or on the iso lation of the fungus from pathologic materials; the results of the ser ologic tests were taken into consideration. Chest roentgenograms also contributed to the diagnosis. Patients. The patients were seven rural children, five girls and two boys, ages 1 to 14 years (mean, 4.6), wit h a confirmed diagnosis of disseminated histoplasmosis and who had no underlying disease other than malnourishment. Results. The seven child ren experienced a subacute febrile syndrome for 4 months accompanied b y anorexia, weight loss and signs of reticuloendothelial involvement s uch as lymph node hypertrophy, hepatomegaly and/or splenomegaly. The l ung revealed roentgenographic alterations consisting mainly of nodular infiltrates. All patients received itraconazole orally in a mean dosa ge of 7.2 mg/kg/day, for variable periods (3 to 12 months), depending on the individual response and the toxic effects of the medication. On e of the patients who was improving after 1 month of treatment was tak en from the hospital by his guardian against medical advice and died s hortly afterward. The remaining six patients responded to the treatmen t with marked clinical improvement and showed negative cultures and de creases in anti-H. capsulatum antibody titers after 3 months of treatm ent. Only one patient, the youngest and most severely affected child, exhibited hepatotoxicity, which subsided when itraconazole was discont inued. Extended follow-up studies revealed no relapses. Conclusion. Th e results of this study indicate that itraconazole is effective for tr eatment of disseminated childhood histoplasmosis. More studies should be performed to determine the most appropriate dosage and the optimal duration of itraconazole treatment in children.