Disseminated histoplasmosis in infants

Background Disseminated histoplasmosis usually occurs in immunocompromised patients who reside in Histoplasma capsulatum-endemic regions. It has also been described in immunocompetent infants after exposure to a large inoculu m of the pathogen resulting in case fatality rates of 40 to 50%, Methods, From 1983 through 1996 all infants with documented disseminated hi stoplasmosis were treated with amphotericin B followed by daily ketoconazol e for 3 months. Immunologic workups were performed at the time of diagnosis and at 4 to 6 weeks of therapy. Surviving patients were followed for at le ast 1 year, Time to resolution of signs and symptoms was recorded, as were complications. Results, We managed 40 patients with disseminated histoplasmosis. The age i n months at diagnosis was 15.3 +/- 10.2 (mean +/- SD), and 24 were male. Al l patients were from endemic regions and they presented with fever, spleen and/or liver enlargement and hematologic abnormalities. Diagnosis was made by histology and culture of bone marrow, spleen, lymph node, bronchoalveola r or liver samples. Twenty patients presented with T cell deficiency that r esolved at 4 to 6 weeks of therapy in all of the retested patients, and 10 of 12 tested patients had hyperglobulinemia that resolved. Thirty-five (88% ) patients were cured by treatment; 4 died and 1 relapsed, Conclusions. Disseminated histoplasmosis should be considered in infants fr om endemic areas who present with fever, hepatosplenomegaly and hematologic abnormalities, These patients develop transient hyperglobulinemia and T ce ll deficiency that resolve with treatment. Treatment with amphotericin B fo llowed by an oral azole for 3 months is effective in most patients.