Practice guidelines for the management of patients with histoplasmosis

Objective. The objective of this guideline is to provide recommendations fo r treating patients with the more common forms of histoplasmosis. Participants and consensus process. A working group of 8 experts in this fi eld was convened to develop this guideline. The working group developed and refined the guideline through a series of conference calls. Outcomes. The goal of treatment is to eradicate: the infection when possibl e, although chronic suppression may be adequate for patients with AIDS and other serious immunosuppressive disorders. Other important outcomes are res olution of clinical abnormalities and prevention of relapse. Evidence. The published literature on the management of histoplasmosis was reviewed. Controlled trials have been conducted that address the treatment of chronic pulmonary and disseminated histoplasmosis. but clinical experien ce and descriptive studies provide the basis for recommendations for other forms of histoplasmosis. Value. Value was assigned on the basis of the strength of the evidence supp orting treatment recommendations, with the highest value assigned to contro lled trials, according to conventions established for developing practice g uidelines. Benefits and costs. Certain forms of histoplasmosis cause life-threatening illnesses and result in considerable morbidity, whereas other manifestation s cause no symptoms or minor self-limited illnesses. The nonprogressive for ms of histoplasmosis. however. may reduce functional capacity, affecting wo rk capacity and quality of life for several months. Treatment is clearly be neficial and cost-effective for patients with progressive forms of histopla smosis, such as chronic pulmonary or disseminated infection. It remains unk nown whether treatment improves the outcome for patients with the self-limi ted manifestations, since this patient population has not been studied. Oth er chronic progressive forms of histoplasmosis are not responsive to pharma cologic treatment. Treatment options. Options for therapy for histoplasmosis include ketoconaz ole, itraconazole, fluconazole. amphotericin B (Fungizone; Bristol-Meyer Sq uibb. Princeton. NJ), liposomal amphotericin B (AmBisome; Fujisawa, Deerfie ld, IL), amphotericin B colloidal suspension (ABCD, or Amphotec : Seques, M enlo Park. CA), and amphotericin B lipid complex (ABLC, or Abelcet: Liposom e. Princeton, NJ).