Diagnosis and management of central nervous system histoplasmosis

Clin Infect Dis. 2005 Mar 15;40(6):844-52. doi: 10.1086/427880. Epub 2005 Feb 16.

Abstract

Two cases of Histoplasma meningitis are presented, illustrating the difficulty in diagnosis and treatment. The first case occurred in a patient with acquired immunodeficiency syndrome as a relapse of disseminated histoplasmosis and resolved after prolonged treatment and ongoing antiretroviral therapy. The second case occurred in a cardiac allograft recipient as meningitis and focal brain lesions that responded to liposomal amphotericin B, but the patient died shortly after therapy was completed. Unfortunately, there are no prospective studies addressing the diagnosis and management of patients with histoplasmosis of the central nervous system from which to provide evidence-based guidelines for care. In the absence of such data, an approach will be presented on the basis of our experience and opinions.

Publication types

  • Case Reports
  • Review

MeSH terms

  • Acquired Immunodeficiency Syndrome / complications
  • Adult
  • Aged
  • Amphotericin B / therapeutic use
  • Antifungal Agents / therapeutic use
  • Female
  • Fluconazole / therapeutic use
  • Histoplasmosis / diagnosis*
  • Histoplasmosis / drug therapy*
  • Humans
  • Immunocompromised Host
  • Male
  • Meningitis, Fungal / diagnosis*
  • Meningitis, Fungal / drug therapy
  • Meningitis, Fungal / microbiology*
  • Mycological Typing Techniques / methods
  • Sensitivity and Specificity

Substances

  • Antifungal Agents
  • Amphotericin B
  • Fluconazole