Central nervous system histoplasmosis: Multicenter retrospective study on clinical features, diagnostic approach and outcome of treatment
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Author
Wheat, JosephMyint, Thein
Guo, Ying
Kemmer, Phebe
Hage, Chadi
Terry, Colin
Azar, Marwan M.
Riddell, James
Ender, Peter
Chen, Sharon
Shehab, Kareem
Cleveland, Kerry
Esguerra, Eden
Johnson, James
Wright, Patty
Douglas, Vanja
Vergidis, Pascalis
Ooi, Winnie
Baddley, John
Bamberger, David
Khairy, Raed
Vikram, Holenarasipur R.
Jenny-Avital, Elizabeth
Sivasubramanian, Geetha
Bowlware, Karen
Pahud, Barbara
Sarria, Juan
Tsai, Townson
Assi, Maha
Mocherla, Satish
Prakash, Vidhya
Allen, David
Passaretti, Catherine
Huprikar, Shirish
Anderson, Albert
Affiliation
Univ Arizona, Coll Med, Tucson, AZ USAIssue Date
2018-03
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LIPPINCOTT WILLIAMS & WILKINSCitation
Wheat, J., Myint, T., Guo, Y., Kemmer, P., Hage, C., Terry, C., ... & Shehab, K. (2018). Central nervous system histoplasmosis: Multicenter retrospective study on clinical features, diagnostic approach and outcome of treatment. Medicine, 97(13).Journal
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Copyright © 2018 the Author(s). Published by Wolters Kluwer Health, Inc. This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CC BY-NC-ND).Collection Information
This item from the UA Faculty Publications collection is made available by the University of Arizona with support from the University of Arizona Libraries. If you have questions, please contact us at repository@u.library.arizona.edu.Abstract
Central nervous system (CNS) involvement occurs in 5 to 10% of individuals with disseminated histoplasmosis. Most experience has been derived from small single center case series, or case report literature reviews. Therefore, a larger study of central nervous system (CNS) histoplasmosis is needed in order to guide the approach to diagnosis, and treatment.A convenience sample of 77 patients with histoplasmosis infection of the CNS was evaluated. Data was collected that focused on recognition of infection, diagnostic techniques, and outcomes of treatment.Twenty nine percent of patients were not immunosuppressed. Histoplasma antigen, or anti-Histoplasma antibodies were detected in the cerebrospinal fluid (CSF) in 75% of patients. One year survival was 75% among patients treated initially with amphotericin B, and was highest with liposomal, or deoxycholate formulations. Mortality was higher in immunocompromised patients, and patients 54 years of age, or older. Six percent of patients relapsed, all of whom had the acquired immunodeficiency syndrome (AIDS), and were poorly adherent with treatment. While CNS histoplasmosis occurred most often in immunocompromised individuals, a significant proportion of patients were previously, healthy. The diagnosis can be established by antigen, and antibody testing of the CSF, and serum, and antigen testing of the urine in most patients. Treatment with liposomal amphotericin B (AMB-L) for at least 1 month; followed by itraconazole for at least 1 year, results in survival among the majority of individuals. Patients should be followed for relapse for at least 1 year, after stopping therapy.Note
Open access journal.ISSN
0025-7974PubMed ID
29595679Version
Final published versionSponsors
NIH [K23MH095679]Additional Links
http://Insights.ovid.com/crossref?an=00005792-201803300-00052ae974a485f413a2113503eed53cd6c53
10.1097/MD.0000000000010245
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Except where otherwise noted, this item's license is described as Copyright © 2018 the Author(s). Published by Wolters Kluwer Health, Inc. This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CC BY-NC-ND).
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