Central nervous system histoplasmosis: Multicenter retrospective study on clinical features, diagnostic approach and outcome of treatment
Azar, Marwan M.
Vikram, Holenarasipur R.
AffiliationUniv Arizona, Coll Med, Tucson, AZ USA
MetadataShow full item record
PublisherLIPPINCOTT WILLIAMS & WILKINS
CitationWheat, 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).
RightsCopyright © 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 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.
Collection InformationThis 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 email@example.com.
AbstractCentral 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.
NoteOpen access journal.
VersionFinal published version
- Neuroendoscopic diagnosis of central nervous system histoplasmosis with basilar arachnoiditis.
- Authors: Rangel-Castilla L, Hwang SW, White AC, Zhang YJ
- Issue date: 2012 Feb
- Improvement in Diagnosis of Histoplasma Meningitis by Combined Testing for Histoplasma Antigen and Immunoglobulin G and Immunoglobulin M Anti-Histoplasma Antibody in Cerebrospinal Fluid.
- Authors: Bloch KC, Myint T, Raymond-Guillen L, Hage CA, Davis TE, Wright PW, Chow FC, Woc-Colburn L, Khairy RN, Street AC, Yamamoto T, Albers A, Wheat LJ
- Issue date: 2018 Jan 6
- Involvement of intraocular structures in disseminated histoplasmosis.
- Authors: Ala-Kauhaluoma M, Aho I, Ristola M, Karma A
- Issue date: 2010 Jun
- [Central nervous system histoplasmosis].
- Authors: Hamada M, Tsuji S
- Issue date: 2009 Feb
- Diagnosis and management of central nervous system histoplasmosis.
- Authors: Wheat LJ, Musial CE, Jenny-Avital E
- Issue date: 2005 Mar 15