Histoplasmosis B39.41

Intracellular systemic mycosis with infestation of the immune system and internal organs by the dimorphic fungus Histoplasma capsulatum.

Histoplasma capsulatum(dimorphic fungus living as a saprophyte in soil, dust, bird and bat droppings).

• Benign or asymptomatic form
• Acute pulmonary histoplasmosis
• Disseminated form
• Chronic pulmonary histoplasmosis.

Most infections are subclinical or inapparent. When a lung infection manifests itself, it appears as a tuberculosis-like disease, which can heal spontaneously.

Inhalation of a large amount of pathogens can lead to the development of acute pneumonia.

In individual cases, especially in immunocompromised persons, a haematogenic spread can occur with infestation of the lymph nodes, spleen, liver and bone marrow.

Primary infections of the skin (and/or mucous membranes) can lead to chronic ulcers at the inoculation site.

Skin alterations are also observed in hematogenic sowing: disintegrated granulomas in the area of mouth, nose and larynx with later mutilation.

• In immunocompetence: In non-meningeal, non-life-threatening, disseminated forms, antifungal therapy with azole derivatives. Itraconazole (e.g. Sempera Kps.) 200-400 mg/day for 6-9 months has proven to be the preparation with the fewest side effects and good efficacy.
• For immunosuppression or life-threatening forms: Amphotericin B once/day 0.3-0.8 mg/kg bw i.v. for 6 weeks. Gradual introduction with 0.25 mg/kg bw/day, with good tolerability increase to the above-mentioned dose as a continuous infusion over 4-6 hours. Side effects such as paresis, arachnoiditis or radiculitis can be reduced by pre-injection of glucocorticoids. Subsequent maintenance therapy with itraconazole 200 mg/day p.o. Maintenance therapy is absolutely necessary in immunocompromised patients because of the high relapse rate. Therapy duration depends on the clinic.

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