How is it treated?

People with healthy immune systems who are diagnosed with histoplasmosis don't necessarily require treatment, as the symptoms are usually mild and clear up on their own. For people with compromised immune systems, histoplasmosis can be progressive and life threatening and, as a result, often requires treatment.

Treatment depends on the severity of disease. In patients with moderate to severe disease, liposomal amphotericin B (either Ambisome, Abelcet or Amphotec) is given every day through an IV line, usually while staying in a hospital. IV treatment is continued for at least two weeks or until the patient is feeling better.

If the patient has meningitis, the dose of liposomal amphotericin B is usually increased and continued for four to six weeks.

In patients with less severe histoplasmosis, oral itraconazole (Sporanox) may be all that's needed—at a dose of 200 mg three times daily for three days followed by 200 mg twice daily thereafter. The liquid version of Sporanox is preferred because it is better absorbed by the body and has fewer interactions with food.

After histoplasmosis is successfully treated, liposomal amphotericin B is discontinued and Sporanox is started or continued. This is necessary to help prevent the histoplasmosis from recurring. Oral Sporanox is continued for as long as the CD4 count remains below 150—it can be discontinued if the CD4 count remains above this level for at least six months.

A syndrome—called immune reconstitution inflammatory syndrome (IRIS)—where antiretroviral treatment can actually exacerbate the symptoms of an opportunistic infection due to a strengthened immune response, has not been commonly reported with histoplasmosis.

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