Prognosis

See the list below:

Most cases of histoplasmosis spontaneously resolve and do not recur.
Reinfection is possible, as is reactivation in individuals from endemic areas who become immunosuppressed.
The mortality rate of disseminated disease even with appropriate treatment is high (7-23%); without treatment it is as high as 80%.
Poor clinical response or relapse may indicate insufficient total dose of antifungal agent, unrecognized immunosuppression, or occult localized infection, such as endocarditis or meningitis.
Relapse occurs in 10-20% of patients with disseminated infection and in as many as 80% of those with AIDS.
Myint et al performed a multicenter retrospective cohort study to determine the outcome in AIDS patients following discontinuation of suppressive antifungal therapy for histoplasmosis. The study found that discontinuation of antifungal therapy was safe in adherent patients who completed at least 1 year of antifungal treatment, and had CD4 counts >150 cells/mL, HIV RNA < 400 c/mL, Histoplasma antigenuria < 2 ng/mL (equivalent to < 4.0 units in second-generation method), and no CNS histoplasmosis.^[25]

Patient Education

See the list below:

Prevention of histoplasmosis can be difficult because the source of organisms cannot always be determined, although reports of decontamination of environmental sources have been reported.
Immunocompromised individuals should be counseled to avoid situations in which the likelihood of exposure is high, such as spelunking or outdoor construction projects in endemic areas where significant disturbance of soil occurs.
For excellent patient education resources, see eMedicineHealth's patient education article Bronchoscopy.

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Media Gallery

Hilar lymphadenopathy in an 11-year-old child.
Map demonstrates the distribution of histoplasmin skin-test positivity by region. Used with permission from the American Thoracic Society.
Hematoxylin and eosin stain of infected lung tissue. Histoplasma organisms appear to have a false capsule.
Starling roost in Alabama.
Acute pulmonary syndrome in a 16-year-old female adolescent.
Fibrosing mediastinitis with mediastinal widening and tracheal deviation.

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Author

James S Hagood, MD Professor of Pediatrics and Chief, Division of Respiratory Medicine, Department of Pediatrics, University of California, San Diego, School of Medicine and Rady Children's Hospital of San Diego

James S Hagood, MD is a member of the following medical societies: American Thoracic Society

Disclosure: Nothing to disclose.

Coauthor(s)

Asad Ansari, MD, MPH Attending Physician, Pediatric Pulmonology and Infectious Diseases, Memorial Children's Hospital

Asad Ansari, MD, MPH is a member of the following medical societies: American Academy of Pediatrics, American College of Chest Physicians, American Thoracic Society, Infectious Diseases Society of America, Pediatric Infectious Diseases Society

Disclosure: Nothing to disclose.

Gulnur Com, MD Pediatric Pulmonologist, University of Arkansas for Medical Sciences Children's Hospital

Gulnur Com, MD is a member of the following medical societies: American Academy of Pediatrics, American Thoracic Society, Cystic Fibrosis Foundation

Disclosure: Nothing to disclose.

Specialty Editor Board

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Larry I Lutwick, MD, FACP Editor-in-Chief, ID Cases; Moderator, Program for Monitoring Emerging Diseases; Adjunct Professor of Medicine, State University of New York Downstate College of Medicine

Larry I Lutwick, MD, FACP is a member of the following medical societies: American Association for the Advancement of Science, American Association for the Study of Liver Diseases, American College of Physicians, American Federation for Clinical Research, American Society for Microbiology, Infectious Diseases Society of America, Infectious Diseases Society of New York, International Society for Infectious Diseases, New York Academy of Sciences, Veterans Affairs Society of Practitioners in Infectious Diseases

Disclosure: Nothing to disclose.

Chief Editor

Russell W Steele, MD Clinical Professor, Tulane University School of Medicine; Staff Physician, Ochsner Clinic Foundation

Russell W Steele, MD is a member of the following medical societies: American Academy of Pediatrics, American Association of Immunologists, American Pediatric Society, American Society for Microbiology, Infectious Diseases Society of America, Louisiana State Medical Society, Pediatric Infectious Diseases Society, Society for Pediatric Research, Southern Medical Association

Disclosure: Nothing to disclose.

Additional Contributors

Glenn Fennelly, MD, MPH Director, Division of Infectious Diseases, Lewis M Fraad Department of Pediatrics, Jacobi Medical Center; Clinical Associate Professor of Pediatrics, Albert Einstein College of Medicine

Glenn Fennelly, MD, MPH is a member of the following medical societies: Pediatric Infectious Diseases Society

Disclosure: Nothing to disclose.