Pediatric Histoplasmosis Follow-up

Updated: Jan 14, 2015
  • Author: James S Hagood, MD; Chief Editor: Russell W Steele, MD  more...
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Follow-up

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. [21]
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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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