HIV-Associated Histoplasmosis: Current Perspectives

Thein Myint,1 Nicole Leedy,1 Evelyn Villacorta Cari,1 L Joseph Wheat2 1Division of Infectious Diseases, Department of Internal Medicine, University of Kentucky, Lexington, KY, USA; 2MiraVista Diagnostics, Indianapolis, IN, USACorrespondence: Thein MyintDivision of Infectious Diseases, Department of...

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Autores principales:	Myint T, Leedy N, Villacorta Cari E, Wheat LJ
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2020
Materias:	histoplasmosis hiv Immunologic diseases. Allergy RC581-607
Acceso en línea:	https://doaj.org/article/886e84eaa8854c58a7eaf7bfb3f4d3dc
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spelling	oai:doaj.org-article:886e84eaa8854c58a7eaf7bfb3f4d3dc2021-12-02T11:51:20ZHIV-Associated Histoplasmosis: Current Perspectives1179-1373https://doaj.org/article/886e84eaa8854c58a7eaf7bfb3f4d3dc2020-03-01T00:00:00Zhttps://www.dovepress.com/hiv-associated-histoplasmosis-current-perspectives-peer-reviewed-article-HIVhttps://doaj.org/toc/1179-1373Thein Myint,1 Nicole Leedy,1 Evelyn Villacorta Cari,1 L Joseph Wheat2 1Division of Infectious Diseases, Department of Internal Medicine, University of Kentucky, Lexington, KY, USA; 2MiraVista Diagnostics, Indianapolis, IN, USACorrespondence: Thein MyintDivision of Infectious Diseases, Department of Internal Medicine, University of Kentucky, Lexington, KY 40536, USATel +1 859-323-8178Fax +1 859-323-8926Email thein.myint3@uky.eduAbstract: Histoplasmosis is an endemic mycosis caused by Histoplasma capsulatum. Infection develops by inhalation of microconidia from environmental sites inhabited by birds and bats. Disseminated disease is the usual presentation due to impaired cellular immunity. Common clinical manifestations include fever, fatigue, malaise, anorexia, weight loss, and respiratory symptoms. Histoplasma antigen detection is the most sensitive method for diagnosis. The sensitivity of the MVista® Quantitative Histoplasma antigen enzyme immunoassay is 95– 100% in urine, over 90% in serum and bronchoalveolar lavage (BAL) antigen and 78% in cerebral spinal fluid (CSF). A proven diagnosis can be established by culture or pathology with sensitivities between 70% and 80%. The sensitivity of antibody detection by immunodiffusion or complement fixation was between 60% and 70%. Diagnosis using molecular methods has not been adequately validated for implementation and FDA cleared assays are unavailable. Liposomal amphotericin B should be used for 1– 2 weeks followed by itraconazole for at least one year until CD4 counts are above 150 cells/mm3, HIV viral load is below 400 copies/mL and Histoplasma urine antigen is negative. Serum itraconazole level should be monitored to avoid drug toxicity. Antigen should be measured periodically to establish that treatment is effective and to assist in identifying relapse. The incidence of immune reconstitution inflammatory syndrome is low but it must be considered in patients who are thought to be failing antifungal treatment as it does not respond to changing antifungal agents but rather to initiation of corticosteroid therapy. In this review, we discuss pathogenesis, clinical manifestations, diagnosis and treatment based on personal experience and relevant publications.Keywords: histoplasmosis, HIVMyint TLeedy NVillacorta Cari EWheat LJDove Medical PressarticlehistoplasmosishivImmunologic diseases. AllergyRC581-607ENHIV/AIDS: Research and Palliative Care, Vol Volume 12, Pp 113-125 (2020)
institution	DOAJ
collection	DOAJ
language	EN
topic	histoplasmosis hiv Immunologic diseases. Allergy RC581-607
spellingShingle	histoplasmosis hiv Immunologic diseases. Allergy RC581-607 Myint T Leedy N Villacorta Cari E Wheat LJ HIV-Associated Histoplasmosis: Current Perspectives
description	Thein Myint,1 Nicole Leedy,1 Evelyn Villacorta Cari,1 L Joseph Wheat2 1Division of Infectious Diseases, Department of Internal Medicine, University of Kentucky, Lexington, KY, USA; 2MiraVista Diagnostics, Indianapolis, IN, USACorrespondence: Thein MyintDivision of Infectious Diseases, Department of Internal Medicine, University of Kentucky, Lexington, KY 40536, USATel +1 859-323-8178Fax +1 859-323-8926Email thein.myint3@uky.eduAbstract: Histoplasmosis is an endemic mycosis caused by Histoplasma capsulatum. Infection develops by inhalation of microconidia from environmental sites inhabited by birds and bats. Disseminated disease is the usual presentation due to impaired cellular immunity. Common clinical manifestations include fever, fatigue, malaise, anorexia, weight loss, and respiratory symptoms. Histoplasma antigen detection is the most sensitive method for diagnosis. The sensitivity of the MVista® Quantitative Histoplasma antigen enzyme immunoassay is 95– 100% in urine, over 90% in serum and bronchoalveolar lavage (BAL) antigen and 78% in cerebral spinal fluid (CSF). A proven diagnosis can be established by culture or pathology with sensitivities between 70% and 80%. The sensitivity of antibody detection by immunodiffusion or complement fixation was between 60% and 70%. Diagnosis using molecular methods has not been adequately validated for implementation and FDA cleared assays are unavailable. Liposomal amphotericin B should be used for 1– 2 weeks followed by itraconazole for at least one year until CD4 counts are above 150 cells/mm3, HIV viral load is below 400 copies/mL and Histoplasma urine antigen is negative. Serum itraconazole level should be monitored to avoid drug toxicity. Antigen should be measured periodically to establish that treatment is effective and to assist in identifying relapse. The incidence of immune reconstitution inflammatory syndrome is low but it must be considered in patients who are thought to be failing antifungal treatment as it does not respond to changing antifungal agents but rather to initiation of corticosteroid therapy. In this review, we discuss pathogenesis, clinical manifestations, diagnosis and treatment based on personal experience and relevant publications.Keywords: histoplasmosis, HIV
format	article
author	Myint T Leedy N Villacorta Cari E Wheat LJ
author_facet	Myint T Leedy N Villacorta Cari E Wheat LJ
author_sort	Myint T
title	HIV-Associated Histoplasmosis: Current Perspectives
title_short	HIV-Associated Histoplasmosis: Current Perspectives
title_full	HIV-Associated Histoplasmosis: Current Perspectives
title_fullStr	HIV-Associated Histoplasmosis: Current Perspectives
title_full_unstemmed	HIV-Associated Histoplasmosis: Current Perspectives
title_sort	hiv-associated histoplasmosis: current perspectives
publisher	Dove Medical Press
publishDate	2020
url	https://doaj.org/article/886e84eaa8854c58a7eaf7bfb3f4d3dc
work_keys_str_mv	AT myintt hivassociatedhistoplasmosiscurrentperspectives AT leedyn hivassociatedhistoplasmosiscurrentperspectives AT villacortacarie hivassociatedhistoplasmosiscurrentperspectives AT wheatlj hivassociatedhistoplasmosiscurrentperspectives
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HIV-Associated Histoplasmosis: Current Perspectives

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