Diagnosing and Treating Histoplasmosis
What to Expect
As long as the diagnosis is made and antifungal therapy started in a timely fashion, histoplasmosis can be effectively treated with the currently available therapies.
How Histoplasmosis Is Diagnosed
Acute histoplasmosis is diagnosed by healthcare providers by asking patients questions about potential exposure and compatible symptoms and findings of physical examination and chest X-ray. They also order tests to confirm the diagnosis of acutre histoplasmosis. These tests include blood test for Histoplasma antibodies and antigen. The antibody test might be negative if done early after the infection. Antibody tests might be repeated a few weeks later to confirm the diagnosis. The antigen can also be negative if the infection is mild.
Chronic histoplasmosis may be diagnosed when health-care providers notice patients with underlying emphysema who develop a chronic infection resembling tuberculosis and who may have been exposed to Histoplasma fungi. A chest X-ray is often done and shows a cavity in the upper lung zones filled with fluid. Histoplasma antibody test results are usually positive, and sputum cultures usually grow Histoplasma.
Rapid diagnosis of disseminated histoplasmsosis is absolutely essential to ensuring early treatment and a good outcome. Histoplasma antigen and bronchoscopy are the most effective and widely used methods to secure an accurate and timely diagnosis of disseminated histoplasmosis. These tests are done when disseminated histoplasmosis is suspected in a severely ill patient with depressed immunity and who resides in the endemic area or had a compatible exposure.
How Histoplasmosis Is Treated
Most acute histoplasmosis cases are resolve themselves after a few weeks of illness. If symptoms are disabling or last beyond four weeks, antifungal therapy is recommended.
Chronic histoplasmosis is treated with an anti-fungal for 12 to 18 months until signs and symptoms disappear.
Disseminated histoplasmosis is treated initially with a combination of IV and oral drugs. In addition, the underlying immunosuppression needs to be addressed.