A 27-Year-Old Man with AIDS and Disseminated Histoplasmosis

Last updated March 12, 2015
Case Authors: 
Brian R. Wood, MD
Assistant Professor of Medicine
Division of Infectious Diseases
University of Washington School of Medicine
David H. Spach, MD's picture
David H. Spach, MD
Professor of Medicine
Division of Infectious Diseases
Clinical Director, Frontier AIDS Education and Training Center
University of Washington School of Medicine
Learning Objectives: 
  1. Summarize the clinical manifestations of HIV-infected persons with disseminated histoplasmosis.
  2. State appropriate therapy for initial managment of progressive disseminated histoplasmosis.

Display Group

  1. Wheat J. Endemic mycoses in AIDS: a clinical review. Clin Microbiol Rev. 1995;8:146-59.
  2. Kauffman CA. Histoplasmosis: a clinical and laboratory update. Clin Microbiol Rev. 2007;20:115-32.
  3. Wheat J. Histoplasmosis in the acquired immunodeficiency syndrome. Curr Top Med Mycol. 1996;7:7-18.
  4. Panel on Opportunistic Infections in HIV-Infected Adults and Adolescents. Guidelines for the prevention and treatment of opportunistic infections in HIV-infected adults and adolescents: recommendations from the Centers for Disease Control and Prevention, the National Institutes of Health, and the HIV Medicine Association of the Infectious Diseases Society of America. Endemic mycoses plus aspergillosis: histoplasmosis. May 7, 2013.
  5. McKinsey DS, Spiegel RA, Hutwagner L, et al. Prospective study of histoplasmosis in patients infected with human immunodeficiency virus: incidence, risk factors, and pathophysiology. Clin Infect Dis. 1997;24:1195-203.
  6. Chaturvedi S, Frame P, Newman SL. Macrophages from human immunodeficiency virus-positive persons are defective in host defense against Histoplasma capsulatum. J Infect Dis. 1995;171:320-7.
  7. Couppié P, Sobesky M, Aznar C, et al. Histoplasmosis and acquired immunodeficiency syndrome: a study of prognostic factors. Clin Infect Dis. 2003;38:134-8.
  8. Wheat LJ, Chetchotisakd P, Williams B, Connolly P, Shutt K, Hajjeh R. Factors associated with severe manifestations of histoplasmosis in AIDS. Clin Infect Dis. 2000;30:877-81.
  9. Koduri PR, Chundi V, DeMarais P, Mizock BA, Patel AR, Weinstein RA. Reactive hemophagocytic syndrome: a new presentation of disseminated histoplasmosis in patients with AIDS. Clin Infect Dis. 1995;21:1463-5.
  10. Subedee A, Van Sickels N. Hemophagocytic Syndrome in the Setting of AIDS and Disseminated Histoplasmosis: Case Report and a Review of Literature. J Int Assoc Provid AIDS Care. 2015 Feb 10. [Epub ahead of Print]
  11. Joseph Wheat L. Current diagnosis of histoplasmosis. Trends Microbiol. 2003;11:488-94.
  12. Williams B, Fojtasek M, Connolly-Stringfield P, Wheat J. Diagnosis of histoplasmosis by antigen detection during an outbreak in Indianapolis, Ind. Arch Pathol Lab Med. 1994;118:1205-8.
  13. Connolly PA, Durkin MM, Lemonte AM, Hackett EJ, Wheat LJ. Detection of histoplasma antigen by a quantitative enzyme immunoassay. Clin Vaccine Immunol. 2007;14:1587-91.
  14. Wheat LJ, Freifeld AG, Kleiman MB, et al. Clinical practice guidelines for the management of patients with histoplasmosis: 2007 update by the Infectious Diseases Society of America. Clin Infect Dis. 2007;45:807-25.
  15. Johnson PC, Wheat LJ, Cloud GA, et al. Safety and efficacy of liposomal amphotericin B compared with conventional amphotericin B for induction therapy of histoplasmosis in patients with AIDS. Ann Intern Med. 2002;137:105-9.
  16. Wheat LJ, Cloud G, Johnson PC, et al. Clearance of fungal burden during treatment of disseminated histoplasmosis with liposomal amphotericin B versus itraconazole. Antimicrob Agents Chemother. 2001;45:2354-7.
  17. Wheat LJ, Connolly P, Smedema M, et al. Activity of newer triazoles against Histoplasma capsulatum from patients with AIDS who failed fluconazole. J Antimicrob Chemother. 2006;57:1235-9.
  18. Restrepo A, Tobón A, Clark B, et al. Salvage treatment of histoplasmosis with posaconazole. J Infect. 2006;54:319-27.
  19. Goldman M, Zackin R, Fichtenbaum CJ, et al. Safety of discontinuation of maintenance therapy for disseminated histoplasmosis after immunologic response to antiretroviral therapy. Clin Infect Dis. 2004;38:1485-9.
  20. Tobón AM, Agudelo CA, Rosero DS, et al. Disseminated histoplasmosis: a comparative study between patients with acquired immunodeficiency syndrome and non-human immunodeficiency virus-infected individuals. Am J Trop Med Hyg. 2005;73:576-82.
  21. Koo HL, Hamill RJ, Andrade RA. Drug-drug interaction between itraconazole and efavirenz in a patient with AIDS and disseminated histoplasmosis. Clin Infect Dis. 2007;45:e77-9.
  22. Crommentuyn KM, Mulder JW, Sparidans RW, Huitema AD, Schellens JH, Beijnen JH. Drug-drug interaction between itraconazole and the antiretroviral drug lopinavir/ritonavir in an HIV-1-infected patient with disseminated histoplasmosis. Clin Infect Dis. 2004;38:e73-5.