Treatment

Acute, uncomplicated pulmonary histoplasmosis may be treated with watchful waiting in patients with normal immune systems (Wheat et al., 2004). Severe disseminated histoplasmosis or severe diffuse pulmonary histoplasmosis is treated with the liposomal form of amphotericin B for 3 to 10 days, followed by 12 weeks of oral itraconazole therapy, and then lifelong itraconazole prophylaxis. New antifungal agents such as voriconazole, caspofungin, and micafungin are potential alternatives (Herbrecht et al., 2005; Ruhnke, 2004). Detailed treatment guidelines for the management of histoplasmosis and blastomycosis infections are available from IDSA (Chapman et al., 2008; Wheat et al., 2007).

For coccidioidomycosis and blastomycosis, amphotericin B is usually chosen for initial therapy. Less serious infections might respond to fluconazole or itraconazole, and some treatment success has been demonstrated with voriconazole (Bakleh et al., 2005). Meningitis is treated with fluconazole or intrathecal amphotericin B. The CDC recommends treatment with voriconazole for invasive aspergillosis.

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