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Disseminated Histoplasmosis Treatment — SCE Infectious Diseases MCQ

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ModerateFungal InfectionsDisseminated Histoplasmosis TreatmentSCE Infectious Diseases

A 40-year-old man with advanced HIV (CD4 25) develops wasting, fever, and pancytopenia. Blood cultures grow Histoplasma capsulatum. He recently returned from the Ohio River valley. What is the treatment for disseminated histoplasmosis?

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Correct answer: E — Liposomal Amphotericin B 3 mg/kg daily for 2 weeks (induction) followed by Itraconazole 200 mg BD for at least 12 months (consolidation/maintenance)

Disseminated histoplasmosis in advanced HIV is treated with a two-phase approach: induction with Liposomal Amphotericin B (3 mg/kg daily for at least 2 weeks — until clinical improvement) followed by consolidation/maintenance with oral Itraconazole 200 mg BD for at least 12 months. Itraconazole TDM (target trough >1 mg/L) is essential. Echinocandins have NO activity against Histoplasma. Secondary prophylaxis continues until CD4 >150 for ≥6 months on ART.

Reference: BHIVA 2022 – OI; IDSA 2007 – Histoplasmosis; WHO 2021