Treatment of Mild Acute Pulmonary Histoplasmosis in Immunocompetent Patients
This protocol addresses immunocompetent patients — those with no immunocompromising condition — who present with mild acute pulmonary histoplasmosis. Mild disease is characterised by symptoms such as cough, fever, dyspnoea, or chest discomfort that do not interfere with normal activities.
Current guidance takes a position on whether antifungal therapy is routinely indicated in this specific population. When treatment is determined to be warranted, a preferred antifungal agent has been identified. The complete selection criteria, regimen structure, and monitoring requirements are detailed in the full protocol.
When antifungal therapy is initiated, a defined serum drug-level target guides dosing to optimise efficacy while limiting toxicity. The specific target range and the assay method used to measure it are specified in the full protocol.
References
In immunocompetent adults and children presenting with mild acute pulmonary histoplasmosis, the panel suggests against routinely providing antifungal treatment (conditional recommendation, very low certainty of evidence).
Mild acute pulmonary histoplasmosis: mild symptoms (eg, cough, fever, dyspnea, chest discomfort) that do not interfere with normal activities.
When treatment is indicated, itraconazole is preferred.
A goal trough concentration of itraconazole component >1 mg/L and <3–4 mg/L (as measured by chromatographic assay) is associated with efficacy and a lower risk of toxicity.
DOI: 10.1093/cid/ciaf256
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