Immunocompromised patients with mild or moderate acute pulmonary histoplasmosis who are at moderate to high risk of progression to disseminated disease require active management — even when the pulmonary presentation appears mild.
This protocol addresses immunocompromised adults and children presenting with mild or moderate acute pulmonary histoplasmosis who carry a moderate to high risk of progression to disseminated histoplasmosis. Because of this elevated risk, antifungal treatment is recommended regardless of disease severity at presentation.
Antifungal therapy is the foundation of management in this population. Oral itraconazole is the preferred agent. The complete regimen — covering formulation options, weight-based and adult dosing, and course duration — is available in the full protocol.
Therapeutic drug monitoring targeting a specific itraconazole trough concentration range is used to balance antifungal efficacy against the risk of toxicity.
DOI: 10.1093/cid/ciaf256
In immunocompromised adults and children presenting with mild or moderate acute pulmonary histoplasmosis who are at moderate to high risk of progression to disseminated disease, the panel suggests antifungal treatment (conditional recommendation, very low certainty of evidence).
When treatment is indicated, itraconazole is preferred.
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