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1996-03-04
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Document 0807
DOCN M9640807
TI Disseminated histoplasmosis in persons infected with human
immunodeficiency virus.
DT 9604
AU Hajjeh RA; Emerging Bacterial and Mycotic Diseases Branch, Centers for;
Disease Control and Prevention, Atlanta, Georgia 30333, USA.
SO Clin Infect Dis. 1995 Aug;21 Suppl 1:S108-10. Unique Identifier :
AIDSLINE MED/96002837
AB Disseminated histoplasmosis is an AIDS-defining illness that occurs in
about 5% of AIDS patients residing in histoplasmosis-endemic areas of
the United States (the Mississippi and Ohio river valleys). This disease
develops as a result of acute infection and perhaps also as the result
of reactivation of latent infection: cases reported from areas such as
New York City, where histoplasmosis is not endemic, are most likely due
to reactivation of an infection acquired earlier in a
histoplasmosis-endemic area, while cases in histoplasmosis-endemic areas
are most likely due to acute infection, especially in outbreak settings.
Disseminated histoplasmosis in HIV-infected patients is usually
associated with advanced immunosuppression, with CD4+ lymphocyte counts
of < 75/mm3. Currently, histoplasmin skin testing of HIV-infected
patients does not seem to be useful in detecting previous exposure and
therefore is not helpful in identifying groups of patients who are at
risk for dissemination and who should be targeted for preventive
efforts. The current public health recommendation for HIV-infected
patients is to avoid exposure to sites likely to harbor high levels of
Histoplasma capsulatum, such as chicken coops and bird roosts. The role
of chemoprophylaxis is not clear, but an ongoing study by the Mycoses
Study Group is evaluating the role of prophylactic itraconazole. If
strategies for the prevention of disseminated histoplasmosis in
HIV-infected patients are to be improved, studies must better define the
risk factors for this opportunistic infection, describe its natural
history, and develop more reliable tests to predict its development.
DE Antifungal Agents/THERAPEUTIC USE AIDS-Related Opportunistic
Infections/*EPIDEMIOLOGY/PREVENTION & CONTROL Fluconazole/THERAPEUTIC
USE Histoplasmosis/*EPIDEMIOLOGY/PREVENTION & CONTROL Human Incidence
Itraconazole/THERAPEUTIC USE Risk Factors United States/EPIDEMIOLOGY
JOURNAL ARTICLE REVIEW REVIEW, TUTORIAL
SOURCE: National Library of Medicine. NOTICE: This material may be
protected by Copyright Law (Title 17, U.S.Code).