Management of Histoplasmosis by Infectious Disease Physicians

Histoplasmosis remains common along the Mississippi and Ohio river valleys, though 27% of infectious disease physicians reported seeing histoplasmosis outside these endemic areas. Variability of management strategy is increased for scenarios where guidelines lack strong recommendations, particularly for immunocompromised patients. Background The Infectious Diseases Society of America (IDSA) guidelines for the management of histoplasmosis were last revised 15 years ago. Since those guidelines were compiled, new antifungal treatment options have been developed. Furthermore, the ongoing development of immunomodulatory therapies has increased the population at increased risk to develop histoplasmosis. Methods An electronic survey about the management practices of histoplasmosis was distributed to the adult infectious disease (ID) physician members of the IDSA's Emerging Infections Network. Results The survey response rate was 37% (551/1477). Only 46% (253/551) of respondents reported seeing patients with histoplasmosis. Regions considered endemic had 82% (158/193) of physicians report seeing patients with histoplasmosis compared to 27% (95/358) of physicians in regions not classically considered endemic (P < 0.001). Most ID physicians follow IDSA treatment guidelines recommending itraconazole for acute pulmonary (189/253 [75%]), mild-moderate disseminated (189/253 [75%]), and as step-down therapy for severe disseminated histoplasmosis with (232/253 [92%]) and without (145/253 [57%]) central nervous system involvement. There were no consensus recommendations observed for survey questions regarding immunocompromised patients. Conclusions Though there are increased reports of histoplasmosis diagnoses outside regions classically considered endemic, a majority of ID physicians reported not seeing patients with histoplasmosis. Most respondents reported adherence to IDSA guidelines recommending itraconazole in each clinical situation. New histoplasmosis guidelines need to reflect the growing need for updated general guidance, particularly for immunocompromised populations.

Automated summary

Histoplasmosis is still common in the Mississippi and Ohio river valleys, but there have been reported cases outside these endemic areas. The variability of management strategy is higher for immunocompromised patients due to the lack of strong recommendations. Most infectious disease physicians follow the guidelines recommending itraconazole for histoplasmosis treatment, but there is no consensus for immunocompromised patients.