       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).

