**2.4 Other manifestations of pulmonary histoplasmosis**


With the development of effective antifungal therapy, histoplasmosis of SNC has been transformed from a universally fatal illness to a manageable condition if diagnosed early. Aggressive and prolonged antifungal therapy is indicated in all cases of CNS histoplasmosis. However, there is no definitive treatment for CNS histoplasmosis [42].

The Infectious Disease Society of America (IDSA) guideline for the treatment of CNS histoplasmosis recommends an initial course of liposomal amphotericin B because it is known to penetrate CNS structure well (5 mg/kg daily for a total of 175 mg/kg over 4–6 weeks) followed by itraconazole (200 mg 2–3 times daily) for at least one year and until resolution of CSF abnormalities, including negative histoplasma antigen [4, 41, 43].

Because of the risk of relapse, it is recommended to re-evaluate CSF parameters before discontinuation of itraconazole at 12 months and should be followed for at least three years for recurrence.

e.Pregnant patients with histoplasmosis should consider efficacy and safety data carefully. Treatment with amphotericin B for a total of 4–6 weeks, since azoles are teratogenic, particularly in the first trimester, is indicated in moderately severe or severe acute pulmonary disease, chronic pulmonary disease, or disseminated disease and any involving the central nervous system [44, 45].
