Risk of reactivation of other latent infections (TB, coccidiomycosis) also present
Secondary prophylaxis rationale
Antigenuria recurs in approximately 90% of patients who relapse
Lifelong prophylaxis may be required in persistently immunosuppressed patients
Patient Discharge Instructions
copy discharge instructions
Diagnosis and overview
Disseminated histoplasmosis is a serious fungal infection requiring prolonged treatment
Caused by a fungus found in soil contaminated with bat or bird droppings
Treatment typically lasts at least 12 months — do not stop early
Medications
Itraconazole instructions
Take liquid itraconazole on an empty stomach for best absorption
Take capsules with food and an acidic beverage (not with antacids or PPIs)
Do not miss doses — missing doses can lead to treatment failure
Do not stop medication without speaking to your doctor
Complete all prescribed antifungal therapy
Even if you feel better, the infection is not fully treated
Activity and diet
Adequate hydration while on amphotericin B (if prescribed at home)
Drink plenty of fluids daily
Avoid returning to high-risk environments
Bat caves, bird roosts, demolition sites, chicken coops
These environments may cause reinfection
Follow-up care
Return for blood and urine monitoring as directed
Kidney function tests during amphotericin B therapy
Itraconazole blood level check at 2 weeks
Urine antigen levels during treatment to confirm response
Infectious disease follow-up mandatory
Initial follow-up within 1–2 weeks of discharge
Return to emergency department immediately for
Warning signs requiring immediate care
Recurrent fevers, worsening fatigue, or new weight loss
New or worsening headache, confusion, or seizures
Fainting, dizziness, or inability to stand (adrenal insufficiency)
New skin lesions or mouth sores
Shortness of breath or chest pain
Severe nausea, vomiting, or diarrhea preventing medication intake
Bleeding or severe bruising
References
Guidelines and key sources
IDSA/DHHS Opportunistic Infections Guidelines
Benson C, Brooks J, Dhanireddy S, et al.
Guidelines for the Prevention and Treatment of Opportunistic Infections in Adults and Adolescents With HIV
IDSA and Office of AIDS Research Advisory Council, 2025
clinicalinfo.hiv.gov
Kapogiannis BG, Yates F, Li W, et al.
Guidelines for the Prevention and Treatment of Opportunistic Infections in Children With and Exposed to HIV
Office of AIDS Research Advisory Council, 2025
Systematic reviews and landmark studies
Limper AH, Adenis A, Le T, Harrison TS.
Fungal Infections in HIV/AIDS
Lancet Infectious Diseases, 2017. PMID 28774701
Murray M, Hine P.
Treating Progressive Disseminated Histoplasmosis in People Living With HIV
Cochrane Database of Systematic Reviews, 2020
Pasqualotto AC, Le T, Vieceli T, et al.
Histoplasmosis: A Missing Piece in the Global Efforts to End HIV Deaths
Lancet HIV, 2026. PMID 41833293
Global endemic mycoses guidelines
Thompson GR, Le T, Chindamporn A, et al.
Global Guideline for the Diagnosis and Management of the Endemic Mycoses
Lancet Infectious Diseases, 2021. PMID 34364529
ECMM/ISHAM collaborative guideline
Diagnostic and scoring tools
Hoyos Pulgarín JA, Moreno Gómez GA, et al.
Development of a Diagnostic Score for Histoplasmosis in a Cohort of Patients With HIV
Open Forum Infectious Diseases, 2025. PMID 40635908
Hage CA, Carmona EM, Epelbaum O, et al.
Microbiological Laboratory Testing in the Diagnosis of Fungal Infections in Pulmonary and Critical Care Practice
American Thoracic Society Clinical Practice Guideline, 2019. PMID PMC6727169
Additional evidence sources
Adamian CMC, de Lima Mota MA, et al.
Progressive Disseminated Histoplasmosis in HIV-positive Patients
International Journal of STD and AIDS, 2022. PMID 35343333
Galgiani JN, Kauffman CA.
Coccidioidomycosis and Histoplasmosis in Immunocompetent Persons
New England Journal of Medicine, 2024
Azar MM, Loyd JL, Relich RF, Wheat LJ, Hage CA.
Current Concepts in the Epidemiology, Diagnosis, and Management of Histoplasmosis Syndromes
Seminars in Respiratory and Critical Care Medicine, 2020. PMID 32000281
SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.