Clinical Research Center, Fundación Valle del Lili, 760032 Cali, Colombia.
Faculty of Health Sciences, Universidad Icesi, 760032 Cali, Colombia.
Med Mycol. 2024 Jul 4;62(7). doi: 10.1093/mmy/myae058.
Histoplasmosis presents a substantial clinical challenge globally, with a particular prevalence in South America, especially among patients with concurrent Human Immunodeficiency Virus (HIV) infection. Despite itraconazole's established efficacy, investigating alternative therapeutic approaches remains imperative. This is the largest study in our region to date, assessing the effectiveness of the less explored posaconazole treatment. This observational study, conducted at Fundación Valle del Lili (FVL) from 2016 to 2022, encompassed adults with disseminated histoplasmosis. Patients (n = 31) were treated with liposomal amphotericin B as an initial treatment, followed by consolidation treatment with posaconazole or itraconazole. Patients with single-organ cases, those lacking microbiological diagnosis, those who received initial treatment with antifungals other than liposomal Amphotericin B and those with < 6 months follow-up were excluded (Figure 1). Analyses considered population characteristics, treatments, and outcomes. Patients (average age: 45.6; 58.1% female) had common comorbidities (HIV 38.7%, solid organ transplantation 29% and oncologic disease 12.9%). Lungs (48.4%) and lymph nodes (16.1%) were commonly affected. Biopsy (64.5%) was the primary diagnostic method. Initial treatment with liposomal amphotericin B (100%) was given for 14 days on average. Follow-up indicated 71% completion with 19.4% requiring treatment modifications. Notably, 70.9% completed a posaconazole consolidation regimen over 350 days on average. Drug interactions during consolidation (80.6%) were common. No relapses occurred, and three deaths unrelated to histoplasmosis were reported. Traditionally, itraconazole has been the prevalent initial treatment; however, in our cohort, 55.9% of patients received posaconazole as the primary option. Encouragingly, posaconazole showed favorable tolerance and infection resolution, suggesting its potential as an effective and well-tolerated alternative for consolidation treatment. This finding prompts further exploration of posaconazole, potentially leading to more effective patient care and better outcomes.
组织胞浆菌病在全球范围内构成了重大的临床挑战，特别是在南美洲，特别是在同时患有人类免疫缺陷病毒 (HIV) 感染的患者中。尽管伊曲康唑已被证实有效，但探索替代治疗方法仍然至关重要。这是迄今为止我们地区规模最大的研究，评估了探索较少的泊沙康唑治疗的效果。这项观察性研究于 2016 年至 2022 年在 Fundación Valle del Lili (FVL) 进行，纳入了患有播散性组织胞浆菌病的成年人。患者（n=31）最初接受脂质体两性霉素 B 治疗，然后用泊沙康唑或伊曲康唑进行巩固治疗。排除了单器官病例患者、缺乏微生物学诊断的患者、接受除脂质体两性霉素 B 以外的初始抗真菌治疗的患者以及随访时间<6 个月的患者（图 1）。分析考虑了人口特征、治疗方法和结果。患者（平均年龄：45.6；58.1%为女性）具有常见的合并症（HIV 38.7%、实体器官移植 29%和肿瘤疾病 12.9%）。肺部（48.4%）和淋巴结（16.1%）是常见的受累部位。活检（64.5%）是主要的诊断方法。平均给予脂质体两性霉素 B（100%）初始治疗 14 天。随访显示，71%的患者完成了治疗，19.4%的患者需要治疗调整。值得注意的是，70.9%的患者平均在 350 天以上完成了泊沙康唑巩固治疗方案。巩固治疗期间药物相互作用常见（80.6%）。没有复发，报告了 3 例与组织胞浆菌病无关的死亡。传统上，伊曲康唑是主要的初始治疗方法；然而，在我们的队列中，55.9%的患者选择泊沙康唑作为主要治疗方案。令人鼓舞的是，泊沙康唑显示出良好的耐受性和感染缓解，表明其作为巩固治疗的有效且耐受性良好的替代方案的潜力。这一发现促使进一步探索泊沙康唑，可能为患者提供更有效的治疗和更好的结果。
