Histoplasmosis: recognition and treatment.

Histoplasmosis has become an important mycosis in regions of endemicity in North and Central America. Traditionally, treatment has been reserved for patients with disseminated or chronic pulmonary histoplasmosis. The availability of safe and effective oral regimens, however, has offered alternatives to amphotericin B. Administration of amphotericin B is highly effective as therapy and produces a rapid clinical response; it remains the treatment of choice for patients with severe or moderately severe manifestations of histoplasmosis. Ketoconazole and itraconazole are well tolerated and are effective alternatives to amphotericin B for treatment of patients with milder illnesses or for use following response to amphotericin B. The determination of fluconazole's role in therapy for histoplasmosis awaits completion of ongoing trials. Continued research is needed to develop better-tolerated fungicidal alternatives to amphotericin B and oral agents with better absorption and drug interaction profiles than those of itraconazole and ketoconazole. Preventive strategies should be explored to reduce the frequency of histoplasmosis among individuals from regions of endemicity who are at high risk for more severe manifestations of histoplasmosis.