Document 0566
 DOCN  M9460566
 TI    Histoplasmosis in Missouri: historical review and current clinical
       concepts.
 DT    9404
 AU    McKinsey DS; Smith DL; Driks MR; O'Connor MC; Dept. of Epidemiology and
       Infectious Disease, Research Medical; Center, Kansas City, Missouri
       64132.
 SO    Mo Med. 1994 Jan;91(1):27-32. Unique Identifier : AIDSLINE MED/94166719
 AB    Histoplasmosis is particularly common in Missouri, and many important
       clinical observations about the disease were made in this state in the
       1950s and 1960s. When the AIDS epidemic spread to Missouri in the
       mid-1980s, histoplasmosis became recognized as a common and important
       opportunistic infection among Missourians with AIDS. Clinicians must
       maintain a high level of suspicion for histoplasmosis in any
       HIV-infected patient who presents with unexplained fever, particularly
       if the patient has evidence of hepatosplenomegaly, generalized
       lymphadenopathy, pancytopenia, abnormal liver function tests, or
       bilateral pulmonary infiltrates. The diagnosis of histoplasmosis can be
       established rapidly by observation of organisms on peripheral blood
       smear or bone marrow biopsy specimens or by Histoplasma Polysaccharide
       Antigen testing. The diagnosis can be confirmed by blood cultures in
       most cases. Histoplasmosis in AIDS is invariably fatal if not treated.
       Treatment consists of two phases: initial induction therapy and
       subsequent lifelong maintenance therapy. Amphotericin B and itraconazole
       are extremely effective for induction and maintenance therapy;
       fluconazole appears to be effective maintenance therapy. Strategies for
       the prevention of histoplasmosis in high risk patients are being
       evaluated currently.
 DE    *Histoplasmosis/DIAGNOSIS/EPIDEMIOLOGY/THERAPY  Human
       Missouri/EPIDEMIOLOGY  JOURNAL ARTICLE  REVIEW  REVIEW, TUTORIAL

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