Journal Article

Recognition, Diagnosis, and Treatment of Histoplasmosis Complicating Tumor Necrosis Factor Blocker Therapy

Chadi A. Hage, Suzanne Bowyer, Stacey E. Tarvin, Debra Helper, Martin B. Kleiman and L. Joseph Wheat

Edited by Ellie J.C. Goldstein

in Clinical Infectious Diseases

Published on behalf of Infectious Diseases Society of America

Volume 50, issue 1, pages 85-92
Published in print January 2010 | ISSN: 1058-4838
Published online January 2010 | e-ISSN: 1537-6591 | DOI: http://dx.doi.org/10.1086/648724
Recognition, Diagnosis, and Treatment of Histoplasmosis Complicating Tumor Necrosis Factor Blocker Therapy

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Life-threatening histoplasmosis is one of the most common opportunistic infections in patients receiving tumor necrosis factor (TNF) blockers. Delays in considering the diagnosis may lead to increased morbidity and mortality. Most affected patients present with pneumonitis, usually accompanied by additional signs of progressive dissemination, or with signs of progressive dissemination alone. The diagnosis often can be promptly established using antigen detection or direct examination of bronchoalveolar lavage specimens. If histoplasmosis is diagnosed promptly, antifungal therapy is highly effective. After a favorable clinical response, the safety of both discontinuation of antifungal therapy and the resumption of TNF blocker remains undetermined. The management of the immune reconstitution inflammatory syndrome that may follow discontinuation of TNF blockers also requires investigation. Prescribers should become aware of the recognition, diagnosis, and treatment of histoplasmosis and educate recipients about decreasing their risk of exposure and both recognizing and reporting signs of early infection.

Journal Article.  5790 words. 

Subjects: Infectious Diseases ; Immunology ; Public Health and Epidemiology ; Microbiology

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