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, L. Joseph Wheat

Research output: Contribution to journalReview article

106 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)85-92
Number of pages8
JournalClinical Infectious Diseases
Volume50
Issue number1
DOIs
StatePublished - Jan 1 2010

ASJC Scopus subject areas

  • Microbiology (medical)
  • Infectious Diseases

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