Histoplasmosis in Indianapolis.

Recurrent outbreaks of histoplasmosis in Indianapolis since 1978 have expanded our understanding of histoplasmosis. Histoplasmosis has emerged as the leading opportunistic infection in patients with AIDS from Indianapolis. Clinical manifestations of histoplasmosis are influenced by host factors. Underlying lung disease predisposes to chronic pulmonary histoplasmosis, and immunosuppressive medications or disorders predispose to dissemination. Inflammatory manifestations, including arthritis, erythema nodosum, and pericarditis, commonly occur with acute histoplasmosis. Diagnosis of histoplasmosis requires understanding of the accuracy and limitations of cultural and serological methods. More recently, radioimmunoassay for polysaccharide antigen has offered a new diagnostic approach. Amphotericin B remains the gold standard for treatment and is highly effective, even in immunocompromised individuals. Itraconazole shows promise as an alternative to amphotericin B for treatment of less severely ill patients. The role of fluconazole in therapy remains unknown until ongoing clinical trials are completed. Histoplasmosis cannot be cured in individuals with AIDS and in a small proportion of other individuals with other underlying immunosuppressive conditions. In such cases, long-term maintenance treatment is required to prevent relapse. Antigen detection has proven useful for following progress during treatment and for identifying relapse.