Histoplasmosis of the Central Nervous System

Abstract

Histoplasmosis of the central nervous system (CNS) is not an uncommon complication of Histoplasma capsulatum infection since it occurs in ∼2% to 20% of disseminated cases. CNS histoplasmosis carries a mortality rate that ranges from 11.1% to 100%, and the risk factors for dissemination to the brain have yet to be determined. Diagnosis is often difficult and time consuming, which can result in delayed initiation of treatment. The recommended treatment for CNS histoplasmosis involves a high dose liposomal amphotericin B followed by maintenance azole therapy, usually for at least a year; however no comparative trials have been performed to prove efficacy of one regimen over another. Further, prospective and in vivo studies are necessary to more effectively combat this disease.