Histoplasmosis: An endemic mycosis.Overview of epidemiology, clinical features, diagnosis, and treatment

Histoplasmosis is an endemic fungal disease in America caused by a dimorphic fungus, Histoplasma capsulatum, which affects immunocompetent individuals and, more significantly, those with immune system impairments or at the extremes of age. Children are particularly susceptible to disseminated disease and severe forms, with high lethality if left untreated. The most common symptoms include fever, weight loss, and visceromegaly, although the disease can often be completely asymptomatic, depending on host factors and the initial inoculum size. Histopathology, antigen and antibody measurement, culture, and molecular techniques are fundamental in diagnosing histoplasmosis, with varying effectiveness across different clinical forms. When treatment is indicated, international guidelines recommend intensive induction therapy with Amphotericin B for 2 to 4 weeks, followed by itraconazole for 12 months as maintenance therapy in disseminated forms. Follow-up should ensure clinical and microbiological cure and a decrease in antigenuria levels to prevent relapse and ensure therapeutic success