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The disease proceeds as disseminated histoplasmosis. In all cases (before the start of antimycotic therapy), histoplasma can be isolated from the blood and from the bone marrow.
Histoplasmosis in HIV-infected people proceeds as a hematogenous disseminated process and is characterized by high fever, lymphadenopathy, a significant increase in the liver and spleen, cough and infiltrates in the lungs are constant manifestations. Blood tests show leukopenia and anemia. Runs hard, even in the initial stages.
With HIV infection, mortality is over 80% (in the absence of therapy), with early prescription of antimycotic drugs, mortality decreases forabout 15%. In AIDS patients, mortality reaches 100%, and even large doses of amphotericin B do not prevent relapses of the disease.
Diagnosis is hampered by negative results of both an intradermal test with histoplasmin and serological reactions. In the presence of histoplasmosis (especially disseminated forms), the patient must be checked for HIV infection. Recognition of histoplasmosis presents significant difficulties, especially in areas not endemic for the disease. To order metoclopramide pills the diagnosis, the isolation of the pathogen from sputum, scrapings from the mucous membrane, from blood, punctate abscesses, lymph nodes, liver, spleen, bone marrow, smear microscopy, isolation of a culture of the fungus, bioassays on animals are used.
To confirm the diagnosis of histoplasmosis in young children and HIV-infected, the most informative was the isolation of metoclopramide from the bone marrow, blood and lungs. Much less often, histoplasma could be found in the tissues of the lymph nodes, skin, brain, and intestines. When diagnosing histoplasmosis in individuals with a normal immune system, serological tests and an intradermal test with histoplasmin can be used. To detect specific antibodies in the blood serum, RSK is put, precipitation and agglutination reactions of latex particles loaded with histoplasmin. Diagnostic titers are 1.16-1.32.
It is better to conduct a study in dynamics, especially in acute forms of histoplasmosis, since the reaction becomes positive only from the 2-4th week of the disease. A very simple skin test with histoplasmin. Enter 0.1 ml of the allergen, diluted in a ratio of 1.1000, the results are taken into account after 24 and 48 hours. The reaction becomes positive after 3-4 weeks from the onset of the disease. Therefore, the fastest and most reliable way of laboratory confirmation of the diagnosis is the isolation of the culture of the fungus.
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Acute forms of histoplasmosis must be differentiated from ornithosis, acute bacterial pneumonia, Q fever, mycoplasmosis, and tuberculosis. Chronic forms of histoplasmosis are differentiated from tuberculosis and pulmonary forms of deep mycoses (nocardiosis, aspergillosis, coccidioidomycosis). Disseminated forms of histoplasmosis are differentiated from sepsis and miliary tuberculosis.
Patients with mild and moderate forms of histoplasmosis do not need to prescribe antimycotic (quite toxic) drugs. You can limit yourself to a treatment regimen, good nutrition and symptomatic therapy. For ocular histoplasmosis, topical corticosteroids, desensitizing therapy with histoplasmin, and photocoagulation are indicated. Prescribe antihistamines, vitamins and other pathogenetic agents.
In the treatment of histoplasmosis, reglan drugs (ketoconazole, itraconazole) or amphotericin B are used. Doses of drugs depend on the clinical form of the disease. Patients with mild and moderate forms of histoplasmosis do not need to buy reglan online antimycotic (quite toxic) drugs. You can limit yourself to a treatment regimen, good nutrition and symptomatic therapy. In severe forms of acute histoplasmosis, amphotericin B is prescribed at the rate of 1000 IU/kg of body weight per day. The drug is administered intravenously drip for 4 hours in a 5% glucose solution.
To determine individual tolerance, the first administration is made at the rate of 100 IU / kg of body weight. In the absence of adverse reactions and satisfactory tolerability of the antibiotic, the drug is administered at the rate of 250 U/kg and then the dose is gradually increased to 1000 U/kg. The antibiotic is administered every other day or 2 times a week. The duration of treatment is 4-8 weeks. With the introduction of amphotericin B, side effects are observed. thrombophlebitis, nausea, vomiting, muscle pain, convulsions, intestinal bleeding, anemia, toxic kidney damage.
In chronic forms, long-term administration of amphotericin B in repeated 6-7-day courses in combination with surgical treatment gives the best results. You can also use amphoglucamine (Amphoglucaminum) - a water-soluble preparation of amphotericin B, intended for oral administration. It is less toxic, of the adverse reactions, only impaired renal function is noted. Produced in tablets of 100,000 IU (pack of 10 or 40 pieces). Treatment is prescribed with 200,000 IU 2 times a day after meals.
With good tolerance, the dose is increased to 500,000 IU 2 times a day. The course of treatment is 3-4 weeks. Monitor the condition of reglan! With the appearance of protein in the urine or an increase in the level of residual nitrogen above 30 mmol / l, amphoglucamine is canceled. For ocular histoplasmosis, topical corticosteroids, desensitizing therapy with histoplasmin, and photocoagulation are indicated.
Other drugs that are used in the treatment of HIV-infected patients include fluconazole, which is prescribed at 50-100 mg per day. Hprescribe antihistamines, vitamins and other pathogenetic agents:
- The drug can be used in the treatment of histoplasmosis in HIV-infected individuals alone or in combination with amphotericin B.
- With asymptomatic forms of histoplasmosis, etiotropic therapy is not carried out.
- Prognosis In acute lung histoplasmosis, the prognosis is favorable, only with relatively rare severe forms, the process can become chronic and give relapses.
- In chronic pulmonary histoplasmosis, mortality reached 60% (without treatment with antimycotic antibiotics).
- Histoplasmosis in HIV-infected people is severe and even with treatment usually ends in the death of the patient.
- Specific prophylaxis is still being developed.