Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with acute onset of fever, non-productive cough, retrosternal chest pain, and generalized malaise. History significant for recent exposure to bird/bat guano or soil disruption in endemic areas (e.g., Ohio/Mississippi River valleys). Symptoms began [Number] days ago, progressive in nature, associated with dyspnea on exertion and occasional night sweats. Denies hemoptysis or significant weight loss.
Clinical Examination Findings
Vitals: Febrile, tachypneic, O2 saturation [Percentage]% on room air. HEENT: No cervical lymphadenopathy. Respiratory: Auscultation reveals diffuse crackles or scattered wheezing; no signs of consolidation or pleural effusion. Cardiovascular: Tachycardic, regular rhythm, no murmurs. Skin: No evidence of erythema nodosum or erythema multiforme.
Treatment Protocol
For mild-to-moderate acute pulmonary histoplasmosis in immunocompetent patients, supportive care is indicated. If symptoms persist >4 weeks or are moderate-to-severe, initiate Itraconazole 200mg BID for 6-12 weeks. Monitor LFTs and serum drug levels. If severe/hypoxemic, consider initial IV Amphotericin B followed by oral step-down therapy.