[Histoplasmosis: not only a tropical disease].

Histoplasmosis is a fungal infection resulting from inhalation of spores from the fungus Histoplasma capsulatum; it is known to be endemic in various parts of the world, especially in North and Latin America, and can produce a spectrum of illness, from subclinical infection to progressive disseminated disease. The majority of infected persons have an asymptomatic, self-limiting illness. Clinical pneumonia occurs in those with exposure to a large number of infecting spores. Disseminated histoplasmosis usually occurs in immunosuppressed patients or in patients with chronic illness. Diagnosis is best made by visualization of yeast in tissue or by culture. In most cases, amphotericin B is the initial drug of choice, followed by one of the azoles for lifelong maintenance therapy. Itraconazole is the drug of choice for treatment of disseminated histoplasmosis in less severe cases, while fluconazole therapy for histoplasmosis is only moderately effective.