[The treatment of aspergillosis, cryptococcosis and histoplasmosis in immunocompromised patients. Report of experience in the United States].

Itraconazole has emerged as an important new oral agent in the treatment of systemic fungal infections. We report a summary of available data on its use in aspergillosis, cryptococcosis and histoplasmosis compiled in the United States with particular attention to the immunocompromised host. Data has been accrued in open-label studies including 57 patients with cryptococcal disease where the overall response rate among patients with meningitis was 86%, 28 patients (seven with HIV infection) with invasive aspergillus where the overall response rates were 80% in non-AIDS and 42% in HIV patients. Data is summarized on six patients with allergic bronchopulmonary aspergillosis, all of whom improved on therapy, and twelve patients with histoplasmosis including eight with AIDS, eleven of whom responded (three newly reported cases are included). In summary, itraconazole showed activity in human studies of aspergillosis, cryptococcosis and histoplasmosis with minimal toxicity. Itraconazole offers a new oral alternative to conventional amphotericin B therapy in these infections. Comparative studies are needed to clarify its role.