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Antimicrobial Agents and Chemotherapy, August 2001, p. 2354-2357, Vol. 45, No. 8
0066-4804/01/$04.00+0   DOI: 10.1128/AAC.45.8.2354-2357.2001
Copyright © 2001, American Society for Microbiology. All rights reserved.

Clearance of Fungal Burden during Treatment of Disseminated Histoplasmosis with Liposomal Amphotericin B versus Itraconazole

L. Joseph Wheat,1,2,3,* Gretchen Cloud,4 Philip C. Johnson,5 Patricia Connolly,1,2 Mitchell Goldman,1 Ann Le Monte,1,2 Deanna E. Fuller,1 Thomas E. Davis,1 Richard Hafner,6 The AIDS Clinical Trials Group, and The Mycoses Study Group Of NIAID

Indiana University School of Medicine,1 Histoplasmosis Reference Laboratory,2 and Veterans' Affairs Medical Center,3 Indianapolis; Indiana, University of Alabama at Birmingham, Birmingham, Alabama4; University of Texas-Houston Medical School, Houston, Texas5; and Division of AIDS, National Institute of Allergy and infectious Diseases, Rockville, Maryland6

Received 25 January 2001/Returned for modification 26 March 2001/Accepted 7 May 2001

Animal studies have shown that fungal burden correlates with survival during treatment with new antifungal therapies for histoplasmosis. The purpose of this report is to compare the clearance of fungal burden in patients with histoplasmosis treated with liposomal amphotericin B versus itraconazole. In two separate closed clinical trials that evaluated the efficacy of liposomal amphotericin B and itraconazole treatment of disseminated histoplasmosis in patients with AIDS, blood was cultured for fungus and blood and urine were tested for Histoplasma antigen. The clinical response rates were similar; 86% with liposomal amphotericin B (n = 51) versus 85% with itraconazole (n = 59). Of the patients with positive blood cultures at enrollment, after 2 weeks of therapy cultures were negative in over 85% of the liposomal amphotericin B group versus 53% of the itraconazole group (P = 0.0008). Furthermore, after 2 weeks, median antigen levels in serum fell by 1.6 U in the liposomal amphotericin B group versus 0.1 U in the itraconazole group (P = 0.02), and those in urine fell by 2.1 U in the liposomal amphotericin B group and 0.2 U in the itraconazole group (P = 0.0005). The more rapid clearance of fungemia supports the use of liposomal amphotericin B rather than itraconazole for initial treatment of moderately severe or severe histoplasmosis.

* Corresponding author. Mailing address: Indiana University School of Medicine, Histoplasmosis Reference Laboratory, 1001 West Tenth St., Indianapolis, IN 46202-2879. Phone: (317) 630-6262. Fax: (317) 630-7522. E-mail: lwheat{at}iupui.edu.

Antimicrobial Agents and Chemotherapy, August 2001, p. 2354-2357, Vol. 45, No. 8
0066-4804/01/$04.00+0   DOI: 10.1128/AAC.45.8.2354-2357.2001
Copyright © 2001, American Society for Microbiology. All rights reserved.


This article has been cited by other articles:

  • Olson, J. A., Adler-Moore, J. P., Jensen, G. M., Schwartz, J., Dignani, M. C., Proffitt, R. T. (2008). Comparison of the Physicochemical, Antifungal, and Toxic Properties of Two Liposomal Amphotericin B Products. Antimicrob. Agents Chemother. 52: 259-268 [Abstract] [Full Text]  
  • Connolly, P. A., Durkin, M. M., LeMonte, A. M., Hackett, E. J., Wheat, L. J. (2007). Detection of Histoplasma Antigen by a Quantitative Enzyme Immunoassay. CVI 14: 1587-1591 [Abstract] [Full Text]  
  • Kauffman, C. A. (2007). Histoplasmosis: a Clinical and Laboratory Update. Clin. Microbiol. Rev. 20: 115-132 [Abstract] [Full Text]  
  • Wheat, L. J., Connolly, P., Haddad, N., Le Monte, A., Brizendine, E., Hafner, R. (2002). Antigen Clearance during Treatment of Disseminated Histoplasmosis with Itraconazole versus Fluconazole in Patients with AIDS. Antimicrob. Agents Chemother. 46: 248-250 [Abstract] [Full Text]  
  • (2001). Treatment of Disseminated Histoplasmosis in AIDS Patients. JWatch Infect. Diseases 2001: 7-7 [Full Text]  


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