Treatment

Seek expert advice.

• asymptomatic individuals with only calcific pulmonary nodules do not require treatment
  • also, most individuals with only a few noncalcified nodules do not require treatment
  • histoplasmosis in immunocompetent, healthy people will resolve without antifungal therapy
  • asymptomatic patients with elevated risk for developing disseminated/severe histoplasmosis, such as those with specific immunocompromising conditions, should be closely monitored for clinical/radiological change, and the treating clinician should consider starting itraconazole
• acute pulmonary histoplasmosis
  • treatment should be considered in immunocompromised individuals and individuals whose symptoms have not improved after 4 weeks, with progression of pulmonary infiltrates, or with enlarging hilar or mediastinal adenopathy
  • in adults, itraconazole is preferred - treatment duration is 6–12 weeks
• chronic pulmonary histoplasmosis
  • prolonged course of itraconazole (≥ 12 months)
• treatment of moderately severe–severe histoplasmosis (defined as histoplasmosis associated with systemic illness, organ dysfunction, or respiratory compromise, or disseminated disease)
  • consists of a minimum of 10–14 days of induction therapy with amphotericin B, followed by consolidation with oral itraconazole for at least 12 months in total, or until immune reconstitution or restoration
• CNS involvement
  • treatment consists of 4–6 weeks of amphotericin B, followed by 1 year of itraconazole
• surgical intervention may be required for the excision of histoplasmomas or chronic cavitatory lung lesions

Reference:

1. Brown L et al. Histoplasmosis in the United Kingdom: Diagnosis and management in a non-endemic setting.Clinical Infection in Practice August 7th 2026.
2. Jenks JD, Koirala J. Histoplasmosis. [Updated 2026 Jul 15]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2026 Jan-.