Internal Medicine

0521779407-09 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:13

722 Histoplasma Capsulatum Homocystinuria

■Subacute and Chronic PDH

➣Itraconazole

➣Amphotericin

Side Effects & Complications

■Itraconazole – absorption issues related to acidity, IV form not

approved for severely impaired renal function. Interferes with P450

metabolism, multiple drug interactions, possible hepatitis

■Ketoconazole – more drug-drug interactions, GI side effects, hepati-

tis

■Amphotericin B – nephrotoxicity, infusion-related side effects, hypo-

kalemia, hypomagnesemia

follow-up

During Treatment

■Clinical follow-up

■Periodic CXR with cavitary disease

■Document negative cultures from normally sterile site (blood, CSF,

pleural/pericardial)

Routine

■Lifelong suppression for AIDS or post-transplant/severely immuno-

compromised

complications and prognosis

■Disseminated disease (see above) – meningitis, endocarditis, peri-

carditis

■Progressive disease (see above)

■Prognosis – Good for acute disease, chronic disease in non-

immunosuppressed individuals; poor for acute disseminated dis-

ease, especially if continued immunosuppression

Homocystinuria.....................................

GREGORY M. ENNS, MD

history & physical

History

■history of parental consanguinity or previously affected sibling

(autosomal recessive inheritance)

■newborn screening in some states, countries (incidence∼1/250,000)