ArticleClinical infectious diseases : an official publication of the Infectious Diseases Society of America2021
Voriconazole Versus Itraconazole for the Initial and Step-down Treatment of Histoplasmosis: A Retrospective Cohort.
Article in Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 20 papers.
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20 citing papers in PubMed, 43 citations in OpenAlex.
- Emerging Antifungal Resistance in Tropical Mycoses: A Genomic and Clinical Perspective From Endemic Zones.Journal of the Royal Society of New Zealand · 2026Review
- Histoplasmosis: a missing piece in the global efforts to end HIV deaths.The lancet. HIV · 2026Review
- A Retrospective, Comparative Cohort Analysis of the Utilization of Voriconazole-Containing Regimens Versus Itraconazole in the Treatment of Blastomycosis.Journal of fungi (Basel, Switzerland) · 2026Article
- Real-world Evaluation of Histoplasmosis Diagnosis and Treatment in Patients From a Michigan Health System.Open forum infectious diseases · 2025Article
- In Silico Evaluation of Acalypha indica Phytochemicals as Potential Antifungal Agents Targeting Saccharomyces cerevisiae Lanosterol 14-Alpha Demethylase.Cell biochemistry and biophysics · 2025Article
- Lymphoma Induced Chylothorax Complicated by Disseminated Histoplasmosis and Esophagopericardial Fistula.Clinical case reports · 2025Article
- Chronic cavitary pulmonary histoplasmosis treated with isavuconazole after a hypersensitivity reaction to itraconazole.Medical mycology case reports · 2025Article
- Histoplasmosis.Infectious disease clinics of North America · 2025Review
- Challenges in Management of Uncommon Otologic Fungal Disease - a Case Series and Review of Literature.Indian journal of otolaryngology and head and neck surgery : official publication of the Association of Otolaryngologists of India · 2024Article
- Histoplasmosis in Taiwan: Case Summary and Literature Review.Life (Basel, Switzerland) · 2024Review
- Case Report: Primary Cutaneous Histoplasmosis in an Immunocompetent Patient After Cosmetic Injection of Platelet-Rich Plasma Treated with Trimethoprim-Sulfamethoxazole.The American journal of case reports · 2024Article
- MSG-15: Super-Bioavailability Itraconazole Versus Conventional Itraconazole in the Treatment of Endemic Mycoses-A Multicenter, Open-Label, Randomized Comparative Trial.Open forum infectious diseases · 2024Article
- An update on the global treatment of invasive fungal infections.Future microbiology · 2023Review
- Diagnosis and Treatment of Fungal Infections in Lung Transplant Recipients.Pathogens (Basel, Switzerland) · 2023Review
- Reply to Ito and Ogawa.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2022Article
- Management of Histoplasmosis by Infectious Disease Physicians.Open forum infectious diseases · 2022Article
- Global guideline for the diagnosis and management of the endemic mycoses: an initiative of the European Confederation of Medical Mycology in cooperation with the International Society for Human and Animal Mycology.The Lancet. Infectious diseases · 2021Review
- Diagnostic Methods and Risk Factors for Severe Disease and Mortality in Blastomycosis: A Retrospective Cohort Study.Journal of fungi (Basel, Switzerland) · 2021Article
- Prospects for durable immune control of SARS-CoV-2 and prevention of reinfection.Nature reviews. Immunology · 2021Review
- Treatment and Prevention of Histoplasmosis in Adults Living with HIV.Journal of fungi (Basel, Switzerland) · 2021Review
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7 authors at 1 institution in 1 country.
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Abstract
backgroundItraconazole is the preferred azole for histoplasmosis in the current Infectious Diseases Society of America guidelines. Voriconazole is increasingly used as treatment for histoplasmosis; it has in vitro activity against Histoplasma capsulatum and has shown success in case reports and small case series, but may have a lower barrier to resistance. No comparative studies have been published.
methodsWe constructed a single-center, retrospective cohort of adult patients diagnosed with histoplasmosis from 2002 to 2017. Individual charts were reviewed to gather clinical information, including demographics, clinical features, immune status, treatments, and mortality. Patients were categorized based on the choice of azole and use as an initial treatment or as a step-down therapy from amphotericin B. Initial therapies with other azoles were excluded. Mortality was compared using a multivariable Cox proportional hazards with Heaviside function at 42 days.
resultsWe identified 261 cases of histoplasmosis from 2002 to 2017. After excluding patients not treated with itraconazole or voriconazole, 194 patients remained. Of these, 175 (90%) patients received itraconazole and 19 (10%) received voriconazole. There were no significant demographic differences between patient populations receiving either azole as their initial azole treatment. Death at 180 days occurred in 41 patients (23.4%) in the itraconazole group and 6 patients (31.6%) in the voriconazole group. Patients on voriconazole had a statistically significant increase in mortality during the first 42 days after initiation of treatment when compared to patients receiving itraconazole (hazard ratio, 4.30; 95% confidence interval, 1.3-13.9; P = .015), when controlled for other risk factors.
conclusionsVoriconazole in histoplasmosis was associated with increased mortality in the first 42 days when compared to itraconazole.
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