Findings in moderately severe histoplasmosis:
(1) fever with body temperature > 39.5°C
(2) Karnofsky score < 60
(3) serum albumin < 3 g/dL
(4) liver function tests > 5 times normal
(5) pancytopenia, with absolute neutrophil count < 500 per µL and platelet count < 50,000 per µL
(6) serum creatinine > 5 times normal
Findings in severe histoplasmosis:
(1) hypotension with systolic blood pressure < 90 mm Hg
(2) hypoxemia, with PaO2 < 60 mm Hg
(3) mental status changes
(4) rhabdomyolysis with serum creatine kinase > 10 times normal
(5) coagulopathy
The more severe clinical course may require therapy with amphotericin B rather than with itraconazole or ketoconazole.
