Dr. Deepe, who published a study on the association between TNF blockers and histoplasmosis infections last year, said the spores seemed to be confined to specific geographic areas, particularly the Ohio River Valley in the Midwest, and the southeastern states, excluding Florida. But he also cautioned, “We don’t know where it all is.”
Once exposed, a healthy person may carry histoplasmosis spores around for a lifetime and never get sick. Drugs that suppress the immune system like TNF blockers may give the infection an opportunity to take hold.
“The problem with histoplasmosis is that there are no clinical signs or symptoms that are specific to this infection,” Dr. Deepe said. “People get fever and chills, and they can have a cough,” symptoms that could easily be mistaken for the flu or another viral complaint, he added.
Physicians who are unfamiliar with the infection, or who live in areas where it hasn’t historically been a problem, would be less likely to suspect it, Dr. Deepe said.
“If some of these patients had been from the Midwest, but now lived in these areas where it is not common, the doctor may also be less familiar with it,” Dr. Deepe said.
Patients taking TNF blockers, then, should see their doctor at the first sign of any illness.
And Dr. Deepe said he hoped the new FDA warning would spur doctors prescribing TNF blockers to closely question patients about any history of living in areas where the spores are found.
Histoplasmosis can be treated with antifungal agents if it is caught before it overwhelms the body.
