Histoplasmosis is one of the most frequent causes of fungal respiratory infection in endemic regions, has a broad spectrum of clinical manifestations and can present in several forms. The extent of disease is determined by the number of conidia inhaled, the immune response of the host and the integrity of the respiratory tract. From an initial and most benign form, acute pulmonary histoplasmosis (an influenza-like illness that is typically asymptomatic or mild in persons without prior immune compromise), histoplasmosis can become a lifethreatening progressive disseminated infection (PDH) that affects mainly immunocompromised patients, with high morbidity and mortality. Chronic pulmonary histoplasmosis is an uncommon manifestation of Histoplasma infection, with features similar to pulmonary tuberculosis, and if it remains undiagnosed or untreated it also can cause significant morbidity. Some rare but serious complications may also occur that are produced by an excessive immune response, such as mediastinal fibrosis, histoplasmoma and broncholithiasis. Histoplasmosis is highly endemic in regions of North, Central and South America as well as being reported in parts of Asia and Africa. The risk of histoplasmosis is greatest in patients with HIV infection, especially those with CD4⁺ counts of <200 cells/μL. We review clinical manifestations, radiological findings and treatment options according to the clinical form (induction therapy and maintenance therapy), as well as different diagnosis tools and new laboratory tests that have been recently developed and validated and are becoming widely available. These should have an impact in reducing time for diagnosis and starting therapy and in reducing morbidity and mortality, especially in patients with HIV infection, where histoplasmosis is currently estimated to be responsible for 5-15% of AIDS-related deaths.

组织胞浆菌病是流行地区真菌性呼吸道感染的最常见原因之一，具有广泛的临床表现并且可以以多种形式存在。疾病的程度取决于吸入的分生孢子数量、宿主的免疫反应和呼吸道的完整性。从最初和最良性的形式，急性肺组织胞浆菌病（一种流感样疾病，在没有先前免疫受损的人中通常无症状或轻微），组织胞浆菌病可以成为危及生命的进行性播散性感染 (PDH)，主要影响免疫功能低下的患者，具有高发病率和死亡率。慢性肺组织胞浆菌病是一种不常见的表现形式组织胞浆菌感染，具有类似于肺结核的特征，如果仍未确诊或未治疗，也可能导致严重的发病率。一些罕见但严重的并发症也可能由过度的免疫反应产生，例如纵隔纤维化、组织胞浆菌瘤和支气管结石。组织胞浆菌病在北美、中美和南美地区高度流行，在亚洲和非洲部分地区也有报道。HIV 感染者发生组织胞浆菌病的风险最大，尤其是那些 CD4 ⁺<200 个细胞/μL 的计数。我们根据临床形式（诱导治疗和维持治疗）审查临床表现、放射学发现和治疗方案，以及最近开发和验证并广泛使用的不同诊断工具和新实验室测试。这些应该对减少诊断和开始治疗的时间以及降低发病率和死亡率产生影响，特别是在 HIV 感染患者中，目前估计组织胞浆菌病是 5-15% 的 AIDS 相关死亡原因。