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For asymptomatic or people with acute localized infection who are otherwise healthy, antifungal treatment is usually not recommended by the Centers for Disease Control and Prevention (CDC) as the infection will resolve on its own in about three weeks. If symptoms persist a month or more, itraconazole (Sporanox), ketoconazole (Nizoral), or amphotericin B may be effective. If central nervous system (CNS) involvement occurs, or if the person is compromised by other diseases or is immunocompromised and has severe histoplasmosis (progressive disseminated histoplasmosis), either itraconazole or amphotericin B is recommended. The lengths of time, dosing amounts, and dosing routes are individualized for the patient; consultations with both infectious disease and pulmonary specialists are recommended. Treatments may last for many weeks to about a year. Immunocompromised patients may require lifelong antifungal medication. Other new azole compounds may be effective in some difficult or unresponsive cases; specialists could help select the appropriate new drug treatment. Surgery has been used to treat some complications seen in some individuals with histoplasmosis. For example, pericardiocentesis or a pericardial window procedure (both designed to remove fluid that compresses the heart) may be performed in patients who develop pericarditis. Surgery is also used to resect cavitary lung lesions, to excise lymph nodes that compress pulmonary, vascular or other structures, or to replace damaged heart valves or other structures.
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