Objective:To refine diagnostic ability and therapeutic decisions of clinicians and to come up with some evidence for epidemiological survey of disseminated histoplasmosis(DH). Methods:A retrospective descriptive study was conducted between 2008 and2014 in the First Affiliated hospital of Chongqing Medical University. The clinical signs

epidemiology

diagnosis

treatment

and outcomes of 6 DH patients confirmed by direct examination of bone marrow smear or lymph node biopsy were retrospectively analyzed.Results:The 6 patient were HIV negative and their CD4 lymphocyte counts were normal. The main clinical signs noted in 6 patients were fever

weight loss

lassitude

lymphadenopathy

hepatosplenomegaly. Laboratory abnormalities including pancytopenia

elevated γ-glutamine transferase(GGT)

alkaline phosphatase(ALP)were common findings. Cultures of blood

bone marrow were all negative. Of the 6 DH cases

5 were confirmed by direct examination of bone marrow smears

1 was confirmed by biopsy of the right axillary lymph node

which revealed necrotizing granulomas

periodic acid-schiff stains were positive for fungi. Antifungal therapy were started on amphotericin B(Am B)in 4 patients

and started on liposomal amphotericin B(L-Am B)or voriconazole in another 2 patients

respectively. Then the 2 latter patients were subsequently switched on day 7 to Am B secondary economic hardship or having no improvement of symptoms. Six patients with gradual escalation up to 0.5-0.65 mg/kg/day for 23-60 days;all of the patient’s symptoms were found to be significantly improved or disappeared. After that

4 patients transitioned to oral itraconazole of 200 mg for 15 days-6 months.The patients all cured;all patients have been followed up 1-7 years without relapse. Conclusion:Chongqing may be one of the natural epidemics zone of DH. The observed clinical and biological signs of DH do not differ from the literature;clinical symptoms of DH are unspecific and mimicking the features of tuberculosis;the clinicians should therefore be aware of this uncommon infection and its various clinical manifestations in immunocompetent patients. The direct examination of bone marrow aspiration or the lymph node cytology maybe is a rapid

cost-effective and reliable method to identify infection with DH. Although L- Am B is the recommended first-line treatment for DH

Am B is the accepted standard of care for the treatment of moderate to severe DH in this cohort.