At the 2025 International Society for Human and Animal Mycology (ISHAM) meeting in Brazil, the Histoplasmosis ISHAM Working Group was again convened to update the 2019 aspirational targets adopted – ‘the Manaus Declaration’.
A recent estimate indicated over 70,000 cases of histoplasmosis in AIDS and probably about 66,000 deaths, primarily because of a lack of suspicion and diagnosis.
The ‘Manaus Declaration’ focussed on Latin America – the new targets are global. Likewise, the previous targets were focussed on diagnosis with antigen and/or PCR and availability of antifungal targets – the new targets have added starting treatment for documented disease.
Attended by 84 experts from across the world, and more online, the next steps were partly informed by GAFFI’s FungiRed project in Guatemala, presented by Eduardo Arathoon. The meeting heard about significant, but incomplete, progress in Latin America towards fulfilling the Manaus Declaration aspiration – 100% country access to Histoplasma antigen and/or PCR testing and access to liposomal amphotericin B and itraconazole for treatment.
The newly minted global targets are focussed on:
- Diagnosis of symptomatic patients with possible histoplasmosis (as determined by immune deficiency, respiratory cavitation or nodules, adrenal masses, gut ulceration, prolonged fever or unusual skin lesions)
- Initiation of treatment in those with evidence of histoplasmosis
- Reducing mortality of histoplasmosis to under 10%.
The research agenda to be laid out as part of these new targets is extensive, including new endpoints and strategies for successful therapy, better understanding of pulmonary histoplasmosis, including those with susceptible or resistant TB, inclusion of Histoplasma antibody and antigen testing in diagnostic algorithms, identifying gaps in health systems pertaining to histoplasmosis, defining patients at risk and new endemicity localities and regions.
The meeting was organised by Alessandro Pasqualotto of the Federal University of Health Sciences of Porto Alegre, Brazil, and Antoine Adenis, from the Cayenne Hospital Center, French Guiana, in association with the PanAmerican Health Organization (PAHO) and ISHAM. Pasqualotto declared: “Progress towards achieving the goals set out in 2019 in Manaus has been steady, but since then substantial numbers of patients with histoplasmosis have been identified in many other countries, and new, important data have emerged. It is time to broaden the scope and geographical reach of recommendations. Our meeting identified many knowledge, diagnostic and treatment gaps. We hope these new global targets will enable better patient outcomes and fewer deaths.”
The full details about the targets will be published (after consultation) in the next few months.
