Histoplasmosis case-Fatality Score

Prognostic of death at 30 days of treatment of disseminated histoplasmosis in patients living with HIV

Clinical criteria





Radiological criterion

Biological criteria


Cytopenia








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A HFS <5 is associated with a risk of death < 5% after 30 days of antifungal therapy → Induction treatment with itraconazole can be considered

A HFS ≥5 is associated with a risk if death ≥ 33% after 30 days of antifungal therapy → Induction treatment with liposomal amphotericin B is recommended


Supplemental data


HFS scale
Performance Status ≥3 +2
Altered mental Status +3
Dyspnea +2
Intestitial lung pattern on thoracic X-ray +1
CRP ≥75 mg/L +2
One cytopenia (Hb <9 g/dL or platelet <100000 /mL) +1
Two cytopenia (Hb <9 g/dL and platelet <100000 /mL) +2


Performance Status scale
Fully active, able to carry on all predisease performance without restriction 0
Restricted in physically strenous activity, but ambulatory and able to carry out work of a light and sedentary nature (e.g. light house work, office work) 1
Ambularoty and capable od all self-care but unable to carry out any work activities. Up and about more than 50% of waking hours 2
Capable of only limited self-care, confined to bed or chair more than 50% of waking hours 3
Completely disabled. Cannot carry on any self-care. Totally confined to bed or chair. 4
Dead 5
Reference : Françoise U, Nacher M, Bourne-Watrin M, Epelboin L, Thorey C, Demar M, Carod JF, Djossou F, Couppié P, Adenis A. Development of a case fatality prognostic score for HIV-associated histoplasmosis. Int J Infect Dis. 2023 Jul;132:26-33. doi: 10.1016/j.ijid.2023.03.048. Epub 2023 Apr 7. PMID: 37030655.