Match each immunocompromised patient scenario with the most appropriate antimicrobial prophylaxis or maintenance regimen.
- A 34-year-old with HIV, CD4 count 85 cells/mm³, positive Toxoplasma gondii IgG, severe sulfonamide allergy (Stevens-Johnson syndrome), and known glucose-6-phosphate dehydrogenase (G6PD) deficiency.Atovaquone monotherapy
- A 41-year-old with HIV, CD4 count 40 cells/mm³, positive Toxoplasma gondii IgG, sulfonamide-induced anaphylaxis, and normal G6PD enzyme levels.Dapsone, pyrimethamine, and leucovorin
- A 29-year-old with HIV, CD4 count 180 cells/mm³, asymptomatic, positive interferon-gamma release assay, and a clear chest radiograph.Isoniazid and pyridoxine
- A 38-year-old with HIV, CD4 count 80 cells/mm³, asymptomatic, who just completed 2 weeks of induction therapy with liposomal amphotericin B and flucytosine for meningoencephalitis.Fluconazole monotherapy
Answer
The correct pairings match Patient 1 with atovaquone monotherapy, Patient 2 with dapsone, pyrimethamine, and leucovorin, Patient 3 with isoniazid and pyridoxine, and Patient 4 with fluconazole monotherapy.
Each patient scenario is correctly matched to a regimen by assessing the pathogen targets required by the CD4 count and patient history, and then navigating the specific pharmacological contraindications (such as G6PD deficiency and severe sulfa allergies) to find the safest and most effective standard-of-care regimen.
Step-by-Step Solution
Key Concept
Selection of appropriate opportunistic infection prophylaxis and maintenance therapy in immunocompromised patients, tailored to specific medication allergies and enzyme deficiencies.