Examkin

Question

Difficulty: HardInfectious Diseases

Match each clinical vignette describing a systemic fungal infection with the most appropriate first-line pharmacotherapy.

  • A 45-year-old immunocompetent man from Wisconsin with a 6-week history of productive cough, low-grade fever, and a verrucous, crusted plaque on his forearm. Sputum cytology reveals large, broad-based budding yeasts. He is hemodynamically stable with no neurologic symptoms.Oral itraconazole
  • A 32-year-old man with advanced HIV presents with a 4-week history of fever, significant weight loss, hepatosplenomegaly, and painful palatal ulcers. Bone marrow biopsy demonstrates small oval yeasts packed closely within macrophages.Intravenous liposomal amphotericin B followed by oral itraconazole
  • A 38-year-old woman with advanced HIV presents with a 2-week history of worsening headache, nausea, and lethargy. Lumbar puncture reveals an opening pressure of 320 mm H2O. CSF India ink preparation reveals heavily encapsulated budding yeasts.Intravenous liposomal amphotericin B plus oral flucytosine
  • A 55-year-old man with acute myeloid leukemia and profound neutropenia for 15 days develops fever, pleuritic chest pain, and hemoptysis. Chest computed tomography shows a right upper lobe macronodule surrounded by a ground-glass opacity (halo sign).Intravenous voriconazole

Answer

Mild-to-moderate blastomycosis is matched with oral itraconazole; Disseminated histoplasmosis is matched with intravenous liposomal amphotericin B followed by oral itraconazole; Cryptococcal meningoencephalitis is matched with intravenous liposomal amphotericin B plus oral flucytosine; Invasive pulmonary aspergillosis is matched with intravenous voriconazole.
Each fungal infection dictates a highly specific regimen. Mild blastomycosis is successfully treated with itraconazole. Disseminated histoplasmosis demands amphotericin B induction followed by itraconazole maintenance. Cryptococcal meningitis requires synergistic amphotericin B and flucytosine to clear the CNS. Invasive aspergillosis uniquely requires the mold-active triazole voriconazole.

Step-by-Step Solution

1
Analyze the first vignette to determine the pathogen and disease severity.
Broad-based budding yeasts in a stable patient from Wisconsin indicates mild-to-moderate blastomycosis, which responds well to oral triazoles.
Accurate pathogen identification and severity stratification dictate whether oral or intravenous antifungal therapy is required.
2
Analyze the second vignette for pathogen morphology and clinical status.
Intracellular yeasts in macrophages with hepatosplenomegaly in an HIV patient indicates progressive disseminated histoplasmosis, requiring aggressive two-step therapy.
Disseminated endemic mycoses in severely immunocompromised hosts are fatal without rapid, broad fungicidal induction.
3
Evaluate the third vignette based on CSF findings.
Encapsulated yeasts in CSF with high opening pressure indicates cryptococcal meningitis, necessitating combination therapy that penetrates the blood-brain barrier.
CNS fungal infections require specific regimens optimized for rapid CSF sterilization to prevent mortality.
4
Interpret the fourth vignette's radiologic and hematologic clues.
A prolonged neutropenic patient with hemoptysis and a CT halo sign has invasive pulmonary aspergillosis, requiring targeted mold-active therapy.
Aspergillus is an angioinvasive mold; its treatment fundamentally differs from yeast infections.

Key Concept

Definitive Pharmacotherapy for Systemic Fungal Infections based on Pathogen and Disease Severity
Rate this question

Topics

Infectious Diseases

More questions from this topic