Match each clinical presentation of an immunocompromised patient with the most appropriate primary pharmacotherapy for their underlying condition.
- A patient with profound chemotherapy-induced neutropenia who develops fever, pleuritic chest pain, and a pulmonary nodule with a surrounding ground-glass halo.Intravenous voriconazole
- A patient with advanced HIV presenting with subacute headache and an elevated opening pressure on lumbar puncture; CSF shows encapsulated yeast.Liposomal amphotericin B and flucytosine
- A patient with advanced HIV presenting with progressive focal neurologic deficits; brain MRI reveals asymmetric, non-enhancing white matter lesions lacking mass effect.Initiation of combination antiretroviral therapy (cART)
- A solid-organ transplant recipient presenting two months post-operation with fever, cytopenias, and a positive serum PCR for a beta-herpesvirus.Intravenous ganciclovir or oral valganciclovir
Cevap
Invasive aspergillosis (halo sign) pairs with voriconazole. Cryptococcal meningitis (encapsulated yeast, high opening pressure) pairs with liposomal amphotericin B and flucytosine. Progressive multifocal leukoencephalopathy (non-enhancing white matter lesions) pairs with combination antiretroviral therapy. Cytomegalovirus (post-transplant cytopenias, beta-herpesvirus) pairs with ganciclovir or valganciclovir.
Each specific opportunistic infection requires a targeted primary approach: voriconazole for invasive aspergillosis, amphotericin B and flucytosine for induction in cryptococcal meningitis, cART for immune reconstitution in PML, and ganciclovir for CMV.
Adım Adım Çözüm
Anahtar Kavram
Targeted management of opportunistic infections in immunocompromised patients depends heavily on correlating specific radiographic and laboratory clues with the causative organism.
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