Histoplasma capsulatum var. capsulatum is isolated from BAL of an immunocompromised patient from Madhya Pradesh with persistent fever and hepatosplenomegaly. On Sabouraud's agar at 25°C, the colony produces microconidia and distinctive tuberculate macroconidia. What is the recommended treatment for severe disseminated histoplasmosis?
- A Voriconazole 6 mg/kg loading dose then 4 mg/kg twice daily for 12 months
- B Liposomal amphotericin B 3 mg/kg/day for 1–2 weeks followed by itraconazole for 12 months ✓
- C Fluconazole 400 mg daily for 12 months as monotherapy
- D Conventional amphotericin B deoxycholate 1 mg/kg/day for 2 weeks then fluconazole step-down
Explanation
IDSA 2007 guidelines (still current) recommend liposomal amphotericin B (L-AmB) 3 mg/kg/day as induction therapy for severe or disseminated histoplasmosis, given for 1–2 weeks or until clinical improvement, followed by step-down oral itraconazole 200 mg twice daily for at least 12 months. Itraconazole is the preferred azole due to its potent activity against Histoplasma; fluconazole has inferior activity. Voriconazole has in-vitro activity but is not a standard recommendation. Conventional deoxycholate AmB is more nephrotoxic and is reserved for resource-limited settings where L-AmB is unavailable.
Reference: Ananthanarayan & Paniker's Textbook of Microbiology, 11th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
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