An immunocompromised patient has a serum galactomannan index of 1.8 (positive cut-off ≥0.5) on two consecutive samples. CT chest shows a halo sign. BAL galactomannan is also elevated. The most appropriate initial antifungal treatment is:

• A Fluconazole 400 mg daily
• B Amphotericin B deoxycholate 1 mg/kg daily
• C Caspofungin 70 mg loading dose then 50 mg daily
• D Voriconazole 6 mg/kg IV twice on day 1, then 4 mg/kg twice daily ✓

Explanation

Voriconazole is the first-line treatment for invasive pulmonary aspergillosis per IDSA and ESCMID guidelines, superior to amphotericin B in mortality and response rates. Galactomannan (a fungal polysaccharide cell-wall antigen of Aspergillus) combined with CT halo sign provides high diagnostic confidence. Fluconazole has no activity against Aspergillus. Caspofungin (an echinocandin) is used as salvage therapy. Amphotericin B deoxycholate is associated with higher nephrotoxicity and inferior outcomes.

Reference: Ananthanarayan & Paniker's Textbook of Microbiology, 11th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.