A neutropenic patient post-chemotherapy develops fever unresponsive to antibiotics, new pulmonary infiltrate on CT (halo sign), and serum galactomannan index of 2.3 on two consecutive samples. The most appropriate initial antifungal is:
- A Fluconazole
- B Amphotericin B deoxycholate
- C Voriconazole ✓
- D Echinocandin (caspofungin) alone
Correct answer: C. Voriconazole
Explanation
Voriconazole is the first-line treatment for invasive pulmonary aspergillosis (IPA) per IDSA and ECMYCOSIS guidelines; galactomannan index ≥1.0 on two sequential samples in a high-risk host (neutropenic) combined with the CT halo sign (hemorrhagic infarct surrounding a fungal nodule) fulfils diagnostic criteria. Fluconazole has no activity against Aspergillus. Amphotericin B deoxycholate is less effective and more nephrotoxic than voriconazole. Echinocandins (glucan synthase inhibitors) are second-line or salvage therapy for IPA.
Reference: Ananthanarayan & Paniker's Textbook of Microbiology, 11th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
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