Which of the following drugs would be appropriate for this patient?
A 30-year-old Filipino man, who is a lifelong resident of the San Joaquin Valley,
California presented to the hospital with a 4-day history low-grade fever (99.8 F°), severe
a headache, irritability, and fatigue. Physical examination showed stiff neck and Kerning’s
sign. Microscopic analysis of the spinal fluid revealed spherules filled with endospores.
A. Flucytosine B. Penicillin G C. Gancyclovir D. Amphotericin B E. Gentamicin F. Zidovudine
Amphotericin b-answer: d
the signs and symptoms of the patient suggest the diagnosis of meningitis and the lab results
confirms that tha man is suffering from meningeal coccidioidomycosis. the infection is caused
by coccidioides immitis, a soil mold that lives in semiarid regions of the globe (southwestern
usa, argentina, etc.). inhalation of the arthrospores leads to a primary infection that is
asymptomatic in 60% of individuals. the others develop a flu-like self limited illness called
valley fever or desert rheumatism. following inhalation the arthrospores forms spherules that
contain endospores. in biologic specimens these spherules are diagnostic of coccidioides
immitis infection. in less than 1% of individuals a secondary or disseminated infection evolves
within a year after the primary one. this secondary infection is often life-threatening and can
affect many tissues but the most frequent organs are the bone and joints, and the meninges.
untreated meningitis is always fatal.
coccidioides immitis is sensitive to amphotericin b and to antifungal azoles. amphotericin b is
the drug of choice and is usually administered intrathecally in meningeal coccidioidomycosis,
since the drug penetration into the cns is limited.
a) flucytosine can easily enter the brain but is not effective against coccidioides immitis.
b, c, e, f) these agents are not antifungal drugs.