Which of the following drugs would be an appropriate treatment for this patient?
A 31-year-old homosexual male with AIDS presents to the emergency room with fever
(102.3 F°), headache, confusion, muddled thinking, and vomiting. Physical examination
reveals nuchal rigidity, diplopia, and loss of vision. An agglutination test of the spinal fluid
for capsular polysaccharide antigen is positive.
A. Ampicillin and erythromycin B. Saquinavir and foscarnet C. Pyrimethamine and sulfadiazine D. Amphotericin B and flucytosine E. Tolnaftate and nystatin F. Terbinafine and griseofulvin
Amphotericin b and flucytosine-answer: d
the history, symptoms an signs of the patient strongly suggest the diagnosis of cryptococcal
meningitis. in fact after toxoplasmosis, cryptococcosis is the most common cns infection
associated with aids. cryptococcus neoformans is a yeast that is characterized by a thick
polysaccharide capsule. during infection the capsular polysaccharide is solubilized in spinal
fluid and can be detected by an agglutination test which is diagnostic of cryptococcosis.
cryptococcus neoformans is sensitive to amphotericin b, flucytosine and antifungal azoles. the
current treatment recommended for acute cryptococcal meningitis is amphotericin b plus
flucytosine. synergism between the two drugs has been demonstrated in vitro and in vivo. it
may be related to enhanced penetration of flucytosine through the amphotericin-damaged
fungal cell membrane.
a, b, c) these agents are not antifungal drugs.
e, t) these antifungal drugs are not effective against cryptococcus neoformans.