Which of the following statements correctly pairs the most likely disease of the patient with the appropriate treatment?
A 33-year-old, HIV positive homosexual man living near Mississippi river, was
admitted to the hospital with a 3-week history of a cough, productive yellow sputum,
progressive dyspnea of exertion and 14-pound weight loss. Pertinent lab results on
admission were: CD4+ lymphocyte counts 320 cells/mm
3, lactate dehydrogenase 5000
IU/L (normal < 600). A blood stain showed neutrophils containing small, uninucleated and
A. Progressive disseminate histoplasmosis - amphotericin B B. Progressive disseminate coccidioidomycosis - fluconazole C. Pulmonary blastomycosis - fluconazole D. Meningeal cryptococcosis- amphotericin B E. Disseminate sporotrichosis - amphotericin B
Progressive disseminate histoplasmosis - amphotericin b-answer: a
the fact that uninucleated, encapsulated microorganisms are found intracellularly suggests an
infections with histoplasma capsulatum. other intracellular microorganisms are either
multinucleated, like blastomyces, or not encapsulated, like the intracellular stage of several
pathogenic protozoa. infection with histoplasma capsulatum is extremely common. in the vast
majority of cases it is subclinical, or may manifest itself as a mild, self-limited pneumonia.
progressive disseminate histoplasmosis usually occurs in people with suppressed cell-mediated
immunity, especially if they are from endemic areas (mississippi river valleys and carribean
basin), like in the present case. most laboratory findings are nonspecific but the lactate
dehydrogenase level can reach ten times over normal. the progressive disseminate
histoplasmosis has a high fatality rate. amphotericin b remains the drug of choice but mild
cases can be treated initially with parenteral azoles.
b) progressive disseminate coccidioidomycosis may have symptoms and sings similar to those
of the present case but microscopic finding is different .
c) blastomyces dermatitidis is a multinucleate fungus without capsule.
d) meningeal cryptococcosis is one of the most common opportunistic infection in aids
patients and is treated with amphotericin b. however clinical and laboratory findings are quite
different from those of the present case.
e) sporothrix schenckii may cause a disseminate infection from a cutaneous or a pulmonary
lesion. however it does not grow intracellularly.