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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 encapsulated microorganisms.



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

This question is part of block 15 pharm antifungal drugs

Asked by Camilla, Last updated: Sep 18, 2020

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1 Answer

John Smith

John Smith

John Smith
John Smith

Answered Sep 09, 2016

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.
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