Fungal Disease (Infectious Disease): The Daily PANCE Blueprint

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Fungal Disease (Infectious Disease): The Daily PANCE Blueprint

A 32-year-old man with a history of HIV presents to the clinic with a headache, neck stiffness, and blurred vision. He reports feeling progressively fatigued over the past two weeks and notes having fever and chills. On physical examination, he appears confused, with a fever of 101.5°F and nuchal rigidity. Fundoscopic examination reveals bilateral papilledema. A lumbar puncture is performed, and the cerebrospinal fluid (CSF) shows elevated opening pressure, low glucose, and a high white blood cell count predominantly of lymphocytes. An India ink stain is positive. Which of the following is the most appropriate initial treatment?

A. Acyclovir
B. Amphotericin B and flucytosine
C. Ceftriaxone and vancomycin
D. Doxycycline
E. Fluconazole

Answer and topic summary

The answer is B. Amphotericin B and flucytosine

This combination is the initial treatment of choice for cryptococcal meningitis, particularly in immunocompromised patients such as those with HIV. Amphotericin B has potent antifungal activity, while flucytosine enhances its efficacy and prevents relapse. This regimen is followed by consolidation and maintenance therapy with fluconazole.

  • Prophylaxis if CD4 < 100 with Fluconazole
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Smarty PANCE Content Blueprint Review:

PANCE Blueprint Infectious Disease -> Fungal Disease (PEARLS) -> Cryptococcosis

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