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Leprosy — SCE Infectious Diseases MCQ

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HardTropical & Imported InfectionsLeprosySCE Infectious Diseases

A man with advanced HIV who lived in northern Thailand has fever, anaemia, hepatosplenomegaly and umbilicated papules. Blood and skin cultures grow Talaromyces marneffei. Which European induction-consolidation sequence is preferred?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: E — Liposomal amphotericin B 3 mg/kg daily for 2 weeks, then itraconazole 200 mg three times daily for 3 days and twice daily for at least 10 weeks

Explanation lettering: B = shown as A · E = shown as B · A = shown as C · C = shown as D · D = shown as E

D is correct. EACS recommends liposomal amphotericin B 3 mg/kg daily for two weeks or until clinical improvement for disseminated talaromycosis, followed by itraconazole loading and at least ten weeks of consolidation, then secondary prophylaxis until immune recovery. A omits the amphotericin induction shown to improve outcomes and underdoses itraconazole. B uses a less active azole and an inadequate course. C has no established sequential role. ART should be introduced promptly after effective induction planning, with azole levels and interactions reviewed rather than withholding immune restoration indefinitely.

Reference: EACS guideline 12.0: talaromycosis: https://www.eacsociety.org/media/guidelines-12.0.pdf