Disseminated Histoplasmosis — SCE Infectious Diseases MCQ

Correct answer: B — Induce with liposomal amphotericin B, then step down to prolonged itraconazole once clinically stable, with therapeutic-drug and interaction monitoring with follow-up

The best answer is “Induce with liposomal amphotericin B, then step down to prolonged itraconazole once clinically stable, with therapeutic-drug and interaction monitoring with follow-up”. Severe disseminated disease requires rapidly fungicidal amphotericin induction before prolonged oral consolidation; adrenal failure and ART timing need parallel management. “Use fluconazole monotherapy for 5 days” is less appropriate because it conflicts with the decisive clinical feature or cited guidance. “Use itraconazole alone despite shock and organ involvement” is less appropriate because it conflicts with the decisive clinical feature or cited guidance. “Use an echinocandin because Histoplasma is Candida” is less appropriate because it conflicts with the decisive clinical feature or cited guidance. “Stop antifungal therapy once blood cultures clear” is less appropriate because it conflicts with the decisive clinical feature or cited guidance.

Reference: WHO disseminated histoplasmosis in people with HIV guideline: https://www.who.int/publications/i/item/9789240006430