A healthy 10-year-old boy is visiting friends on a farm during the month of July. He presents with fever, cough, and lower respiratory symptoms (no upper respiratory tract symptoms). He has been ill for 5 days. Auscultatory findings are consistent with pneumonia. Chest radiograph, CECT and peripheral smear examination were done The first line drug for the above condition is: -
This is a case of acute histoplasmosis. The radiograph shows small, patchy infiltrates with hilar adenopathy. His blood smear shows small, nondescript yeast forms inside monocytic cells. Microconidia are oval and are small enough (2-4 mm) to reach the terminal bronchioles and alveoli. Sholy after infecting the host, mycelia transform into the yeasts that are found inside macrophages and other phagocytes. The yeast forms are characteristically small (2-5 mm), with occasional narrow budding. In the laboratory, mycelia are best grown at room temperature, whereas yeasts are grown at 37degC on enriched media. TREATMENT: - Acute pulmonary, moderate to severe illness: -Lipid AmB Chronic/ cavitatory pulmonary: - Itraconazole Progressive disseminated: - Lipid AmB+ Itraconazole CNS: - Liposomal AmB + Itraconazole
Liposomal amphotericin B
Terbinafine
Voriconazole
Itraconazole
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