Infectious diseases: disseminated histoplasmosis: practice question

A General Medicine question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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General Medicine · Infectious diseases: disseminated histoplasmosis

Sample item

A man with advanced HIV and a CD4 count of 30 cells per microlitre has fever, weight loss, pancytopenia, hepatosplenomegaly and hypotension. Marrow biopsy shows small oval yeasts with narrow-based budding inside macrophages. What is the best initial treatment?

ALiposomal amphotericin B, then itraconazoleBIntravenous caspofungin alone for two weeksCOral itraconazole alone from the startDOral fluconazole alone for six months

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

A. Liposomal amphotericin B, then itraconazole

Severe disseminated histoplasmosis is treated with liposomal amphotericin B for the first one to two weeks, followed by prolonged itraconazole. Itraconazole alone is reserved for mild to moderate disease. Antiretroviral therapy is started afterwards.

Option by option

A. Liposomal amphotericin B, then itraconazole (correct)
Correct. Amphotericin induction then itraconazole is standard for severe disseminated disease.
B. Intravenous caspofungin alone for two weeks
Echinocandins are not effective for histoplasmosis.
C. Oral itraconazole alone from the start
Itraconazole alone is for mild disease, as severe illness needs amphotericin first.
D. Oral fluconazole alone for six months
Fluconazole is less effective than itraconazole and not recommended for severe disease.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

Questions about this General Medicine question

What is the answer to this General Medicine question?

The best answer is A, Liposomal amphotericin B, then itraconazole. Severe disseminated histoplasmosis is treated with liposomal amphotericin B for the first one to two weeks, followed by prolonged itraconazole.

Why is "Intravenous caspofungin alone for two weeks" not the answer?

Echinocandins are not effective for histoplasmosis.

Why is "Oral itraconazole alone from the start" not the answer?

Itraconazole alone is for mild disease, as severe illness needs amphotericin first.

Why is "Oral fluconazole alone for six months" not the answer?

Fluconazole is less effective than itraconazole and not recommended for severe disease.

What concept does this question test?

It tests Infectious diseases: disseminated histoplasmosis in General Medicine. Itraconazole alone is reserved for mild to moderate disease. Antiretroviral therapy is started afterwards.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Infectious diseases: disseminated histoplasmosis?

For each disease know the classic presentation, the best test, and the first-line treatment. Then use the flashcards and the other General Medicine questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.