American Board of Internal Medicine (ABIM) Certification Practice Exam

What is the recommended treatment for acute progressive disseminated histoplasmosis?

1. Lipid formulation of amphotericin B followed by itraconazole

2. Fluconazole for 8 weeks

3. Itraconazole only

4. No treatment required

The correct answer is: Lipid formulation of amphotericin B followed by itraconazole

The recommended treatment for acute progressive disseminated histoplasmosis involves the administration of a lipid formulation of amphotericin B, followed by itraconazole. This approach is based on the severity of the condition and the need for effective antifungal therapy. Acute progressive disseminated histoplasmosis is a serious infection caused by the fungus Histoplasma capsulatum, often seen in immunocompromised individuals or those with significant exposure risks. The lipid formulation of amphotericin B is preferred because it has a better safety profile and less nephrotoxicity compared to the deoxycholate formulation of amphotericin B. It provides rapid and effective control of the infection, especially in disseminated cases where the fungus affects multiple organ systems. After stabilization and improvement with amphotericin B, itraconazole is introduced as a long-term maintenance therapy to prevent relapse and assist in the clearance of the organism from the body. Itraconazole is particularly effective for chronic or less severe forms of histoplasmosis, but in cases of acute progressive disease, it is not sufficient as a standalone treatment initially. In summary, utilizing the lipid formulation of amphotericin B followed by itraconazole offers a comprehensive treatment strategy that addresses the immediate urgent need for antifungal