American Board of Internal Medicine (ABIM) Certification Practice Exam

What is the treatment for primary pulmonary coccidioidomycosis in high-risk patients?

1. Fluconazole and itraconazole

2. Amphotericin B

3. Only observation is required

4. Oral flucytosine for 8 weeks

The correct answer is: Fluconazole and itraconazole

In high-risk patients with primary pulmonary coccidioidomycosis, the preferred treatment involves the use of antifungal medications, specifically fluconazole and itraconazole. These drugs are effective against the fungal pathogen Coccidioides immitis, which causes coccidioidomycosis. Fluconazole is often chosen due to its good bioavailability and ease of use, while itraconazole may be used in certain situations depending on additional patient factors or if there is a need for broader spectrum antifungal coverage. High-risk patients, such as those with significant comorbidities, immune suppression, or severe pulmonary symptoms, are more likely to develop serious disease and thus benefit from early intervention with these antifungals to reduce the risk of severe complications. The recommendation for only observation is more applicable to immunocompetent individuals with mild symptoms, where the infection may resolve spontaneously without treatment. In contrast, high-risk individuals typically require proactive treatment to manage their condition and prevent potentially life-threatening complications. Amphotericin B, while a potent antifungal treatment, is generally reserved for severe infections or cases where the patient has not responded to conventional therapies. Additionally, oral flucytosine is not commonly used for primary pulmonary