American Board of Internal Medicine (ABIM) Certification Practice Exam

Which of the following antifungal treatments targets allergic bronchopulmonary aspergillosis?

1. Amphotericin B

2. Caspofungin

3. Fluconazole

4. Voriconazole

The correct answer is: Voriconazole

Allergic bronchopulmonary aspergillosis (ABPA) is a hypersensitivity reaction to the Aspergillus species, most commonly Aspergillus fumigatus, that primarily occurs in individuals with asthma or cystic fibrosis. The treatment for ABPA typically focuses on controlling the allergic response and managing the fungal infection. Voriconazole is the most appropriate antifungal treatment for ABPA because it is effective against Aspergillus species. It demonstrates good penetration into pulmonary tissues and has been shown to improve symptoms and lung function in patients suffering from ABPA. Voriconazole's mechanism of action involves inhibiting the key enzyme 14α-demethylase in the ergosterol biosynthesis pathway, leading to fungal cell death. In contrast, other treatments listed may not be as specifically effective for ABPA. Amphotericin B, while used in severe fungal infections, is often associated with significant side effects and is generally reserved for invasive fungal infections. Caspofungin is an echinocandin that is effective for invasive candidiasis and some Aspergillus infections but is not typically used for treating ABPA. Fluconazole, on the other hand, is mainly effective against Candida species and has limited efficacy against Aspergillus organisms, making