American Board of Internal Medicine (ABIM) Certification Practice Exam

For moderately severe to severe pulmonary histoplasmosis, what is the suggested treatment regimen?

1. Itraconazole

2. Conventional amphotericin B

3. Lipid formulation of amphotericin B followed by itraconazole

4. No treatment required

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

In the case of moderately severe to severe pulmonary histoplasmosis, the recommended treatment approach typically involves the use of antifungal therapy that addresses the intensity of the infection effectively. The combination of a lipid formulation of amphotericin B followed by itraconazole is considered the optimal regimen for this level of severity. Lipid formulations of amphotericin B are favored because they are generally better tolerated and associated with fewer side effects compared to conventional amphotericin B. This is particularly important in patients with more severe manifestations of histoplasmosis, where the risk of complications may be heightened. The initial use of the lipid formulation serves to provide a rapid and potent antifungal effect, crucial for controlling the infection quickly. Following stabilization or improvement with the lipid formulation of amphotericin B, transitioning to itraconazole is beneficial for prolonged treatment and prevention of relapse. Itraconazole is effective for maintaining long-term control of the infection due to its oral bioavailability and favorable side effect profile. Therefore, the suggested treatment regimen for moderately severe to severe pulmonary histoplasmosis aligns with this strategy, ensuring both immediate and sustained therapeutic action against the infection.