American Board of Internal Medicine (ABIM) Certification Practice Exam

What is the standard treatment for disseminated histoplasmosis?

1. Liposomal amphotericin B with long-term suppressive therapy

2. Fluconazole with short-term therapy

3. Voriconazole alone

4. Mucormycosis treatment regimen

The correct answer is: Liposomal amphotericin B with long-term suppressive therapy

The standard treatment for disseminated histoplasmosis is liposomal amphotericin B, followed by long-term suppressive therapy. This approach is recommended because disseminated histoplasmosis, particularly in immunocompromised patients or those with severe disease, requires aggressive initial treatment to rapidly reduce the fungal burden. Liposomal amphotericin B is preferred due to its efficacy and lower toxicity profile compared to conventional amphotericin B. After the initial treatment phase with liposomal amphotericin B, long-term suppressive therapy, typically using an azole antifungal such as itraconazole, is necessary to prevent relapse, especially in individuals who have ongoing risk factors for histoplasmosis or those with significant immunosuppression. In contrast, fluconazole is not the first-line treatment for disseminated histoplasmosis, as it may not provide adequate coverage for severe cases. Voriconazole is primarily effective against Aspergillus species and does not have the same level of efficacy against Histoplasma capsulatum. Mucormycosis treatment involves a different set of antifungal agents and management strategies, which are not applicable to histoplasmosis. Therefore, the most effective and recommended protocol when treating disseminated histoplasmosis is the combination of liposomal