A 35-year-old man with AIDS presents to the local clinic with complaints of nausea, vomiting, confusion, fever and staggering gait. A lumbar puncture is performed, and an organism with a halo is noted with India ink preparation. What drug would be most beneficial? (AIPG 2011)
|A||Ketoconazole and amphotericin B|
|B||Flucytosine and amphotericin B|
|C||Nystatin and ketoconazole|
|D||Nystatin and miconazole|
The organism present is C. neoformans, the usual treatment for cryptococcosis is amphotericin B and flucytosine. The other drugs listed are not indicated for cryptococcosis.
Ketoconazole is usually used for chronic mucocutaneous candidiasis. Nystatin is used for candidiasis, and griseofulvin is indicated for dermatophytes of the hair, skin, and nails. Miconazole is used for topical fungal infections, oral thrush and vaginitis.