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Chapter 84. Invasive Fungal Infections

A 44-year-old otherwise healthy patient from Tempe, Arizona, presents with a 4-week history of complaints of fever and malaise. A chest x-ray demonstrates several small nodular lesions in both lungs and mediastinal adenopathy. Based on this patient history, the most likely fungal cause of this pneumonia is:

A. Histoplasma capsulatum

B. Blastomycosis dermatitidis

C. Coccidioidomycosis immitis

D. Cryptococcus neoformans

E. Aspergillus fumigatus

Which dosing approach (formulation) of posaconazole will achieve the highest serum levels in a majority of patients?

A. Administer the suspension as a single daily dose

B. Administer the suspension in multiple daily doses (2–4 times per day)

C. Administer the suspension hour prior to or 2 hours after meals

D. Administer delayed-released tablets once daily

Phototoxic reactions with voriconazole:

A. Are not necessarily preventable with sunscreen

B. Have been associated with increased risk of squamous cell carcinoma

C. Typically resolve after the third day of dosing

D. Occur in patients who are developing hepatotoxic reactions to voriconazole

E. Are associated with trough serum concentrations greater than 5.5 mcg/mL (5.5 mg/L; 15.7 μmol/L)

Nephrotoxicity with amphotericin B:

A. Is prevented by using lipid formulations of the drug

B. Is prevented by administering saline infusions before and after doses

C. Is enhanced when the drug is administered by continuous infusion

D. Is enhanced with higher treatment doses and prolonged treatment

E. Rarely develops in hydrated patients

Which antifungals pharmacokinetic properties are closely linked to pharmacogenetic differences in cytochrome P450 2C19 metabolism?

A. Fluconazole

B. Voriconazole

C. Itraconazole

D. Posaconazole

A 56-year-old womanis admitted to the surgical intensive care unit with signs of systemic inflammatory response syndrome (SIRS), renal dysfunction, and infection following an emergency exploratory laparotomy. The patient is started on broad-spectrum antibiotics.


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