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Old 09-22-2012
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Neuro AIDS Patient with Meningitis

A 42 year old man presents to the emergency department with a fever and a headcahe. He also has a stiff neck and photophobia. He has AIDS with a CD4 count of 45 per mcL with 250 lymphocytes in CSF. Which of the following is the most effective therapy for this patient?

A. 5-Flourouracil
B. Caspofungin
C. Pentamidine
D. Nystatin
E. Voriconazole
F. Pyrimethamine and sulfadiazine
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Old 09-22-2012
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Answer E. Voriconazole

Fever and headach and headach and fever --- Its Meningitis --- Dr. Conrad Fischer's

Meningitis in HIV - Cryptococcol..-- Rx -- Amphoteracin .---
Not in choice --- Voriconazole .
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Old 09-22-2012
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yeah i would choose voriconazole too.......
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Old 09-22-2012
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Quote:
Originally Posted by step_enhancer View Post
A 42 year old man presents to the emergency department with a fever and a headcahe.He also has a stiff neck and photophobia.He has AIDS with a CD4 count of 45 per mcL with 250 lymphocytes in CSF .Which of the following is the most effective therapy for this patient?

A. 5-Flourouracil
B. Caspofungin
C. Pentamidine
D. Nystatin
E. Voriconazole
F. Pyrimethamine and sulfadiazine
I think A.......
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Voriconazole is given when Ampho B is not in the choices or the patients has renal failure

K01600.. You never give 5-fluoracil by itself, is like trying to kill the bug by trying to tickle it.
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F. Pyrimethamine and sulfadiazine
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Old 09-23-2012
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Answer E Voriconazole


An AIDS patient with menengitis most likely has Cryptococcus ,which gives a lymphocyte predominance of the CSF. Amphotericin is the drug of choice but not in choices given.Voriconazole will also cover cryptococcus.
Caspofungin is in the class of antifungals called Echinocandins, which are highly active against candida and aspergillus but will not cover cryptococcus .
5-Flourouracil will add some benefit in covering cryptococcus when combined with amphotericin but will not cover anything as a single agent
Pyrimethamine and sulfadiazine will cover CNS toxoplasmosis .
Nystatin is used orally and topically.It can be used for oral candiasis but never for CSF.
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