Which of the following antifungal agents can be used to treat this patient's condition?

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Patients with HIV who develop progressive disseminated histoplasmosis (PDH) require intravenous amphotericin B (usually liposomal), a fungicidal agent. After 1-2 weeks of clinical improvement, most patients are switched to oral itraconazole (fungistatic) for ≥1 year of maintenance therapy. Histoplasmosis is an opportunistic infection; therefore, all patients with HIV who develop PDH should be considered for antiretroviral treatment (usually 2 weeks after starting antifungal therapy). (Choice B) Caspofungin is an effective second-line treatment for aspergillosis. It is not used in the treatment of histoplasmosis. (Choice C) Fluconazole is not as effective as itraconazole; itraconazole is the treatment of choice for mild or limited disease or for maintenance therapy. (Choice D) Flucytosine is effective against Cryptococcus species. It is not used in the treatment of histoplasmosis. (Choice E) Metronidazole is effective against amebiasis and other anaerobic bacterial infections but does not treat Histoplasma infections. Educational objective: Amphotericin B is required in patients with HIV who develop progressive disseminated histoplasmosis (PDH). After 1-2 weeks of clinical improvement, patients are often transitioned to oral itraconazole for >1 year of maintenance therapy. Antiretroviral therapy should be initiated in all patients with HIV who develop PDH (usually 2 weeks after antifungal treatment). > References: Histoplasmosis. (http://www.ncbi.nlm.nih.gov/pubmed/20463244) Treatment of histoplasmosis. (http://www.ncbi.nlm.nih.gov/pubmed/11521246)

Which of the Following Antifungal Agents Can Be Used to Treat