Dip Int Med(SA) Practice Questions - Diploma In Internal Medicine Of The College Of Physicians Of South Africa Dip Int Med(SA) Exam

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A 34-year-old HIV-positive man with a CD4 count of 45 cells/µL presents to a South African district hospital with a 2-week history of worsening severe headache, low-grade fever, and photophobia. On examination, he is confused with neck stiffness. Lumbar puncture shows an opening pressure of 32 cm H2O, and India ink staining of the CSF is positive for encapsulated yeast cells. According to current South African NDoH adult guidelines, what is the initial preferred induction therapy for this patient?

High-dose oral Fluconazole 1200 mg daily for 2 weeks IV Amphotericin B deoxycholate 1 mg/kg daily plus oral Flucytosine 25 mg/kg four times daily for 1 week IV Amphotericin B deoxycholate 1 mg/kg daily for 4 weeks as monotherapy Oral Voriconazole 400 mg twice daily plus IV Ceftriaxone 2 g daily for 2 weeks

Correct Answer:

IV Amphotericin B deoxycholate 1 mg/kg daily plus oral Flucytosine 25 mg/kg four times daily for 1 week

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