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Voriconazole Generic, Vfend
The mold subsequently isolated from the patient’s CSF was identified as Coccidioides immitis. Patients of African-American and Southeast Asian descent as well as immuno-compromised patients are at an increased risk for developing chronic forms of coccidioidomycosis such as meningitis. C. immitis is a dimorphic fungus that grows in the soil of the San Joaquin Valley in California, while closely related C posadasii is found elsewhere in desert regions of the southwest USA, parts of Mexico, and Central and South America. Oral therapy with fluconazole was initiated at a dose of 800 mg/day and patient’s headache, fever, and double vision resolved within 7 days. Patients experiencing treatment failure with fluconazole may require treatment with intrathecal amphotericin B. Generally, coccidioidal meningitis requires lifelong therapy because of a high incidence of disease relapse with treatment discontinua-tion and is 100% fatal without antifungal treatment.
Sharon Safrin, MD
A 35-year-old white woman who recently tested seropositive for both HIV and hepatitis B virus surface antigen is referred for evaluation. She is feeling well overall but reports a 25-pack-year smoking history. She drinks 3–4 beers per week and has no known medication allergies. She has a history of heroin use and is currently receiving methadone. Physical examination reveals normal vital signs and no abnormalities. White blood cell count is 5800 cells/mm3 with a normal differential, hemoglobin is 11.8 g/dL, all liver tests are within normal limits, CD4 cell count is 278 cells/mm3, and viral load (HIV RNA) is 110,000 copies/mL. What other laboratory tests should be ordered? Which antiretroviral medica-tions would you begin?