Antifungals

A 42-year-old woman with acute leukaemia undergoing induction chemotherapy develops fever (38.9°C), cough, and dyspnoea on day 14 of neutropenia (ANC 200/μL). High-resolution CT chest shows multiple nodular infiltrates with a halo sign. Bronchoalveolar lavage culture grows Aspergillus fumigatus. She is started on voriconazole 6 mg/kg IV twice daily on day 1, then 4 mg/kg IV twice daily from day 2 onwards. After 48 hours of therapy, she develops blurred vision and mild confusion. What is the most appropriate management?

A 52-year-old man with chronic kidney disease and recurrent fungal infections is being evaluated for the most common site of invasive candidiasis in hospitalized patients. Which is the most frequent site of disseminated candidiasis in critically ill patients?

A 35-year-old woman with poorly controlled diabetes presents with oral candidiasis and vaginal thrush. She is started on antifungal therapy. Regarding the pharmacokinetic and clinical properties of antifungals used in mucosal candidiasis, all of the following statements are true EXCEPT:

A 62-year-old man with acute leukemia and prolonged neutropenia develops invasive aspergillosis. Which feature best distinguishes voriconazole from itraconazole in the management of this patient?

A 58-year-old man with poorly controlled diabetes mellitus (HbA1c 10.2%) presents with a 3-week history of progressive dysphagia and retrosternal chest pain. Endoscopy reveals white plaques in the oesophagus that do not scrape off easily. KOH mount of the biopsy specimen shows pseudohyphae and budding yeast. He is started on fluconazole 200 mg daily. After 5 days of therapy, he develops severe hepatotoxicity with ALT 1200 U/L and bilirubin 4.2 mg/dL. What is the most appropriate next step in management?