What is the treatment for severe, chronic, or disseminated Histoplasmosis pneumonia?

• A. Fluconazole.
• B. Voriconazole.
• C. Amphotericin B.
• D. Itraconazole.

Answer: (C)

In severe, chronic, or disseminated Histoplasma infection, the goal is rapid and effective fungal killing to control disease quickly. Amphotericin B provides rapid, potent fungicidal activity against Histoplasma and is used as induction therapy to quickly reduce fungal burden in these severe cases. Because of toxicity concerns, the liposomal formulation is preferred to lessen kidney injury, typically given for a short course (about 1–2 weeks). After stabilization, treatment switches to itraconazole for long-term control, usually for at least 12 months with careful monitoring. Fluconazole and voriconazole are less reliable against Histoplasma and aren’t used as first-line induction for severe disseminated disease; itraconazole is the step-down therapy following amphotericin B for sustained treatment.