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Volume 16, Number 6—June 2010


Invasive Aspergillosis after Pandemic (H1N1) 2009

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Article Title: Invasive Aspergillosis after Pandemic (H1N1) 2009

CME Questions

Mr. Washington is a 35-year-old patient with a 2-day history of high fever, malaise, and cough. His son was diagnosed with infection with H1N1 influenza last week. None of the family was vaccinated against H1N1 influenza. He receives supportive care only for his symptoms. However, he presents to the emergency department the following week. He has experienced significant shortness of breath, and a chest x-ray reveals bilateral infiltrates. Mr. Washington is started on antibiotics but decompensates and develops ARDS.

  1. Which of the following diagnostic strategies in this case is most appropriate if invasive aspergillosis (IA) is suspected?

    A. The potential influenza infection does not influence the risk for IA in this immunocompetent patient, and further assessment for IA is not indicated

    B. Bronchoscopy and culture for aspergillosis

    C. Bronchoscopy with direct smear for aspergillosis

    D. Serum galactomannan assay

  2. Mr. Washington is diagnosed with IA. On the basis of this activity, which of the following strategies should be considered?

    A. Aggressive early treatment with antiviral medications

    B. Rapid diagnosis of fungal infection after the initial bronchoscopy

    C. Treatment with corticosteroids

    D. Initial treatment with voriconazole

Activity Evaluation

1. The activity supported the learning objectives.
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2. The material was organized clearly for learning to occur.
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3. The content learned from this activity will impact my practice.
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4. The activity was presented objectively and free of commercial bias.
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