MCQ of the Day: 1 November 2026

Answer: B. Liposomal amphotericin B. Rhino-orbito-cerebral disease with a palatal eschar in a patient with diabetic ketoacidosis, plus broad, pauci-septate, ribbon-like hyphae with wide-angle branching and angio-invasion, indicates mucormycosis (order Mucorales, most often Rhizopus arrhizus in India). India carries one of the highest burdens worldwide, and cases surged with COVID-19-associated mucormycosis in 2021. The ECMM/MSG ERC global guideline recommends high-dose liposomal amphotericin B (5–10 mg/kg/day) as first-line therapy, combined with early, aggressive surgical debridement and control of the underlying condition. Isavuconazole or posaconazole are alternatives or step-down options.

A. Voriconazole, the drug of choice for invasive aspergillosis, has no useful activity against Mucorales; breakthrough mucormycosis is described during voriconazole therapy.

C. Fluconazole has no activity against moulds, including Mucorales and Aspergillus.

D. Echinocandins such as caspofungin lack meaningful activity against Mucorales and are not recommended as monotherapy.