26malik
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A 65-year-old man presents with fever, severe headache, and nuchal rigidity. Physical examination in the emergency department shows a Glasgow coma score of 7. Lumbar puncture reveals cloudy cerebrospinal fluid (CSF) with 1200 neutrophils/mm3, elevated protein, and decreased glucose. Which of the following is the most probable etiologic agent of this condition?
A. Arbovirus
B. Herpesvirus
C. Mycobacterium tuberculosis
D. Neisseria meningitidis
E. Streptococcus pneumoniae
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| paba
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E
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| doc179
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E
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| general malaise
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E
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| yasmeen
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E
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| r_albayunen
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E
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| Rana Khan
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why not D?
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| r_albayunen
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Clues are .. Age and absence of petechial rash caracteristic of neisseria meningidits ..
malik?
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| tolito
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in addition, first this is bacterial meningitis from high neutrop, high prot and low glu.
second, NG mening is more common in infants aged 6mo to 2yrs and army recruits.
third, the most common cause of bacterial meningitis in adult is s. pneum
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| malignant
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| bactitech
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Please be aware that N. meningitidis can occur at any age. I would personally not suspect this organism first in a 6 month old, but would go with S. pneumoniae as a causative agent. H. influenzae, before the HIB vaccine was available, used to be the organism suspected in the young child age group. Thankfully, one hardly sees this organism any more in bacterial meningitis. However, in the unvaccinated child, this still is a threat.
S. pneumoniae can cause meningitis at any age. Yes, it is the most common in an adult, but please don't slot it into an adult-only organism. In a 65 year old man (case in point) I definitely would suspect S. pneumoniae first. The fatality rate is at least 20% in older adults, so this is not an organism to be brushed off easily. It can be extremely dangerous to all age groups in both bacterial meningitis and bacterial pneumonia, and must be hit with big gun antibiotics quickly.
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| 26malik
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The correct answer is E.
The clinical manifestations (fever, headache, nuchal rigidity, and low Glasgow coma score), along with the CSF findings (increased neutrophils, elevated protein, and reduced glucose), strongly indicate acute pyogenic (bacterial) meningitis as the underlying condition. Of the microorganisms listed, either Neisseria meningitidis or Streptococcus pneumoniae can cause this form of meningitis; however, Streptococcus pneumoniae is by far the most frequent organism causing acute meningitis in elderly patients.
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