DrVirgo
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A 25 year old man with AML is undergoing chemotherapy. One week after his therapy, he presents with headache, fever, and confusion. On physical examination, he has nuchal rigidity, Kernig sign, and photophobia. Lab results are notable for a white count of 1000 mm3, Htc of 25%, and a differential of 10% neutrophils, 5% lymphocytes.
LP is consistent with meningitis. Whoch of the following is the most likely pathogen?
A. Bacteroides fragilis
B. Haemophilus influenzae
C. Pseudomonas aeruginosa
D. Staphylococcus arueus
E. Toxoplasma gondii
B or C??? WHY???
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| Justice
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B. Haemophilus influenzae
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| khorshid
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B. ( as for reason I don't have a very clear one  , but if due to his immunodeffieciency he's more susceptible to meningitis and if we think a major route of meningitis is from local spread from otitis or sinusitis or... then h.inf is the one. also pseudomona is not a one of the common causative agents of meningitis. first I was seekin listeria in the options though.)
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| ssrpk
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yeah i was looking for listeria too,
agree with Haemophilus Influenzae
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| prathapdoctor
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Even I was looking for Listeria. I agree with all the inputs.
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| DrVirgo
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answer is C! Pseudomonas!
Explanation:
the person is Neutropenic with an ANC (absolute neutrophil count of 100).
(1000 X % Neutrophils) = 100
ANC < 500 = Neutropenic, and thus we suspect a gram negative bacteria so Pseudomonas! Treatment: IV Ceftiraxone.
BUT Haemophilus is gram negative also and does cause meningitis (but more in children).
SO this one was a bit confusing!
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