| Author | 4 Posts |
Justice
Forum Fanatic
Topics: 100
Posts: 1,900
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Please vote with your answer
A 35-year-old woman who underwent cadaveric renal transplantation 12 months ago is hospitalized because of fever, headache, ataxia, and confusion. Three weeks ago, she attended a family reunion where she ate processed meats and cole slaw. One day after the reunion, she developed loose stools and low-grade fever that lasted for 24 hours. Yesterday (the day prior to hospital admission), fever returned and she developed a headache.
Current medications are prednisone and azathioprine. She is allergic to penicillin, as she developed anaphylactic shock after receiving this drug.
On physical examination, temperature is 39.4 °C (103.0 °F), pulse rate is 100/ min, respiration rate is 30/mm, and blood pressure is 90/60 mm Hg. On neurologic examination, she is confused and oriented only to person. Her neck is supple. Plantar responses are extensor bilaterally.
The leukocyte count is 18,500/μL. (with 20% band forms). Lumbar puncture is performed.
Cerebrospinal fluid leukocyte count is 1500/μL (with 50% neutrophils and 50% lymphocytes), glucose is 30 mg/dL (simultaneous plasma glucose is 81 mg/dL), and protein is 300 mg/dL. Gram stain of cerebrospinal fluid shows gram-positive bacilli.
Which of the following antimicrobial agents should be started?
A. Erythromycin
B. Chloramphenicol
C. Trimethoprim/sulfamethoxazole
D. Vancomycin
E. Levofloxacin
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| guangyu
Forum Elite
Topics: 29
Posts: 308
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A?
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| aspire
Forum Senior
Topics: 24
Posts: 158
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Immunosuppressed pt with meningitis and gram positive bacilli- Listeria
Rx fo listeria is ampicillin-->allergy--> TMP+SMX
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| Justice
Forum Fanatic
Topics: 100
Posts: 1,900
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The correct answer is C
This patient, who underwent renal transplantation and is on immunosuppressive therapy, has meningitis caused byListeria monocytogenes She likely acquired the infection through the gastrointestinal tract, following consumption of cole slaw and/or processed meats, both of which are vehicles of transmission in outbreaks of Listeria infection. The gram-positive bacilli on Gram stain of cerebrospinal fluid indicate that Listeria should be highly suspected as the causative organism. The therapy of choice for Listeria meningitis is ampicillin or penicillin G combined with an aminoglycoside. Given the patient’s severe allergy to penicillin, trimethoprim/sulfamethoxazole is the alternative antimicrobial agent of choice.
Erythromycin, chloramphenicol, and vancomycin have in vitro activity againstL. monocytogenes but are associated with unacceptably high failure rates in patients withListeria meningitis. Levofloxacin has not been studied for treatment of meningitis.
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