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Listeria monocytogenes
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Neisseria meningitidis
Pseudomonas aeruginosa
Staphylococcus aureus
Streptococcus bovis
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On physical exam, she has no focal neurological deficits. A petechial rash is noted. Lumbar puncture is significant for low glucose, high protein, and an elevated white blood count with a polymorphonuclear cell predominance. What of the following paths did the causative organism take to cause this patient's condition? 1. Lungs; 2. Blood stream; 3. Arachnoid granulations 1. Lungs; 2. Blood stream; 3. Choroid plexus 1. Nasopharynx; 2. Blood stream; 3. Choroid plexus 1. Nasopharynx; 2. Direct invasion of blood brain barrier 1. Intestine; 2. Blood stream; 3. Choroid plexus This patient most likely has Neisseria meningitidis meningitis. The route of infection of CSF by neisseria meningitidis involves colonization of nasopharynx, invasion of mucosal epithelium to blood stream, hematogenous spread to choroid plexus, and finally crossing into CNS through blood-brain barrier. N. meningitidis is a Gram-negative cocci that it is a common cause of meningitis in young adults, particularly those in close living quarters such as dormitories and barracks. While most Gram-negative bacteria contain lipopolysaccharide (LPS), which acts as a virulence factor for the bacteria (endotoxin), N. meningitidis contains lipooligosaccharide (LOS), an analogous structure that is responsible for the toxicity of N. meningitidis; LOS levels in the blood correlate with morbidity and mortality. N. meningitidis has its reservoir in the nasopharynx. Bamberger discusses the diagnosis, management, and prevention of meningitis. Clinical signs and symptoms are unreliable to distinguish the more deadly bacterial meningitis from the more common viral meningitis. Lumbar puncture, therefore, is indicated but should never delay the initiation of empiric antibiotic therapy. Concomitant therapy with dexamethasone also has been shown to improve morbidity but only with streptococcal pneumoniae infection. Korzeniewski et al. studied the role of nasal carriage of Neisseria meningitidis in meningitis. They state N. meningitidis is a human commensal organism that colonizes the nasopharynx which is most often asymptomatic. While carriage does not always cause disease, it is prerequisite for disease, with carriers being the major source of infection. Incorrect Answers: Answers 1,2,4,5: These are not the correct routes of infection for N. meningitidis.
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