Please confirm topic selection

Are you sure you want to trigger topic in your Anconeus AI algorithm?

Please confirm action

You are done for today with this topic.

Would you like to start learning session with this topic items scheduled for future?

Review Question - QID 106725

In scope icon M 1 E
QID 106725 (Type "106725" in App Search)
A 21-year-old female presents to the university student health clinic with headache and neck pain. She was feeling under the weather for the past three days. The symptoms began with a headache and malaise and progressed to severe nausea and vomiting. She also endorses neck pain. Past medical and surgical history is unremarkable. Vital signs are stable with the exception of a temperature of 39 degrees Celsius. Physical exam was significant for a lethargic female with significant discomfort with neck flexion. Which of the following would be the most likely cause of this patient's symptoms?

Listeria monocytogenes

0%

0/0

Neisseria meningitidis

0%

0/0

Pseudomonas aeruginosa

0%

0/0

Staphylococcus aureus

0%

0/0

Streptococcus bovis

0%

0/0

Select Answer to see Preferred Response

bookmode logo Review TC In New Tab

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.

REFERENCES (2)
Authors
Rating
Please Rate Question Quality

1.0

  • star icon star icon star icon
  • star icon star icon star icon
  • star icon star icon star icon
  • star icon star icon star icon
  • star icon star icon star icon

(1)

Attach Treatment Poll
Treatment poll is required to gain more useful feedback from members.
Please enter Question Text
Please enter at least 2 unique options
Please enter at least 2 unique options
Please enter at least 2 unique options