A 20-year-old man has had a persistent headache and a fever for a week. He now presents with a seizure. He has no prior medical history and is on no medications. On physical examination, he has a high-grade fever. He has left-sided weakness. He has a rooting reflex and appears disinhibited in his behavior. A CT scan of the head shows a ring-enhancing lesion in the right frontal lobe and an air-fluid level in the right frontal sinus. Which of the following will likely be seen on aspiration of the lesion?
A. Alpha hemolytic Streptococcus and mixed anaerobes
B. Bacteroides fragilis
C. Budding yeast organisms with hyphae
D. Small mononuclear cells suggestive of Burkitt lymphoma
E. Toxoplasma gondii cysts
A. Alpha hemolytic Streptococcus and mixed anaerobes
the answer is EE, whenever you see "ring-enhancing lesion" think of Toxo
Okt3 could you please post the answer? thanks a lot for ...
the answer is EE for sure mohamed.
The correct answer is
A. Neurosurgical aspiration of the lesion would most likely show alpha hemolytic streptococcus and mixed anaerobes. Brain abscesses can occur in young people. Frontal lobe disease is associated with sinusitis and reflects oral flora.
Bacteroides fragilis(choice B) is more commonly found in brain abscesses of otic origin. It would be a pathogen to suspect in a child with an inner ear infection.
Patients who are immunocompetent are rarely afflicted by a fungal abscess (choice C). Patients with diabetes or on steroids may be infected by Mucor. In people with severe acidosis, Zygomycetes can cause brain abscess, but these fungi have no yeast phase.
Primary brain lymphoma is rarely seen in immunocompetent patients. The Epstein-Barr virus has been linked to Burkitt lymphoma (choice D), a disease usually found in Africa.
Toxoplasmosis(choice E) is an infection often seen in an immunocompromised patient. It should be high on the differential diagnosis of any patient with HIV presenting with neurologic symptoms.
oops! sorry mohamed for giving you wrong answer.