35-year-old woman is hospitalized because of feve - pacemaker

[ArchivalUser]

35-year-old woman is hospitalized because of fever, headache, ataxia, confusion, and loose stools. The patient underwent cadaveric kidney transplantation 12 months ago for end-stage renal disease. Current medications are prednisone and azathioprine. She is allergic to penicillin, which causes anaphylactic shock. However, she has received cephalexin in the past without a reaction.

On physical examination, temperature is 39.4 °C (103 °F), pulse rate is 100/min, respiration rate is 30/min, and blood pressure is 90/60 mm Hg. The patient is confused and is oriented to person but not to place or time. Her neck is supple. The plantar response is extensor bilaterally.

The leukocyte count is 18,500/µL (18.5 × 109/L) with 20% band forms. Lumbar puncture is performed; cerebrospinal fluid examination shows the following:

Laboratory Studies
Leukocyte count

1500/µL (1500 × 106/L) with 50% neutrophils and 50% lymphocytes
Glucose

30 mg/dL (1.67 µmol/L)
Protein

300 mg/dL (3000 mg/L)
Gram stain

Negative

In addition to vancomycin, which of the following antimicrobial regimens should be initiated?

A Ceftriaxone
B Ceftriaxone plus trimethoprim“sulfamethoxazole
C Ceftriaxone plus levofloxacin
D Ceftriaxone plus azithromycin

[ArchivalUser]

C..

[ArchivalUser]

bbbbbbbbbbbbbbb

[ArchivalUser]

CMV in an immunocompromised ptttttttt.

[ArchivalUser]

BBB

[ArchivalUser]

Correct Answer = B)
Key Point
The most appropriate therapy for a patient with Listeria meningitis and a severe allergy to penicillin is trimethoprim“sulfamethoxazole.

This patient most likely has meningitis caused by Listeria monocytogenes and is at increased risk because of her renal transplant and immunosuppressive therapy. She may have acquired the infection through the gastrointestinal tract, which has been recognized as a portal of transmission in outbreaks of Listeria infection. The negative cerebrospinal fluid Gram stain indicates that, in addition to Listeria, empiric therapy should be directed against Streptococcus pneumoniae and Neisseria meningitidis. The latter two pathogens should be treated with vancomycin combined with ceftriaxone. The therapy of choice for Listeria meningitis is ampicillin or penicillin G combined with an aminoglycoside. However, because of the patient's severe allergy to penicillin, trimethoprim“sulfamethoxazole is the recommended alternative antimicrobial agent.

Ceftriaxone alone provides insufficient therapy. Levofloxacin has not been studied for the treatment of meningitis. Azithromycin has in vitro activity against L. monocytogenes but is associated with unacceptably high failure rates in patients with Listeria meningitis.

[ArchivalUser]

oopps got the right answer but wrong diagnosis..............