id q.2 - chapper

[ArchivalUser]

A 70 year old nursing home resident is admitted to the ED. She is obtunded & ill appearing. The nursing home staff tell that she has experienced low grade fever, poor appetite and lethargy over several days. A LP is done which reveals gram positive rods and many white cells. Listeria is diagnosed and appropriate antibiotics are started. Which of the below will distinguish Listeria from other causes of bacterial meningitis?

1. Photophobia is common.
2. WBC counts are often elevated in CSF.
3. More neutrophils in CSF differential.
4. More frequent neck rigidity.
5. Often subacute presentation.

[ArchivalUser]

a.

[ArchivalUser]

@ hays....nope...

[ArchivalUser]

subacute..

[ArchivalUser]

5.

[ArchivalUser]

subacute.

[ArchivalUser]

Ans is 5.


Listeria meningitis typically affects the elderly and the chronically ill. It is frequently a more subacute (developing over days) illness than other etiologies of bacterial meningitis. It may be mistaken for aseptic meningitis. Meningeal signs, including nuchal rigidity, are less common, as is photophobia, than in other, more acute causes of bacterial meningitis. Typically WBC counts in the CSF range from 100–5000/ L with a less pronounced neutrophilia. 75% of patients will have a WBC count