Question

A 37 year old HIV+ male presents with one week of headache and low grade fever. For the past two days, he has had nausea and vomiting. On physical exam, temperature is 38.1 C (100.6 F), pulse 80, blood pressure 108/68, respirations 15/min. The patient is somnolent but arousable. Nuchal rigidity is present. With the patient supine, passive knee extension elicits neck pain. Lungs are clear to auscultation. There are no petechiae or cutaneous hemorrhages seen. CT scan shows no focal lesion, and lumbar puncture is performed. CSF analysis shows clear, light yellow CSF with an opening pressure of 290 mm Hg (normal: 70-180 mm Hg), 25 WBC (normal 0-5) with 96% lymphocytes, 15 RBCs, a glucose of 38 mg/dL (normal: 40-70 mg/dL)and protein 50 mg/dL (normal: 15-45 mg/dL). Which of the following would be the most appropriate therapy for this patient?

A. Ceftriaxone
B. Acyclovir
C. Vanc + cefotaxime
D. Trimethoprim-sulfamethoxazole
E. Amphotericin B + flucytosine

Answer 1

The most appropriate therapy for this patient with suspected bacterial meningitis is Vanc + cefotaxime.

Step-by-step explanation:

The most appropriate therapy for this patient with suspected bacterial meningitis is Vanc + cefotaxime. The patient presents with symptoms of headache, low-grade fever, nausea, vomiting, nuchal rigidity, and neck pain upon knee extension. The CSF analysis reveals increased opening pressure, elevated lymphocytes, low glucose levels, and increased protein levels, which are all consistent with bacterial meningitis. Vanc + cefotaxime is a combination therapy that covers the most common pathogens causing meningitis, including Streptococcus pneumoniae and Neisseria meningitidis.