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Fungal CNS Infections 02

Topic: Adult

Created on Sunday, October 14 2007 by jdmiles

Last modified on Sunday, October 14 2007.

A 35 year-old male billionaire playboy is brought into Gotham City emergency room by his butler and his young male live-in companion. The patient is stuporous and vomiting. The butler explains that the patient has had a several week history of slowly progressive course of altered mental status, neck stiffness, nausea and vomiting, and headache.

Physical exam reveals nuchal rigidity, jolt accentuation of headache, postitive Kernig sign, and positive Brudzinski sign.

Lumbar puncture shows clear, colorless CSF. There are 100 cells/mm^3 of fluid, with a lymphocytic predominance. Glucose is 15 mg/dL. Protein is 500 mg/dL. Gram stain is negative. India ink exam is negative.

On review of systems and social history, you learn from the butler and partner that the patient spends most of his leisure time in a bat-infested cave.

Based on this information, which of the following agents is the most likely cause of this patient's symptoms?


 
        A) Mucor
 
        B) Cryptococcus
 
        C) Histoplasmosis
 
        D) Aspergillus
 
        E) Coccidiomycosis
 

 


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This question was created on October 14, 2007 by jdmiles.
This question was last modified on October 14, 2007.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ANSWERS AND EXPLANATIONS




A) Mucor

This answer is incorrect.


This patient's history of a chronic meningitis, along with the CSF findings of lymphocyte-predominant leukocytosis, low glucose, high protein, and negative Gram stain suggest a fungal infection. The exposure to bats suggests hisoplasmosis as the most common agent.

Mucor is more likely to have a neutrophil-predominant leukocytosis.

  (See References)

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B) Cryptococcus

This answer is incorrect.


This patient's history of a chronic meningitis, along with the CSF findings of lymphocyte-predominant leukocytosis, low glucose, high protein, and negative Gram stain suggest a fungal infection. The exposure to bats suggests hisoplasmosis as the most common agent.

The negative India ink stain makes cryptococcus less likely. Cryptococcus is associated with exposure to birds, but not bats.

  (See References)

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C) histoplasmosis

This answer is correct.


This patient's history of a chronic meningitis, along with the CSF findings of lymphocyte-predominant leukocytosis, low glucose, high protein, and negative Gram stain suggest a fungal infection. The exposure to bats suggests hisoplasmosis as the most common agent.  (See References)

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D) Aspergillus

This answer is incorrect.


This patient's history of a chronic meningitis, along with the CSF findings of lymphocyte-predominant leukocytosis, low glucose, high protein, and negative Gram stain suggest a fungal infection. The exposure to bats suggests hisoplasmosis as the most common agent.

Aspergillus is more likely to have a neutrophil-predominant leukocytosis.

  (See References)

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E) Coccidiomycosis

This answer is incorrect.


This patient's history of a chronic meningitis, along with the CSF findings of lymphocyte-predominant leukocytosis, low glucose, high protein, and negative Gram stain suggest a fungal infection. The exposure to bats suggests hisoplasmosis as the most common agent.  (See References)

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References:

1. Giglio, P., and Gilbert, M.R. (2004). Epidemiology of primary brain tumors: Clinical features and complications. In Bradley, W.G., Daroff, R.B., Fenichel, G.M., and Jankovic, J. (Eds.). Neurology in Clinical Practice, Fourth Edition. Butterworth Heinemann, Philadelphia, pp. 1363-1369 (ISBN:0750674695).Advertising:
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adult
Fungal CNS Infections 02
Question ID: 101407086
Question written by J. Douglas Miles, (C) 2006-2009, all rights reserved.
Created: 10/14/2007
Modified: 10/14/2007
Estimated Permutations: 120

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