Question

Read the Case Study and answer the questions that follow

This 19-year old student was in his usual state of health until the evening prior to admission, when he went to bed with a headache. He told his mother that he felt feverish, and on the following morning his mother found him in bed, moaning and lethargic. He was brought to the emergency room, where he appeared toxic and drowsy but oriented. His temperature 40'C, his heart rate was 126/min, and his blood pressure was 100/60 mm Hg. His neck was supple. He had an impressive purpuric rash, not blanching, most prominent on the trunk, legs and wrists. His white blood cell count was 26,000/ul with 25% band forms. The platelet count was 80,000/ul.

         Blood cultures were obtained, a lumbar puncture was performed, and the patient was begun on intravenous ceftriaxone. Cerebrospinal fluid (CSF) glucose, protein, and white blood cell count were normal, and CSF bacterial culture was negative. Blood cultures grew Gram Negative diplococci on chocolate agar.

Answer the following

1) What is the organism causing his illness? Is the finding of a normal CSF profile without evidence of meningitis commonly observed in infection with this organism? Explain.

2)Which prophylactic strategies are used for large populations?

3) Which prophylactic strategies can be used for exposed individuals?

4) What is a purpuric rash, and which virulence factor plays a central role responsible for its appearance?

Thanks

Answer 1

1 )The causative organism is Neisseria meningitidis.

Csf cultures can be negative in early phase of disease where blood cultures are positive especially within 24 hours of onset of illness before the inflammatory response has developed.

2) Meningococcal polysaccharide vaccine is used for large population prophylaxis. Although the guidelines differ in various countries as who will recieve the vaccine.

3) Antimicrobial prophylaxis by RIFAMPIN is preferred for exposed individual.

4)The endotoxin lipopolysaccharide causes the rash.

Purpuric rash is brown to purple in color spot of size1-3mm on skin due to bleeding under skin.