Question

Joe, a 27-year-old white male teacher who works out daily at the gym, begins to complain of a headache and feeling like he is coming down with the flu. The school nurse advises him to go home; rest; take ibuprofen for fever and achiness, antihistamines if needed; and to drink plenty of fluids. Joe goes home and follows the nurse’s advice. After awakening from a nap, he has a fever of 101°F orally and is complaining of a headache, nausea, and sensitivity to light. His wife brings him to the urgent care clinic because he has been talking out of his head and has begun to vomit. PSH-negative PMH; Mononucleosis at age 19 years. Consumes three to four beers per week with an occasional shot of whiskey. No tobacco or illicit drug use. Prior concussions at ages 17 and 20 years. Immunization status unknown. Physical examination reveals 103°F, mucous membrane—dry, pale, poor skin turgor. WBC 15,000, BP 100/60, HR 120. Small healing abrasion on left ankle. The primary care provider plans on admitting to the hospital for probable sepsis rule meningitis.

Related Question #1

What are the clinical manifestations of an infection?

Related Question #2

Why is this patient considered to have sepsis?

Related Question #3

Why is the primary care provider considering meningitis?

Urine and blood cultures are drawn at the hospital. A lumbar puncture is completed. CXR is done. Broad spectrum antibiotics and IV fluids are started. Acetaminophen and ibuprofen are ordered for fever greater than 101°F. His condition improves. Blood cultures are positive. All other diagnostic tests are negative.

Related Question #4

What organism would you suspect and why?

Related Question #5

What precautions to prevent infections should be taken?

Answer 1

1.Clinical manifestations of an infection can be local due to abscess or sometimes due to systemic infections characterized by fever.In most cases multiple organs are affected.Generalized infections may be manifested with sepsis or shock.

2. Sepsis is often caused by an imbalance between the invasiveness of pathogens and the hosts ability to maintain an effective immune response.Poor tissue perfusion is often seen in sepsis.This can be identified by checking the skins colour and temperature.Pallor or greyish skin are signs of poor tissue perfusion seen in septic shock.Patient in septic shock experience low BP,fever,altered level of sensorium,rapid heart rate.Since he is having a positive blood culture report .it can be confirmed that the patient is septic.

3.Meningitis is the infammation or swelling of the lining around the brain and spinal cord,whereas Septicaemia is blood poisoning caused by the same bacteria that cause meningitis.that is the infection that causes meningitis often causes blood infection which is known as septicaemia.General findings of Meningitis are Nausea ,vomiting,fever,chills,photophobia,unrelenting headaches.In some cases Meningitis may present with or without septicaemia.Meningococcus presents as bacterial meningitis or septicaemia or as a combination of both the presentations..So it could be meningitis with septicaemia.

4. Neisseria meningitidis ie Meningococcus.Since the patient presents both the clinical symptoms of septicaemia and meningitis,and all other diagnostic tests being negative.it must be a combination of both.

5.Some of the measures taken to prevent meningitis are

• Taking meningococol conjugate vaccine should be taken between 11 and 12 years old.
• Maintain good personal hygiene.
• Patients who are unvaccinated who got exposd to meningitis should seek immediate medical help,where the doctors will prescribe prophylatic antibiotics
• Avoid sharing drinks,eating from plates which may contain saliva.
• Vaccination should be taken prior to travelling to regions where the outbreak of the disease is common.